Some jobs are more inherently dangerous than others. You’re probably more likely to be injured on the job as a construction worker than if you went into the legal field. Workplace injuries and fatalities can happen, even when you’re following all safety regulations.

The U.S. reported 5,486 workplace fatalities in 2022, a slight increase from the previous year. When you’re injured on the job, you expect workers’ compensation to help cover your damages. However, sometimes employee claims are denied. You may not need an attorney to file the initial claim, but if it’s denied and involves a retaliation case, you definitely want to consult with an attorney experienced in handling such claims.

Why a Workers’ Compensation Claims May Be Denied

Filing a workers’ compensation claim is usually a relatively simple process. You alert your employee, fill out the claim form, and provide supporting documentation like medical records. You’ve followed all of the required steps, but your compensation claim has been denied.

There are a few reasons why your claim can be denied. Understanding these reasons may make it easier to appeal the denial.

Missed a Filing Deadline

You only have 30 days from the date of your injury to report the accident to your employer. However, you have three years to file a workers’ compensation claim. Why the long period between filing dates? You want to alert your employer as soon as possible so they can promptly make any necessary changes to help prevent future injuries.

The three-year filing period with worker’s compensation gives you plenty of time to assess the extent of your injuries. Some injuries take longer than others to start showing signs and symptoms. You may also require long-term medical care, and the extent of the care may not always be immediately obvious.

If your claim is denied, don’t panic—you can still appeal the decision. However, don’t put off filing the appeal. You only have 90 days to submit the form to workers’ compensation.

Lack of Supporting Evidence

Workers’ compensation is a form of insurance most employers are required to carry. This applies to employers in all 50 states, including Colorado. Like all other types of insurance claims, the adjuster is going to request plenty of supporting evidence.

What type of evidence will you need to supply? This varies a bit depending on the type of claim, but almost all will require medical documentation. Workers’ compensation covers injuries and some illnesses, so your medical records are almost always necessary.

Your claim may also be denied if you can’t provide witnesses. This can be fellow employees or security camera footage. If there aren’t any witnesses to your workplace injury, your claim may be initially denied. However, if you can supply medical documentation, most denials are reversed during the appeals process.

The injury Didn’t Occur at Work

Workers’ compensation in Colorado is pretty clear, including what it does and doesn’t cover. The insurance only covers injuries that occur on the job, and this also applies to illnesses.

Your illnesses must be a direct result of your job. For example, an illness relating to your exposure to asbestos is probably covered under workers’ compensation. This is also true if you break a leg falling off the scaffolding on a construction site or in a warehouse.

If your broken leg is caused by a fall at home, workers’ compensation will repeatedly deny your claim. Your homeowners’ or health insurance should cover your damages for an injury that occurs outside of work.

However, there can be an exception for remote staff. If a remote employee is injured at home while working, the insurance may cover the damages.

Discrepancies in Your Statements or Paperwork

As you’re going through the claim process, you’ll fill out paperwork and make statements to the insurance adjuster. Think of your conversation with the insurance adjuster as a type of interview. The adjuster is looking for specific details about how the incident occurred and the severity of your injuries or illness.

Yes, it’s easy to get a little confused about events, especially if you’re in pain. Unfortunately, even the smallest discrepancy can result in a denial of your workers’ compensation claim.

Thankfully, if your claim is denied due to a discrepancy, you can go through the appeals process. By providing supporting documentation, you can often reverse the decision to deny.

Injuries are Caused by the Use of Prohibited Substances

Pretty much every job prohibits the use of alcohol while working, and even bartenders are legally required to refrain from taking shots with customers while on the clock. The use of illegal substances is always strictly prohibited; there aren’t any exceptions to federal and state laws.

Your workers’ compensation claim will be denied if drugs or alcohol play a role in your injuries. Even going through the appeal process isn’t going to change the original decision.

You will be stuck paying for your damages out of your pocket unless you can file a claim with your health insurance provider. If your health insurance is also through work, there’s a good chance you’re out of luck.

Appealing a Denied Insurance Claim

If your workers’ compensation is denied, you have the right to file an appeal. You start by applying for a hearing with the Office of Administration Courts. At the hearing, both you and your employer can submit evidence to the presiding judge. The judge will overview your evidence and make a final decision regarding the status of your claim.

Yes, the judge’s decision is final. This is a final hearing regarding your claim, and there isn’t an appeal process after you have received the judge’s decision.

You may be able to skip the court appearance if the pre-hearing conference goes in your favor. You can request a conference with the insurance adjuster to try to reach a settlement. If you can reach an agreement, the hearing is canceled.

Let a Workers’ Compensation Attorney Handle the Appeals Process

You may not need an attorney to file the initial claim, but if it’s denied, it’s usually best to work with an experienced attorney. Your attorney can help you provide supporting evidence, file for a court hearing, and even take care of negotiations with the insurance adjuster.

Being injured at work doesn’t have to be a financial disaster; you can receive your workers’ compensation benefits even if your claim is initially denied.