Denied Workers' Compensation Claims

The Massachusetts workers’ compensation attorneys at Kantrovitz & Associates have defended the rights of injured workers for over 20 years. We know that clients trust us to tenaciously pursue their cases after their claims for benefits have been denied. We serve workers in Boston, Essex, Middlesex, Norfolk, Suffolk, Plymouth, and Merrimack Valley, as well as across Massachusetts, Rhode Island, and New Hampshire. Let us help you obtain the compensation you deserve.

Denied Workers’ Compensation Claims

If you have lost at least five full days of work due to a job-related injury, your employer is required to file a report with the Department of Industrial Accidents and the workers’ compensation insurance company. You should receive a copy. The insurer may pay benefits for up to 180 days without accepting liability, with the option to terminate benefits with seven days’ notice. This is known as “pay without prejudice.” The insurer may also seek, only with your permission, to extend the payment without prejudice beyond the 180 days. This means “without prejudice” to the insurer, not the worker.

Insurance Company Denial

If the insurer denies benefits, the injured worker may file a claim with the Department of Industrial Accidents, triggering the dispute resolution process. Seeking legal representation is strongly encouraged at this stage. Requirements for filing an employee’s claim form with the Department include submitting:

  • Copies of supporting medical evidence
  • Any medical bills or physician reports
  • Documents showing work-related injury
  • A copy of the employee claim form sent to the insurer

You should keep a copy of the employee claim you submit for your own records. Upon receipt of your claim, the Department will schedule a conciliation, and will provide you with notice of the date, time, and location of the first meeting.

The insurer’s notice of denial will include the reasons for denial and explain your right to appeal. Bring this notice to your first meeting with an attorney, who can contact the insurer on your behalf. Bring any correspondence from the Department and insurer to the first conciliation meeting, including the insurance denial and Department notice of proceeding.

Reasons for Denial of Benefits

A workers’ compensation claim can be denied for various reasons, including:

  • Improper reporting of injury or illness
  • Failure to file timely, accurate report with employer
  • Employer’s untimely report of workplace injury to insurer
  • Deficiencies in employer’s notification to insurer of worker’s condition
    • Description of illness or injury
    • Location, activity at time of injury
    • Explanation of how, why injury occurred
    • Names of any witnesses to accident
  • Injury or condition was not work-related
    • Pre-existing condition or degenerative condition
    • Disabling condition (repetitive motion injury) develops over time
  • Injured worker not “covered employee”
    • Independent contractor
    • Lack of employer-employee relationship
    • Injury outside employer’s control, scope of employment

A denied claim is not the end of the road. Remember that workers’ compensation offices receive a vast number of claims each day and are extremely back-logged. Most denials merit further inquiry and additional, obtainable evidence. An experienced attorney can take care of these multiple deadlines, submit the proper evidence, and represent you in the hearing.

Consult a Workers’ Compensation Lawyer

If your workers’ compensation claim was denied, contact the Massachusetts workers’ compensation lawyers at Kantrovitz & Associates today. For over 20 years, we have turned the process around for numerous injured workers who tried to file alone. We are devoted to providing insightful advice and rigorous representation in your case. Our goal is to get benefits approved for you. The sooner we can help, the faster your benefits will come. Avoid stressful delays and costly mistakes by getting invaluable assistance from the beginning. Call (800) 367-0871 for a free consultation or contact us online.