By John Arthur 
Receiving notice that your workers’ comp claim has been denied is about as enjoyable as a work injury can be.
You know the drill. You reported your injury to your employer. You sought medical care. You filled out all the necessary paperwork. And then… you got a denial letter.
Here’s the thing…
Yes, your claim was denied. But that doesn’t mean all hope is lost.
The problem is — if you don’t know what you’re doing — it sure can feel that way. Understanding what to do next — and just as importantly, what NOT to do — can mean the difference between walking away with nothing or obtaining the benefits you deserve.
Don’t let your claim get denied. Consult a workers comp attorney in Fresno immediately.
What You’ll Learn
- Why Workers’ Comp Claims Get Denied
- What To Do After Your Claim Is Denied
- What Employers Need To Know
- How To File A Stronger Claim From Day One
Denied Claims are More Common Than You Think
Millions of workers’ compensation applications are denied every year. Claims get denied for a variety of reasons.
Approximately 343,000 workers’ compensation claims are denied every year in the United States. That’s out of roughly 4.9 million total filed. To put that into perspective, the average denial rate from 2010 to 2019 was 13.42%. From 2020 to 2024, that number increased to 14.97%. Year over year, workers’ comp denials are becoming more common.
That means thousands of injured workers go without the compensation they deserve.
The bright side? Those numbers also tell us that a denial isn’t the end of your case. From 2020 to 2024, 53% of awarded workers’ comp settlements or awards were initially denied. The key is understanding how to handle a denial.
Reasons Why Claims are Denied
There are several reasons an insurance company or employer will deny a workers’ comp claim. Here are just a few of the most common:
- Failure to report the injury within the required timeframe
- Lack of medical evidence supporting your injury
- Disputing that the injury occurred while working
- Claim form errors
- Failure to obtain witness statements
There’s a remedy for each of these issues. But workers need to know what they are and respond quickly upon receiving a denial.
What To Do If Your Claim is Denied
The most important thing to remember about receiving a denial letter is…
It’s not set in stone.
This doesn’t mean your claim will definitely be overturned. But your appeal has a fighting chance if you know what to do. Here are the next steps:
Read that letter carefully. When an insurer denies your claim, they are required to provide a written statement of why your claim was denied. Understanding why is the first step in determining how to move forward.
Compile every piece of evidence you can. Medical records, doctor’s reports, incident documents, photographs of the injury/workplace, witness statements, etc. If it can help prove that the injury occurred at work and deserves benefits, it needs to be in the file.
Don’t miss your appeal deadline. Every state has a hard deadline by which you can appeal a denied workers’ compensation claim. If that window is missed, the ability to appeal the decision is lost completely. This cannot be stressed enough.
Consult an attorney who knows how to handle denied workers’ comp claims. Many people make the mistake of representing themselves after their claim has been denied. Those who hire an attorney are 3-5 times more likely to win their appeal.
The appeals process isn’t easy. Don’t gamble with your future by delaying or representing yourself.
What Employers Should Know About Denied Claims
Employers, listen up…
Denying a workers’ comp claim doesn’t always save you money.
Research shows that 70.6% of claims denied by insurers end up in litigation. Only 27.5% of allowed claims end up in litigation. Litigation on denied claims costs employers an average of $36,991 in net compensation. Allowed claims that end up in litigation cost an average of $7,489. Litigation costs do not take into consideration time spent managing the claim, legal fees, or disruption to operations.
Simply put: be smart about your workers’ compensation claims.
Employers can reduce their risk by taking these steps:
- Creating an efficient injury reporting process
- Educating managers on how to handle injury reports
- Promptly acknowledging when an injury is reported
- Partnering with quality medical providers
The goal should always be to avoid denying claims altogether. But when employers handle claims correctly from day one, they save money and resources in the long run.
How To Improve Your Claim From The Start
Sometimes workers are at-fault for their own claim denial. Building a strong claim starts on day one.
- Report your injury as soon as it happens. Even if it seems minor, report it immediately. Injuries can come with delayed symptoms. By reporting early, a record of the injury is created should questions arise later on.
- See a doctor right away. Medical records are the strongest asset when dealing with a workers’ comp claim. Without a doctor’s visit, the insurer has justification to deny the claim.
- Take the doctor’s advice seriously. This means going to every follow-up appointment and taking any recommended medications. Failure to do so lets the insurer claim that the injury wasn’t serious enough to require full-time care.
- Keep impeccable records. Keep track of all appointments, prescriptions, and any days missed from work. Save copies of everything and store them somewhere easily accessible if the claim is denied.
Handling a claim correctly from day one drastically reduces the chances of being denied.
In Conclusion
A denied workers’ comp claim isn’t the end of the world. In fact, nearly half of workers who’ve had their claim denied end up receiving workers’ comp settlements or awards after their claim is initially denied.
But they don’t just happen.
Employees who act quickly after a denial, keep meticulous records, and know how to handle a denied workers’ comp claim give themselves the best chance at winning their appeal. Employers who handle claims correctly from the beginning save time and money by not having to deal with denials — and subsequent appeals — down the road.
Getting injured at work is bad enough. A claim denial doesn’t have to make it worse.