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Reasons Why Your Workers' Compensation Claim Got Denied


If you have been injured on the job, you are most likely entitled to workers’ compensation benefits to cover your medical expenses and your lost time from work. Since you do not have to prove fault in order to receive these benefits, most workers who are injured at the workplace, or while performing work duties, are eligible for workers’ compensation.

However, many injured workers are still denied workers’ comp benefits because employers, or their insurance companies, try to look for any possible reason to deny such claims. Of course, the reason should be lawful.

The following are some of the common reasons for claim denials:

  • Missed deadlines – In order to receive workers’ comp benefits, you are required to report your injury or illness to your employer immediately. Although—in Texas—you have 30 days to report an injury to your employer, insurance companies often deny claims due to the fact that they weren’t reported right after the injury occurred.
  • The injury didn’t occur while working – You need to be injured in the “course of employment,” which means you were injured while performing work duties. If your employer believes that your injury did not happen at work or while performing work duties, your claim may be denied. Injuries that occur while you’re commuting to and from work, as well as injuries that happen during lunch when you’re not clocked in, often aren’t covered. On the other hand, you may receive benefits if you were traveling to a work function or delivering something for work at the time of your injury.
  • You had a preexisting injury – If you had a preexisting injury to the same body part that was injured in your work accident, the insurance company may attempt to minimize your claim by pinning the majority of your injury on the previous cause. However, having a preexisting condition does not disqualify form receiving benefits entirely. In Texas and most states, workers’ comp will only cover any worsening of your condition caused by the work accident.
  • You were involved in some type of misconduct at the time – In general, workers’ compensation does not cover injuries caused by being under the influence of alcohol or drugs, injuries caused by horseplay or practical jokes, and injuries that are self-inflicted. Insurance companies typically deny claims based on misconduct on behalf of the injured employee.
  • You went to your own doctor – It is not uncommon for an injured or sick worker to go to their own doctor for treatment. However, your preferred doctor may not be a medical provider within the employer’s insurance network. If you wish to obtain compensation for medical expenses, ensure you see a doctor recommended by your employer. Keep in mind, there is nothing wrong with seeking a second opinion with your own doctor.

Interested in appealing your denial in Fort Worth, TX with experienced legal representation on your side? Request a free consultation with the Law Office of James M. Stanley today.

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