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Why was my workers’ compensation claim denied?

On Behalf of | Sep 30, 2019 | Workers' Compensation

You hurt yourself while working at your job and need the money from workers’ compensation to pay for medical expenses. You file the claim, and the insurer is taking forever to approve it. Then, you receive a denial. 

It seems like the insurer does not want to work to help you understand their reasoning for the denial. You are angry and frustrated and not sure of your next stepIf the company denies your claim, they must give you a reason.  

Bad faith 

Insurance companies in Arizona have the legal responsibility to make the best effort of providing you with compensation when you injure yourself at your jobWorking with you to resolve the issue is acting in good faith. But, there are times when the company denies a claim for no reason or did not properly investigate it. In this case, the insurer is acting in bad faith and you may have a right to legal action. 

Types of bad faith 

The insurer has the power to approve or deny a claim. But they must adhere to the laws of the Arizona Department of Insurance and when bad faith comes into play, they are violating the law. Bad faith can include the following: 

  • Denying a claim without reason 
  • Failing to conduct a thorough investigation of your claim 
  • Forcing you to accept a low-ball offer 
  • Refusing to pay benefits or not paying for medical care 

The claim process 

You have one year from the date of the injury to file a claim. You can either file and sign the claim at the doctor’s office or get a Worker’s Report of Injury and send it in. Your employer has to submit an Employer’s Report of Injury, although this is not a claim. 

Once the insurance carrier receives the claimthe company has 21 days to give its decision. Bad faith actions by insurance companies may leave you feeling you have no recourse. But you have 90 days to file a Request for Hearing if the insurer denies the claim.