My Workers' Comp Claim Was Denied. Now What?

Insurance companies deny workers' comp claims for a reason: it's cheap to deny, most workers don't appeal, and the few who do often miss the deadline. Don't be one of them. Read your denial letter today.

The most common denial reasons (and how to beat them)

• "Injury didn't happen at work." Get witness statements, badge swipe records, security footage, and your supervisor's incident report.
• "You didn't report it in time." Most states require notice within 30 days. If you missed it, document why (you didn't realize the injury was serious, you reported verbally, etc.).
• "Pre-existing condition." Workers' comp covers aggravation of pre-existing conditions in nearly every state. You need a doctor's statement that the work activity made it worse.
• "You weren't injured — failed independent medical exam." IME doctors are paid by the insurer. Get an independent second opinion.
• "Disputed cause." The insurer claims you were hurt off the clock. Phone records, GPS, badge data, and coworker statements rebut this.

Your appeal deadline is short

Most states give you 30–90 days to file an appeal (called different things in each state — Application for Adjudication, Notice of Contest, Petition for Review). Miss it and the denial becomes final. Find the deadline on your denial letter — it's there, in fine print.

The appeals process

1. File the appeal form with your state's workers' comp board.
2. Attend a mediation or settlement conference.
3. If unresolved, the case goes to a workers' comp judge for a hearing.
4. Either side can appeal the judge's decision to a review board.

Do I need a lawyer?

For a denied claim — yes. Workers' comp attorney fees are capped by state law (usually 10–20% of recovered benefits), and you only pay if you win. Workers represented by counsel recover significantly more on average than unrepresented workers, according to studies by RAND and the National Academy of Social Insurance.