The last thing an injured worker wants is to hear that their Workers’ Compensation Claim has been denied. For many employees in Hawaii, workers’ comp is a vital lifeline; it covers medical bills and lost wages while recovering. But denials happen more often than people realize, and understanding why can make a world of difference.
At the Law Offices of Alex M. Sonson, we’ve seen how overwhelming the workers’ compensation claim process can feel. That’s why we’ve broken down the most common reasons claims get denied, so you’ll know what to watch out for and how to protect your rights.
1. Missed Reporting Deadlines
Timing is everything in workers’ comp cases. If you don’t notify your employer about your injury within the required time frame, your claim can get tossed out. In Hawaii, deadlines can be strict, and even a small delay may give insurers a reason to deny coverage.
2. Injury Not Reported as Work-Related
Insurance companies often argue that an injury didn’t actually happen at work or wasn’t connected to job duties. If there isn’t clear evidence, like witness statements or a detailed incident report, they may claim it’s unrelated and deny benefits.
3. Lack of Medical Evidence
A strong paper trail is key. If your medical records don’t clearly link your condition to your workplace accident, your claim may be denied. Always see a doctor right away and follow treatment recommendations to establish a solid connection.
4. Pre-Existing Conditions
Insurers frequently blame an injury on a pre-existing condition instead of workplace activity. For example, if you had prior back problems, they may argue that your current pain wasn’t caused by your job. Skilled workers’ compensation attorneys know how to challenge this tactic with medical proof.
5. Employer Disputes the Claim
Sometimes the problem isn’t the insurance company, it’s the employer. They might argue that you weren’t injured at work, that you were under the influence, or that you weren’t following safety rules. These disputes can stall or block your benefits.
6. Delayed Medical Treatment
If you wait too long to get medical help, insurers may argue your injury wasn’t serious, or didn’t even happen at work. Prompt medical care strengthens your claim and shows that your health is a priority.
7. Incomplete or Incorrect Paperwork
Filing for workers’ comp involves lots of forms, deadlines, and details. Even small mistakes, like leaving out information or missing a signature, can cause a denial. That’s where a knowledgeable workers’ compensation lawyer can step in and ensure nothing slips through the cracks.
8. Injury Not Covered by Workers’ Comp
Not all injuries qualify. Stress-related issues, repetitive strain injuries, or injuries that happen outside normal work hours can sometimes fall into gray areas. Insurance carriers may deny these claims unless there’s clear proof they are job-related.
9. Suspicion of Fraud
If something about the claim seems off, like inconsistent stories, a lack of witnesses, or exaggerated symptoms, the insurance company may assume fraud. Even honest mistakes can raise red flags, so consistency and accuracy are crucial.
10. Returning to Work Too Soon
Sometimes, injured workers return before fully recovering, either due to pressure or financial worries. Insurers may use this as evidence that you weren’t really injured or no longer need benefits. Always consult your doctor before going back on the job.
Protecting Your Claim
Denials are frustrating, but they’re not always the end of the road. With guidance from an experienced workers’ compensation law firm in Hawaii, many denials can be appealed successfully. The right legal support ensures you meet deadlines, gather proper evidence, and fight back against unfair insurance tactics.
If you’re dealing with injured workers’ compensation in Hawaii, don’t navigate it alone. Having a dedicated attorney like Alex M. Sonson by your side can give you the peace of mind and support you need during a stressful time.
FAQs
Why would a workers’ comp claim get denied?
Common reasons include late reporting, lack of medical evidence, pre-existing conditions, or employer disputes. Insurers often look for reasons to save money, so even minor issues can cause denials.
What not to say to a Workman’s Comp adjuster?
Avoid downplaying your injury, admitting fault, or speculating about your condition. Stick to facts and let medical records speak for you.
Which workman’s comp claim would likely be rejected?
Claims with delayed reporting, unclear medical evidence, or injuries outside of work hours are more likely to face rejection.
What percentage of workers’ comp claims get denied?
Nationally, about 7–10% of claims are denied initially. Many of those denials can be overturned on appeal with the right evidence and legal help.
What happens to medical bills when workers’ comp is denied?
If denied, you may need to rely on health insurance or pay out of pocket until the appeal is resolved. An attorney can help push for coverage and reimbursement.
Take the Next Step
If your workers’ comp claim has been denied, or you’re worried it might be, you don’t have to face it alone. The Law Offices of Alex M. Sonson is here to stand up for your rights and guide you through the process. Our team has years of experience helping injured workers in Hawaii fight back against denials and secure the benefits they deserve.
Call us today for a consultation and let us help you move forward with confidence.
