Insurance companies deny workers' compensation claims for a variety of reasons. In my experience as a workers' compensation attorney, these fall into several categories.
Some claims are denied because the employer has a reason to believe (often incorrectly) that the injury did not occur at work. A good example of this might be that your boss knew you were moving furniture over the weekend and you report a back injury claim on Monday. They may believe you are lying about the back injury occurring at work. Although these types of denials are common, they are usually fairly easy to overcome. Workers' compensation judges will listen to your story and will believe your version of events unless there is a strong reason not to.
Another common reason for denying workers' compensation claims is when the insurer determines that work is not the main cause of your injury. Sometimes this is based upon the doctors' chart notes and sometimes it is really just a gut call by the insurance adjuster. The basis for these types of denials is not that you did not have a work injury, but that the major cause of the work injury is something aside from your work activities. A common example is when a worker lifts something heavy at work and injures his or her back. The doctor takes an MRI and finds a disc herniation, but also arthritis in the worker's back. If the insurance company can prove that the work injury "combined" with the arthritis in the worker's back, AND that the major contributing cause of the disc herniation and need for treatment was the arthritis, their denial will be upheld. However, keep in mind that these denials are overturned all the time. Also, even if you cannot get the denial overturned, a workers' compensation attorney may be able to help you negotiate a settlement.
Finally, some denials are simply because the insurance company does not believe you have enough evidence to prove that you were injured at work. These are usually the easiest type of denial to overcome. In fact, the insurance companies will sometimes even withdraw the denial prior to a hearing if your workers' compensation attorney is able to provide enough evidence of your injury.
The most important thing to remember if you have a denied workers' compensation claim, is that denials are overturned all the time. Even if you settle your case prior to going to a workers' compensation hearing, it is worth it to have your attorney appeal the denial.
If you have any other questions about appealing workers' compensation claim denials, visit us at www.oregonworkinjury.com and set up a free consultation.