What to Do if Massachusetts Workers Comp Denied Your Claim

It might come as a surprise to learn that workers compensation claims are denied quite regularly in Massachusetts. This is true for even the most deserving claimants. With that in mind, if you have received a claim denial, don’t panic, as there are options you can take to fight for the benefits that are rightfully yours.

Below, we discuss some of the most common reasons for a work comp denial and how to go about filing your appeal so you can obtain the approval you desperately need to continue supporting yourself and your family while you’re out of work.

Reasons Why Your Work Comp Claim Might Have Been Denied

Your employer’s workers compensation insurance provider will be responsible for providing you with the benefits you’re entitled to. However, the insurer is going to lose money when paying out on your claim, which means the adjuster will be looking for any reason they can to issue a denial. Although some are valid, others are just an attempt by the insurer to get out of approving your claim.

These denial reasons might include any of the following:

• Lack of medical records
• Being under the influence of drugs or alcohol when injured
• Failure to notify your employer in a timely manner
• Errors in your claim
• Violating your employer’s code of conduct
• Having a pre-existing condition
• Injuries endured while committing a crime

Appealing Your Denial

Workers compensation appeals are handled through the Massachusetts Department of Industrial Affairs (DIA). The DIA will independently review the details of your claim and has the power to overturn or uphold the insurance company’s denial.

Most claims are resolved at this level of appeals, but if your denial is upheld, and your attorney believes you have a strong case, we may recommend proceeding to a hearing before an administrative law judge to get your claim approved.

Discuss Your Case with a Boston Workers Comp Lawyer

If you need help reversing your workers compensation claim denial, reach out to a highly trained Boston workers comp lawyer at Joel H. Schwartz, PC today. You can take advantage of our complimentary claim evaluations by giving our office a call at 1-800-660-2270 or by completing the brief contact form included below.