You got hurt at work, filed for workers compensation, and they denied your claim. Now you're dealing with medical bills, lost wages, and a system that seems designed to say no. But here's what the insurance company doesn't want you to know: 55% of workers comp denials are overturned on appeal.
Key Takeaways
- 55% of workers comp denials are overturned on appeal
- Common denial reasons are often challengeable
- You have strict deadlines to appeal — usually 30-90 days
- Medical evidence is the key to winning
- Many workers comp attorneys work on contingency
Why Workers Comp Claims Get Denied
- "Injury not work-related": The insurer claims your injury happened outside work
- "Not reported timely": You waited too long to report the injury
- "Pre-existing condition": They blame a prior condition instead of the work injury
- "Insufficient medical evidence": Your doctor's records don't clearly link the injury to work
- "Employer disputes the claim": Your employer says the injury didn't happen as described
Step-by-Step Appeal Process
Step 1: Read Your Denial Letter
Identify the specific reason for denial and the appeal deadline. This determines your strategy.
Step 2: Get Strong Medical Evidence
The most important piece: a detailed report from your treating physician that clearly states your injury is work-related. Include the mechanism of injury, your symptoms, treatment needed, and work restrictions.
Step 3: File Your Appeal
File with your state workers compensation board within the deadline. Include your denial letter, medical evidence, witness statements, and incident reports.
Step 4: Prepare for the Hearing
Workers comp hearings are less formal than court but still require preparation. Bring all medical records, document your timeline, and be ready to describe the incident clearly and consistently.
Consider an Attorney
Workers comp attorneys typically work on contingency — they take a percentage (usually 15-25%) only if you win. For denied claims, having an attorney significantly increases your chances of a successful appeal.