2024 Scholarship Applications Now Open

If you recently filed a workers’ compensation claim and received a denial, you may be feeling disappointed or confused. It can be disheartening to hear that you may not qualify for benefits, but there are still other options available. Workers’ compensation claims are often denied on a technicality or for other reasons that are easily rectifiable. You have certain rights if you incur an on-the-job injury in the state of Arizona, and the team at Cruz & Associates can help you get the compensation you deserve.

Common Reasons for Claim Denial

There are a few common reasons why injured workers face claim denials. If you recently received a denial letter from your employer’s workers’ compensation insurance company, it could be for one of the following reasons:

Injury Not Reported

Arizona law requires that an injured worker immediately report an injury to their employer, and that the employer inform the workers’ compensation insurance company just as quickly. One major reason for a claim denial is that a worker did not report an injury to an employer, either on time or at all.

Missing or Misfiled Information

If there isn’t enough evidence to confirm your injury was a result of employer negligence, your claim may be denied. Additionally, if the claim was filed incorrectly or any documentation is missing, that could also be grounds for denial. Having an attorney you trust is essential to ensuring your claim is correct and complete.

Injury Is Not Eligible for Compensation

If you have a preexisting condition, were under the influence of drugs or alcohol, or were roughhousing or acting inappropriately at the time of your injury, your claim may be dismissed and ineligible for workers’ compensation.

Employer Dispute

Another common reason for denial is that an employer disputes the claim. For example, an employer may argue that an injury was not work related or that your injury was the result of an “accident,” which means they are saying it was your fault. If this applies to your case, getting a claim approved might be a matter of gathering more evidence, like eyewitness accounts or a note from your health care provider.

Employer Insurance Concerns

Employers will sometimes look for any reason to dispute a claim. When they make workers’ compensation claims, their insurance rates go up and this costs the company money. It might not be fair to you, but it’s a common reason for a denied claim. This is one reason why it’s important to retain the services of a workers’ compensation law firm.

Asking for an Appeal

Your claim denial letter should detail how to file for a workers’ compensation appeal. Read your letter carefully and make note of any filing deadlines. Next, contact your employer or their insurance company to discuss the reason for the claim denial. If it’s a simple matter of misplaced paperwork or a filing mishap, you should be able to rectify it fairly easily. If the claim denial is for another reason, you will have to proceed with filing an appeal. The skilled attorneys at Cruz & Associates can help set your appeal in motion.

Hire a Workers’ Compensation Attorney in Phoenix

If you’ve received a workers’ compensation claim denial, talk to a Phoenix workers’ compensation attorney as soon as possible. Appeal deadlines are often strict, and working with a lawyer from Cruz & Associates can help you maximize your chances of receiving workers’ compensation benefits. Claim appeals can be legally complex procedures, so it’s essential to have an advocate with an in-depth understanding of workers’ compensation and insurance law.

Cruz & Associates brings 25 years of experience to your workers’ compensation appeal. If you recently received a claim denial letter, contact us to schedule a free initial consultation with our firm. We’re committed to helping you understand your rights and responsibilities under the law.