If your workers’ compensation claim has been denied, you’re not alone.
Thousands of claim denials are issued every year, which means many workers don’t get fair compensation for their injuries. If you were injured at work but your claim was denied, you can still fight for the benefits you deserve. We want to learn about your situation so we can help you request a hearing and contest the denial.
Claim Denials Are Often Unfair
Even claims for serious work-related injuries often get denied. Claims for lifting injuries that cause herniated discs or rotator cuff tears are frequently denied, while many simple claims, like broken bones and severe cuts, are accepted. In fact:
- Almost 15% of initial injury claims are denied.
- When a condition occurs from repetitive use, or hearing loss results from occupational exposure to noise, almost 33% are denied.
- For injured workers trying to reopen an already accepted claim with an aggravation claim, about 60% of those are denied.
Claim denials like these typically result in more than 7,000 workers’ compensation hearings each year. Workers win about half of those hearings, but working with an experienced attorney significantly increases your chances of winning.
Why Do Workers’ Compensation Claims Get Denied?
A workers’ compensation claim can be denied for a number of reasons, but just because your claim was initially denied doesn’t mean you aren’t entitled to compensation. The most common reasons for denial include:
Sometimes, insurance companies are simply hoping you won’t appeal the denial. The truth is that many people don’t appeal, and this saves the insurance company money — money that should be paid to workers with legitimate claims.
Another reason for a denial could be that your employer told the insurance company your injury was suspect. This could mean that your employer didn’t see your injury happen, that it was not reported immediately, or that your employer believes you were injured somewhere else other than work. A hearing can clear up this kind of confusion and get your claim covered.
Independent medical examination (IME) reports are the most common reason why claims get denied. Doctors who perform IMEs are hired by workers’ compensation insurance companies, like SAIF, to write reports on workers’ injuries. Many IME doctors are retired, and these reports are their main source of income.
Insurers often already know what certain doctors typically say in their reports. For example, many IME doctors say that nearly all herniated discs are caused by a degenerative disease of the spine. This means your injury claim can be denied because a hand-picked IME doctor says you have a pre-existing condition, even if your own doctor tells you it’s a workers’ comp injury. In this case, a hearing will often get your work-related injury covered.
If you have had a serious work injury, or your claim has been denied or closed, it may be hard to imagine going through a difficult legal process right now. But we want you to get the compensation you deserve. We’ll do our best to understand your concerns and make the experience as easy as we can.
We’re on Your Side
We always begin by listening to you. We want to hear your story and answer your questions. Then we’ll go over your legal options and discuss likely outcomes of your case. Every consultation is free. We don’t charge fees, and we only collect a small percentage if you win or settle your case. If you don’t win or get a settlement, you don’t owe us anything.
Many workers’ compensation claims are wrongfully denied. If your claim has been denied, and you believe you have a chance to win, we can help.
With more than 70 years of combined experience working for injured people’s rights throughout all of Oregon, our legal team is ready to help you get the compensation you deserve. Plus, we only get paid if you win. All your consultations with us are free, including the first one. Contact us today and tell us about your case.