Why do people with valid workers’ compensation claims receive denials?

Workers' Compensation

It is very common for people to receive a determination of ineligibility after applying for workers’ compensation benefits. These claimants should not conclude that a denial of benefits means that they are truly ineligible.

Many claimants can dispute a determination and prevail on appeal by fully addressing any stated reasons for disqualification. Here are a couple of reasons why a workers’ compensation program may deny claims even though they are valid.

Witness corroboration

If an injury is the result of an accident in the workplace, a lack of witnesses to the accident might call a claimant’s account of what happened into question. Nevertheless, workers’ compensation claimants do not have to prove their claims beyond a reasonable doubt. Instead, they must show only that it is probable or more likely than not that what they allege is accurate.

Errors in the review process

Finding the majority of claims to be eligible could be financially problematic for a state’s workers’ compensation program. Authorizing too many claims could draw negative scrutiny towards examiners. Understandably, they may conduct some of their review processes to find any plausible basis to issue a denial. As a result, a programmatic objective to deny claims may create a greater likelihood of mistakes when examiners assess someone’s specific situation and apply the relevant law.

Claimants need to remember that denial may not necessarily be a bar to benefits. Instead, a rejection may be somewhat like a request for additional information before an application can proceed.