Employers carry workers’ compensation to cover the costs when an employee suffers an injury at work. When you sustain an injury at work, you must follow a claim process to receive that coverage. Claim denials happen for many reasons, medical and administrative.
Some denials result from conflicting information and insufficient medical treatment. Understanding those denials may help you prepare an appeal.
Delaying your initial care
When you experience an injury on the job, you should seek treatment right away to document that injury. Any delay in seeking medical care could imply that your injury is less severe than you indicated. Failure to seek treatment right away also creates an opportunity for the insurance carrier to claim that your injury happened elsewhere.
Ignoring treatment recommendations
Your doctor may suggest physical therapy and medical treatments, including surgery. If you fail to follow through with those treatment recommendations, it casts doubt on your injuries. The insurance carrier may declare that you contributed to your condition by neglecting treatment.
When you file a workers’ compensation claim, keep every doctor’s appointment and therapy visit. Canceling any appointments can lead to claim denial. The insurance carrier may imply that you misrepresented your condition and canceled appointments because you had no need for care.
Recognizing some of the common reasons for a medical denial of your workers’ compensation claim helps you prepare a reasonable appeal. When you identify the likely perceptions as a result of your actions, you can better present your case to justify your injury.