Common Reasons That Workers’ Compensation Claims Are Denied 

Workers’ compensation is a lifeline for millions of Kansas employees. In the event of a work-related injury or illness, they know they can rely on this system to provide them with the financial support they need. Right? Well, not always. Unfortunately, not all workers’ compensation claims are approved.  

At Slape & Howard, we have over 35 years of experience dealing with claim denials and uncooperative insurers. We know the arguments insurance companies use when denying claims, and we also know how to make them reverse their decisions so that our clients can get the compensation they are owed.

With an office in Wichita, Kansas, our compassionate legal attorneys serve injured workers and their families throughout the state.  

9 Reasons Workers’ Compensation Claims Are Denied

The benefits that are available through workers’ compensation can help cover your medical expenses and avoid the loss of income concerns as you recover from your injury or illness. That, of course, if your claim is approved.

But not all workers’ compensation claims are approved, and below are some of the most common reasons for claim denials:   

1. Incomplete or Inaccurate Paperwork 

One of the most common reasons for a claim denial is incomplete or inaccurate paperwork. Filing a workers' compensation claim involves a lot of documentation. Even minor errors can be problematic.

For instance, incorrect dates or misspelled names can cause confusion and result in your claim being flagged. If even one form is filled out incorrectly, it can lead to a denial. 

• How to avoid the denial: To avoid this, double-check all forms for completeness and accuracy. If you're unsure about any information, contact an attorney to help you with the paperwork. Keep copies of everything you submit and follow up to ensure your paperwork was received and processed correctly. 

2. You Didn't Report Your Injury or File a Claim on Time 

Delaying your report or claim can lead to a denial, as it may appear that your injury is not serious or not work-related. Some workers might delay reporting an injury, hoping it will heal on its own, or they might fear repercussions from their employer.

Either way, delaying this process can be detrimental to your case. Each state has specific deadlines for reporting injuries and filing claims. According to the Kansas Department of Labor, employees must notify their employer of the injury or illness–either verbally or in writing–within 20 days of the date of accident.  

• How to avoid the denial: Report your injury to your employer as soon as it happens or as soon as your work-related illness is diagnosed. File your claim promptly and keep a record of when and how you reported the injury. 

3. The Injury or Illness Was Not Work-Related 

The injury or illness must be work-related for a workers' compensation claim to be approved. If there's any doubt about this, your claim could be denied. Employers and insurers might argue that your injury occurred outside work hours or while you were engaged in a non-work-related activity.  

• How to avoid the denial: Provide clear evidence that your injury or illness occurred at work or was caused by your job duties. This can include witness statements, video footage, or other documentation. The more detailed the records, the more they can strengthen your claim. 

4. You Were Doing Something You Shouldn’t Have Been 

If you were engaging in horseplay, violating company policies, or doing something outside your job duties when you got injured, your claim might be denied.

Employers and insurers will investigate the circumstances surrounding your injury. If they find evidence that you were engaging in unsafe or unauthorized activities, they can use this as grounds to deny your claim.  

• How to avoid the denial: Always follow company policies and stick to your job duties. If an injury occurs, be honest about the circumstances but also clarify how it was related to your work. Being transparent will help build trust and credibility. 

5. Your Claim Is for a Pre-Existing Medical Condition 

Claims for injuries or illnesses that stem from pre-existing medical conditions are often denied. Insurers may argue that the injury was not caused by your job but rather is a result of a condition you had before starting your current employment.

However, even if you had a pre-existing condition, you could still get benefits if you can prove your work duties made your condition worse or aggravated the symptoms.  

• How to avoid the denial: While you can't change your medical history, you can provide evidence that your job aggravated or worsened your pre-existing condition. Medical records and expert opinions from medical professionals could help in these cases. 

6. You Were Intoxicated at the Time of the Incident 

If you were under the influence of drugs or alcohol when the injury occurred, your claim would likely be denied. Most employers have strict policies against substance use on the job, and intoxication can void your eligibility for benefits.

If your employer suspects intoxication, they may require a drug or alcohol test following the incident. If you test positive, you will most certainly get an automatic denial of your claim. 

• How to avoid the denial: Avoid working under the influence of any substance that can impair your judgment or performance. If you have a prescription for medication that could affect your abilities, inform your employer and follow their guidelines. 

7. You Didn't Seek Immediate Medical Treatment for the Injury or Illness 

Delayed medical treatment can make it appear that your injury or illness isn't serious or that it didn’t happen at work, leading to a claim denial. In most cases, including Kansas, the employer has the right to choose the authorized treating physician for their employees who suffered work-related injuries and illnesses.  

• How to avoid the denial: Seek medical treatment immediately after the injury or onset of illness. Keep all medical records, follow your doctor's advice, and attend all follow-up appointments. Timely medical documentation is crucial for supporting your claim. 

8. Your Job Isn’t Covered by Workers’ Compensation 

Depending on your state and employment status, certain jobs and employment situations may not be covered by workers' compensation laws. Many states exclude certain types of workers, such as independent contractors, freelancers, and certain agricultural workers.

If your job falls into one of these categories, your claim may be denied simply because you're not eligible. 

• How to avoid the denial: Verify whether your job is covered by workers' compensation by consulting with an attorney. If you find that you're not eligible, explore other options for coverage, such as private disability insurance or state-specific programs that may offer assistance. 

9. There Is Not Enough Evidence to Establish Your Claim 

Insufficient evidence can lead to the denial of your workers' compensation claim. The burden of proof is on you to show that your injury or illness is work-related.

A claim is likely to be rejected when it lacks records of all medical visits, written statements from witnesses, and copies of any communication with the employer regarding the injury. 

• How to avoid the denial: Gather as much evidence as possible to support your claim. This includes medical records, witness statements, and any other documentation related to your injury or illness. Better yet, consider hiring an attorney to help you build a compelling case while you focus on your treatment.  

Was Your Workers’ Compensation Claim Denied? We Can Help

Stop trying to find answers online if your workers’ compensation claim is denied. It’s time to get help. Our workers’ compensation attorneys at Slape & Howard can review why your claim was denied and establish a solid appeals case for compensation.

Contact our office now to schedule your free consultation and receive the guidance you need on what to do in your situation.