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Why Some Insurance Companies Deny Workers’ Compensation Claims

Dennis Plank AttorneyBy Dennis L. Plank, Attorney

Every year, millions of workers are hurt on the job. Many of them will receive workers’ compensation, but others will be turned down. The workers’ compensation system can be confusing, and insurance companies often turn down valid claims. However, employees have the right to appeal a denied claim.

There are several reasons insurance companies might initially reject claims. A workers’ compensation attorney can argue the claim and help the employee get the compensation they deserve.

Here are some of the most common reasons workers’ comp claims are initially denied.

Insurance Says the Injury Did Not Happen at Work

Workers’ compensation benefits are meant to cover injuries that happened while performing job duties. This usually means that an accident must occur at the workplace or on a job site to be eligible, but in some instances, qualifying injuries can happen elsewhere. For example, an employee injured while doing errands as part of the job, traveling for work, or while driving for work may qualify for workers’ comp. Staff that is hurt at work events, like conferences or work-mandated retreats, may also be eligible for workers’ compensation.


Many insurance companies will try to prove the injury did not happen at work or while on the job. It can be difficult to challenge the insurer’s decision without witnesses or camera footage. However, an experienced workers’ compensation attorney may be able to help.

Worker Did Not Promptly Report the Injury

The workers’ compensation claim process has deadlines. Once injured, an employee should inform their employer as soon as possible. It’s helpful to have a record of the notification, so the worker should submit it in writing, via email, or even in a text.

When an employee doesn’t report an injury promptly, it slows down the accident investigation. An insurance company may interpret the delay as a sign that the injury did not happen or that it did not occur at work.

Injured Worker Did Not Get a Medical Exam

Many insurers will require a medical examination. That’s why it’s always a good idea to see a doctor after a work accident. The employee should get a thorough examination even if the injury seems minor. With an exam on record, the employee has options if the injury worsens or results in other ailments or injuries later on.

Additionally, insurance companies require a medical exam. They may also request that the injured employee see a particular doctor, even if the worker has already seen a physician. Employees should comply with this request to expedite benefits.

Filer Made Paperwork Errors

Workers’ compensation paperwork can be complicated and confusing. Filers often make mistakes that result in denied claims. A workers’ compensation attorney can help filers work through these issues.

There are also time limits for filing for workers’ compensation claims, even for injuries that occur over time, like back pain or carpel tunnel syndrome. So workers should be aware of deadlines and submit their claims on time.

Employer Disputes the Claim

Employers may dispute valid claims to avoid hikes in insurance rates or to cover irresponsible practices. A company sometimes argues that the employee was at fault, deliberately careless, or lying about the injury.


If a worker feels that their employer is being dishonest or using intimidation to prevent them from filing a claim, it’s time to contact a lawyer. Workers’ compensation attorneys are experienced at evaluating the situation, making sure the employee knows their rights, and enforcing workers’ compensation laws.

Employee Was Under the Influence

If an employee is injured while drinking or using illegal drugs, they may not qualify for workers’ compensation. However, the employer must be able to prove the worker was under the influence when the injury occurred.

Injury Was Caused by Fighting or Roughhousing

If the injury occurred due to fighting or roughhousing, the employee might not be eligible for workers’ compensation benefits. However, exceptions exist, especially if the employee was harassed, attacked, or threatened. In some cases, employers mistakenly categorize bullying as roughhousing.

If a worker feels they were unjustly denied benefits because of an inaccurate accusation of fighting or roughhousing, a workers’ compensation attorney may be able to help.

We Don’t Charge Unless Our Clients Are Awarded Workers’ Comp

At Going and Plank, we offer free workers’ compensation consultations. We’ll help you evaluate your case and won’t charge for our services unless you are awarded workers’ compensation. Contact us today to discuss your options.

Want to learn more about denied workers’ comp claims in Lancaster? Check out these articles.

Five Ways to Ensure a Workers’ Compensation Claim is Approved

We Answer Questions About Denied Workers’ Comp Claims in Pennsylvania

Can Lancaster County Employers Legally Deny Workers’ Comp Claims?

Worried About Filing for Workers’ Compensation? Knowing These Terms Can Help.


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