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5 potential reasons your claim was denied

On Behalf of | Jul 1, 2024 | Workers' Compensation

Workers’ compensation provides essential support for employees who suffer injuries. However, navigating the claims process can be challenging; sometimes, a claim denial is even possible. Here are five potential reasons why:

1. Failure to report the injury on time

Iowa requires you to notify your employer regarding the injury within 90 days. Please report within this period to avoid denial of your claim. Prompt action ensures that your employer can investigate the incident and provide support.

2. Lack of medical evidence

Your claim may only be allowed if you seek medical treatment or provide adequate medical records. Always see a health care professional immediately after an injury and keep all medical documents related to your treatment.

3. Injury was not work-related

Your claim must prove that your injury occurred while performing work-related duties. If the insurance company believes your injury happened outside work or due to nonwork-related activities, they may deny your claim. Providing straightforward evidence that links your injury to your job is essential.

4. Preexisting conditions

If you have a preexisting condition, the insurance company might argue that your current injury is related to that condition rather than a workplace incident. Although having a preexisting condition does not automatically disqualify you, you need to show that your work aggravated or worsened the condition.

5. Discrepancies in your report

Inconsistencies between your injury report, medical records and witness statements can lead to a claim denial. Ensure that all the information you provide is accurate and consistent. Any discrepancies can raise doubts about the legitimacy of your claim.

Taking legal action

Facing a workers’ compensation claim denial can be frustrating and overwhelming. If you understand the reasons for the denial, you can take the necessary steps to address the issue. You may also want to seek out legal professionals to help you fight for your rights.