What to Do When Workers’ Comp is Denied & Your Next Steps

two asian female and one african american male construction workers talking in a meeting

Was your workers’ comp claim denied? If so, you’re not alone. There are ways to fight back and get the compensation you deserve. At Ransom, Gilbertson, Martin, and Ratliff, LLP, we often get calls about workers’ comp claims that have been denied. Often, these calls come from workers who were legitimately injured at work or engaged in a work-related activity and have been wrongfully denied.


Workers’ compensation insurance companies like SAIF, Liberty, Sedgwick, and Hartford deny claims for a variety of reasons. The law in Oregon and other states is complicated, and institutional structures are sometimes stacked against workers and their interests, even when you’re in the right.


But your interests are worth fighting for, and we’re here to help you get the compensation you need and deserve. Keep reading to discover why claims are denied and what to do if you find yourself in this situation.


Why Workers’ Comp Claims May Be Denied

The workers’ compensation claims process can be complicated, making it difficult for injured workers to navigate the legal jargon and fight for their interests. Insurance companies like SAIF deny claims for a variety of different reasons. In some instances, even the IME doctors hired to independently examine injured workers can complicate the facts of your injury and your circumstances, making it harder to advocate for yourself and win your case.

Let’s take a look at some of the most common reasons workers’ comp claims are denied:

  • The injury was not reported on time.
  • The claim was not filed on time.
  • The employer disputed the claim.
  • The injury is not compensable.
  • The employee did not seek medical treatment.
  • There is insufficient evidence that the injury occurred.


What To Do If Your Claim Is Denied

employee who tripped and hurt his back on the stairs

If your claim has been denied, you’re far from alone. Thousands of claim denials are issued each and every year, meaning you’re among thousands of workers who have been denied fair compensation for their injuries. In fact, almost 15% of initial injury claims are denied.


But just because your claim was denied doesn’t mean you’re out of luck. You can still fight for the benefits you deserve by requesting a hearing to contest the denial. More than 7,000 workers’ compensation hearings take place each year, and about half of these workers win their cases and are awarded the benefits they were originally denied. Working with a qualified workers’ comp attorney significantly increases your chances of winning your appeal.

How to Appeal a Denied Claim

older caucasian judge reading some papers

Once you’ve secured a workers’ comp hearing, you — and more specifically, your attorney — will argue your case and try to prove that your claim should not have been denied.


In order to win your appeal, you need to prove two things at your hearing:

1) that your injury occurred on the job and

2) that your work-related injury is the primary reason for your disability/need for medical treatment. Let’s take each of these issues one at a time.


Firstly, you need to prove that the injury happened on the job. This is the simple part. At your workers’ comp hearing, you’ll provide your own testimony and present the testimony of any witnesses to the judge; this may include your boss or other workers. Secondly — and this is the tricky part — you must prove what’s referred to as “medical causation.” Even if you’re able to prove you were injured at work, your claim may be denied if you haven’t successfully argued that the injury is the primary cause of your disability and/or need for medical intervention.


In many of these “medical causation” situations, the insurance company argues that the worker had a preexisting condition prior to their injury that is the main cause of disability. Medical causation claim denials are less about what happened at the time of the injury and more about medical questions like the examples below:


  • “What do the x-rays and MRIs show?”
  • “Did the change in symptoms mean a change in pathology?”
  • “Was there arthritis, and did it contribute to the cause of the condition?”


In order to answer these questions and prove that your injury is in fact the primary cause of your disability and/or need for medical treatment, you need a good doctor and a good lawyer.

When You Should Hire a Workers’ Comp Lawyer

Any time your workers’ compensation claim is denied, you should seek the advice of an experienced workers’ comp attorney. Injured workers with denied claims who hire an attorney are significantly more likely to be successful at securing a workers’ comp hearing and winning their appeal. That’s because lawyers who specialize in workers’ compensation know the ins and outs of the claims and appeals processes. We know the arguments insurance companies make to try to deny compensation to workers, and we know what judges need to hear from workers in order to win.


Look for an experienced attorney who practices locally. It’s important to make sure your lawyer understands the intricacies of workers’ comp law in Oregon, or any other state where you reside. Work with a lawyer who specializes in workers’ comp and works exclusively with injured workers. Some attorneys work with both employers and employees. This is fine, but it means they may have split loyalties. You want an attorney who will fight for your interests as a worker.

Get Professional Workers’ Comp Appeal Help With RGMR

If you were injured at work and your claim was denied, don’t give up. We at Ransom, Gilbertson, Martin, & Ratliff, LLP have devoted our careers to fighting for the rights of injured and mistreated workers. We understand that it can feel like the whole system is stacked against you and no one is on your side. That’s where we step in. We’re committed to understanding the circumstances of your case and working directly with you to make the best argument possible to ensure you get the benefits you need that were denied to you.


We don’t charge fees, and we don’t take any money from you unless we win your case. Contact us today to get a free consultation so we can fight for your interests.

Adian Martin

Adian Martin (JD) is an accomplished attorney with over 25 years of experience. His goal is to use his legal expertise and passion for problem-solving to help people get the benefits and proper compensation they deserve after an injury. He received his law degree from Northwestern School of Law of Lewis & Clark College and is currently a partner at Ransom Gilbertson Martin & Ratliff. In his spare time, Adian enjoys exploring the outdoors with his dog and bicycling.

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