A denied workers’ compensation claim does not necessarily mean you are ineligible for benefits. Learn why claims are denied and what steps you can take to respond.
Common Reasons Workers’ Compensation Claims Are Denied
Insurance companies may deny workers’ compensation claims for several reasons. Understanding the specific reason for your denial is an important first step toward addressing the dispute.
Common reasons include:
- Insufficient medical evidence: Documentation may not adequately establish the relationship between your injury and your employment.
- Disputed workplace injuries: Your employer or insurance company may question whether the injury occurred during work-related activities.
- Missed deadlines: Failing to meet reporting or filing requirements can create complications.
- Preexisting conditions: An insurance company may argue that your symptoms resulted from an existing medical condition rather than a workplace accident.
- Disagreements about disability: The insurer may dispute whether your injury prevents you from working or qualifies you for certain benefits.
A denial does not automatically establish that the insurance company’s position is correct.
Review Your Denial Letter Carefully
When an insurance company denies your claim, it should provide written notification explaining the reasons for its decision.
Review this information carefully to understand which aspects of your claim are being challenged. The denial may involve medical treatment, wage-loss benefits, or the compensability of the injury itself.
Keep copies of all correspondence, medical records, and documents related to your claim. These materials may help you identify missing evidence or inconsistencies that need to be addressed.
Understand Your Right to Request a Hearing
If your employer or its insurance company refuses to provide benefits voluntarily, you may request a hearing before the Virginia Workers’ Compensation Commission.
During a hearing, a Deputy Commissioner reviews the evidence and determines whether benefits should be awarded under Virginia law.
You may need to present medical records, witness testimony, employment documentation, and other evidence supporting your claim.
If you have not already filed a formal claim with the Commission, doing so is essential. Most workplace accident claims must be filed within two years of the injury, although exceptions may apply.
What Happens During the Appeals Process?
If a Deputy Commissioner issues an unfavorable decision following your hearing, you may request a review by the Full Commission.
Generally, this request must be submitted within 30 calendar days of the Deputy Commissioner’s written decision.
Further appeals may be available through Virginia’s court system, depending on the circumstances.
It is important to distinguish an insurance company’s initial denial from an unfavorable Commission decision, as different procedures and deadlines apply.
How an Experienced Attorney Can Help
Disputed workers’ compensation claims often involve complex medical evidence, legal requirements, and disagreements with insurance companies.
An experienced workers’ compensation attorney can review the reasons for your denial, evaluate available evidence, prepare your case, and represent you during Commission proceedings.
At The Law Offices of Charles W. O’Donnell, P.C., we have spent over 30 years helping injured employees throughout Virginia navigate workers’ compensation claims and disputes.
Our experienced, bilingual team is committed to protecting injured workers’ rights and pursuing the benefits available under Virginia law.
Don’t let a denied claim prevent you from exploring your legal options. Contact us today for a free consultation at 703-917-4115. There is no legal fee if your case is unsuccessful.
