5 Reasons Why Your Worker’s Comp Claim Might Be Denied (And How To Fight Back)

When you’re hurt on the job, filing for Iowa workers’ compensation should be a straightforward step toward recovery. But far too often, claims are denied, leaving injured workers with mounting medical bills, missed paychecks, and uncertainty about their future.

This translates to thousands of injured workers being denied the support they need while they recover from their injury.

If your claim is rejected, that doesn’t mean you’re out of options. Many denials can be reversed with the right evidence and legal support. Our Des Moines workers’ comp lawyers explain the five most common reasons for withholding benefits in Iowa cases and how to challenge and win a denial on appeal.

1. Your Employer Disputes Whether the Injury Is Work-Related

One of the most common reasons for denial is the insurer or employer claiming your injury wasn’t work-related. They might argue you were off duty at the time or that your health issue existed before the workplace incident.

Here’s how to challenge this type of denial:

• Record details about what you were doing when you were hurt, including your task, equipment, location, and anyone who saw it.
• Get a medical expert’s opinion linking your injury to the work incident or showing that your job made an existing condition worse.
• Request written statements from coworkers who witnessed the incident or can confirm that you were performing your regular job duties.

Showing proof that your injury happened at work makes it far more difficult for the insurer to dispute your claim.

2. Missed Deadlines for Reporting or Filing

Many claims are denied simply because the worker missed a deadline, either by failing to report the injury to their employer within 90 days or by not filing for benefits within two years. Employers and insurers often use these timing issues as grounds to reject valid claims.

To avoid this type of setback:

• Report your injury to your employer as soon as possible, preferably in writing, and keep a copy for your records.
• Confirm that your employer has submitted the required First Report of Injury or Illness form, and request your claim number.
• Submit any missing forms or details promptly if the insurer requests them to prevent delays or rejection.

Acting quickly is key, but don’t rush the process and make mistakes. Ideally, you want to submit your well-supported claim within the proper window and without any glaring errors.

3. Lack of Medical Evidence Supporting the Injury

If the insurer claims there isn’t enough medical evidence to support your injury or prove how severe it is, your claim may be denied. This often happens when there’s no clear link between the workplace incident and your doctor’s diagnosis.

 Here’s how to make your cases stronger:

• Seek immediate treatment after the injury and keep all relevant medical records.
• Gather as much supportive evidence as possible, including MRI or X-ray results, specialist evaluations, and physical therapy reports.
• Work with a medical expert (such as an occupational medicine doctor) who can speak to causation and impairment.

Thorough medical documentation is often the most effective tool for converting a denied claim into an approved one on appeal.

4. Insurers Challenge the Extent of Your Disability

Insurers may acknowledge that your injury occurred but downplay the extent of your disability or impairment. They might try to reduce your benefits by claiming you’re capable of light-duty work or by disputing how long you should receive disability payments.

You can respond to these denials by:

• Keeping detailed records of your symptoms, work restrictions, and any tasks you can no longer perform.
• Requesting a professional MMI evaluation that provides an impairment rating and explains your functional limitations.
• Emphasizing how the injury affects your daily life, ongoing treatment, and ability to return to your previous job.

These steps help you clearly demonstrate the extent of your limitations and build a stronger case for receiving full benefits.

5. Allegations of Fraud or Misrepresentation

In some cases, claims are denied because the employer or insurer alleges that the worker lied about how the injury happened, misrepresented facts, or was intoxicated or engaging in misconduct that would make them ineligible to receive benefits.

Do the following to protect yourself:

• Be honest from the start; any discrepancy in your statement may be used to deny your claim.
• Gather evidence, such as toxicology reports or witness accounts, to counter their inaccurate narrative.
• Use your appeal to clearly explain the employment connection, the conditions of the injury, and why you believed you were performing job duties at the time.

Many insurance companies hire private investigators to find evidence that could undermine your claim. Be mindful of your actions and avoid anything that might be misinterpreted as proof you’re not injured. A skilled Des Moines workers’ comp lawyer can guide you on how to protect your rights.

Understanding the Appeals Process

Recent surveys indicate that approximately 7% of workers’ compensation claims are initially denied nationwide.  If your Iowa workers’ compensation claim is denied, don’t lose hope. The state offers an appeals process that allows injured workers to contest the decision and submit new evidence to support their claim.

Here’s how appeals work:

• File a Petition for Arbitration: Submit a petition to the Iowa Workers’ Compensation Commissioner within two years of the injury (if no benefits were paid) or three years from the last payment.
• Attend the Arbitration Hearing: Present your evidence and testimony before a Deputy Commissioner; the hearing is scheduled after your petition is filed.
• Appeal to the Commissioner: If you disagree with the decision, request a review by the Commissioner within 20 days of the arbitration ruling.
• Seek Judicial Review: If the denial is upheld, appeal to the Iowa District Court within 30 days of the Commissioner’s final decision.

Working with an experienced attorney can improve your chances of overturning the denial and securing the financial support you need for recovery.

Get Legal Help for a Denied Workers’ Comp Claim

A workers’ comp claim denial can leave you frustrated and unsure how to move forward. Our qualified attorneys at MSMC Injury Lawyers can review your claim, identify the reason it wasn’t approved, and guide you through the appeals process.

We know what it takes to build strong evidence and win on appeal so you receive the benefits you’re owed.

Contact us today for a free case review.