Health Care

What types of reasons do workers’ compensation carriers deny claims?

What types of reasons do workers’ compensation carriers deny claims?

Claims are denied for several reasons, quite often for reasons that are unclear at first. We have seen over the past several years insurance companies be more aggressive in their denials of claims. Claims get denied frequently for credibility reasons – insurance companies believe the injured worker has not been entirely truthful about the circumstances of their injury. Claims get denied because there are prior claims or medical treatment that may be contributing to the current condition. Claims also get denied for legal reasons. Many types of claims require an “injury by accident” in order to be compensable.