Facing a denied workers’ compensation claim can feel overwhelming. Understanding the reasons for denial helps you address issues and improve the chances of a successful appeal. Here are five common reasons why claims may face a denial:
1. Late reporting of injury
Workers must report injuries to their employers promptly. Worker’s compensation law in Rhode Island says you have 30 days to report the incident to your employer and 2 years to file a claim. If you delay reporting your injury, the insurer might question its validity. Report any workplace injury immediately to avoid complications.
2. Lack of medical evidence
Your claim needs solid medical documentation to support your injury. The insurer may deny your claim without proper medical records or doctor’s notes. Always seek immediate medical attention and ensure all treatments and diagnoses are well-documented.
3. Disputes over injury origin
If the insurer believes your injury did not occur at work, they may deny your claim. This often happens when insufficient evidence links the injury to your job. Collect witness statements and maintain detailed records to substantiate your claim.
4. Pre-existing conditions
Insurers might argue that a pre-existing condition, not a workplace incident, caused your injury. While pre-existing conditions do not automatically disqualify you, you must prove the job aggravated or worsened your condition.
5. Non-compliance with treatment
Failing to follow prescribed medical treatments can lead to a claim denial. Attend all medical appointments and follow your doctor’s advice to demonstrate your commitment to recovery.
Is it possible to file for an appeal?
Worker’s compensation is essential for recovery. If you face a denied claim, consider appealing the decision. Begin by reviewing the denial letter to understand why they rejected your claim. Ensure that you gather additional evidence or documentation to support your case.
Filing an appeal involves strict deadlines and procedures and you may want to seek help from a legal professional. They can assist you with the appeal, help gather required evidence and represent your interests to ensure you receive the benefits you deserve.