My Workers' Comp Claim Was Denied — What Now?

A denied workers' compensation claim can feel devastating — but it's not the end of the road. Denials are actually quite common, and many are successfully appealed. Here's what you need to know.

Why Claims Get Denied

Common reasons for denial include: dispute over whether the injury is work-related, missed reporting deadlines, the insurer's claim that a pre-existing condition caused the problem, failure to follow the proper claims process, or the employer contesting the claim.

Read the Denial Letter Carefully

Your denial letter must explain the specific reason(s) for the denial. Understanding why is the first step to challenging it. Different denial reasons require different responses.

The Appeals Process

Every state has an appeals process. Typically you'll request a hearing before a workers' compensation judge or administrative law judge. The specific steps, forms, and deadlines vary by state. Appeals deadlines are strict — often as short as 30–90 days from the denial. Miss the deadline and you may permanently lose your right to appeal.

Get an Attorney Immediately

If your claim is denied, getting an experienced workers' comp attorney is strongly advisable. Studies show claimants with attorneys are far more likely to have denials overturned. Most attorneys take denied claim appeals on contingency — no fee unless you win.

Independent Medical Examination (IME)

If your denial was based on a disputed IME, you have the right to request your own independent medical exam. A second opinion from a doctor who specializes in occupational medicine can directly contradict the insurance company's IME findings.