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5 reasons your Texas workers’ compensation claim may be denied

On Behalf of | Oct 15, 2021 | Workers' Compensation |

Workers’ compensation can give you a feeling of security after suffering a work-related injury. The program pays for necessary medical care and replaces a portion of the income you may lose due to your injury.

It might surprise you to learn that the success of your workers’ comp claim is not guaranteed. Many San Antonio, Texas, workers have learned this the hard way by receiving a claim denial after suffering what appears to be a valid on-the-job injury.

Claims result in a denial for several reasons

Sometimes, claims are denied for administrative reasons like missing documentation or typographical errors. However, most claim denials occur for one of the five reasons discussed below.

  1. You waited too long to report your work injury (or file a claim). In Texas, you must inform your employer of your injury within 30 days and file a formal claim within one year.
  2. Your employer disputes your injury or your claim. Employers have a lot of power in workers’ compensation claims. If they say your injury happened outside of work, for example, a claim denial may occur.
  3. You did not seek medical treatment for your work injury. Successful claims require documented evidence. If you lack an official physician report regarding your harm, a denial may occur.
  4. Your injury is not eligible for compensation. Some conditions, particularly mental or emotional conditions, are notoriously difficult to prove and often result in claim denials.
  5. You do not have enough evidence to show the injury is work-related. It is hard to combat a lack of evidence, but your medical reports and eyewitness statements can help you avoid a possible claim denial.

Fortunately, you can appeal an unfavorable workers’ compensation decision. Most Texas residents find it beneficial to work with a legal advocate when appealing a denied claim. Increasing your knowledge of state workers’ compensation laws and regulations can also help.