Why Workers’ Compensation Claims Are Denied and How to Fight Back

Workplace injuries can disrupt daily life, strain finances, and raise questions about what to do next. When a workers’ compensation claim is denied, the situation becomes more stressful. In Indiana, a denied claim does not necessarily mean that benefits are out of reach. 

There are specific reasons claims are rejected and procedures that allow injured workers to contest those decisions. This guide, written by Klezmer Maudlin, PC, explains why workers’ compensation claims are denied and how to fight back. Our experienced Indianapolis workers’ compensation lawyers can help you challenge a denied claim and pursue the benefits you deserve.  

Schedule a Free Consultation

Common Reasons Workers’ Compensation Claims Are Denied

Many workers who receive a denial notice are left uncertain about what went wrong. A rejection can happen at different stages of the claim and often stems from incomplete documentation, disputed facts, or procedural issues. Some of the most common reasons for denial in Indiana include:

Late Reporting of the Injury

In Indiana, injured workers are expected to report their injuries to their employers promptly—ideally within 30 days. If the report is delayed, the employer or insurer may argue that the injury did not occur on the job or has no connection to work duties. Even if the injury is legitimate, late reporting often results in additional scrutiny and delays.

Workers who do not report minor injuries because they believe symptoms will improve may later struggle to prove the condition developed at work. Timely documentation helps preserve the link between job duties and medical treatment.

Injury Deemed Not Work-Related

Insurers often deny claims by arguing that the injury did not occur during employment or was caused by personal activities. For example, if an employee is injured during a lunch break off-site or while commuting, the claim may be rejected because the incident was outside the scope of employment.

Claims may also be denied if the insurer believes a pre-existing condition caused the injury. In these cases, the worker must show that the job duties aggravated or worsened the condition measurably.

Lack of Medical Documentation

Medical records serve as the foundation for a workers’ compensation claim. If a worker delays seeking care or visits a provider who does not document the cause and extent of the injury, the insurer may reject the claim. Incomplete, inconsistent, or missing records weaken the claim’s credibility.

The treating provider must provide sufficient detail to support a diagnosis related to work duties. If medical documentation does not connect the injury to workplace conditions, benefits may be withheld.

Employer Disputes the Claim

Employers have the right to contest a claim; their input carries weight during the initial evaluation. Some employers dispute that an incident occurred or claim that the worker failed to report it. Others may suggest that the injury happened outside of work or that the worker violated safety protocols.

When an employer disputes the claim, the insurer will delay or deny benefits until further evidence is presented. Written reports, coworker testimony, and medical records can help address employer objections.

Unfavorable Independent Medical Examination (IME)

In Indiana, insurers may require the injured worker to attend an Independent Medical Examination (IME). The insurer selects the physician conducting the IME, who is often asked to determine whether the injury is work-related and whether treatment is necessary.

If the IME report differs significantly from the worker’s primary provider, the insurer may side with the IME and deny the claim. This is especially common in long-term conditions, repetitive strain injuries, or disputed impairments.

What to Do After a Denied Workers’ Comp Claim

Receiving a denial does not automatically close the case. In Indiana, workers have options to respond. The steps that follow depend on the reason for denial and how far the claim has progressed. Taking prompt, organized action improves the chances of success.

Request the Written Denial and Review the Reason

The denial letter should include a specific explanation. Workers should review the reason and compare it to the facts and records submitted. The issue can often be traced back to a missing document, a conflicting report, or an administrative delay.

If the letter does not clearly explain the basis for the denial, the worker may contact the claims administrator or adjuster and request clarification in writing. This helps avoid confusion and ensures accurate preparation for an appeal.

Gather Supporting Documents

Before pursuing an appeal, it’s helpful to review the claim file and gather additional evidence. This may include:

• Incident reports
• Timecards or shift schedules
• Medical evaluations with updated diagnoses or causation opinions
• Witness statements
• Emails or communications with the employer or insurer

Workers should verify that all relevant documents have been submitted. Missing or inconsistent materials can be supplemented before initiating a formal appeal.

Do Not Miss Appeal Deadlines

In Indiana, workers must file a formal appeal with the Workers’ Compensation Board within two years of the injury or the date of the last benefit paid, whichever is later. Delays beyond that window may result in permanent loss of the right to seek benefits.

In cases where the denial is issued early, the clock may already be running. Submitting an appeal within the appropriate timeframe preserves the right to present evidence and challenge the insurer’s decision.

Workers unsure how much time remains can consult legal counsel or request a status review from the Board.

How to Appeal a Denied Workers’ Comp Claim in Indiana

When informal discussions or document submissions do not resolve the issue, the worker may file an Application for Adjustment of Claim with the Indiana Workers’ Compensation Board. This initiates the formal appeals process.

Step 1: Submit the Application

The Application for Adjustment of Claim is a written form that includes details about the injury, treatment, employment status, and denial. It must be filed with the Board and served on the employer and insurer.

Once filed, the case is assigned to a Single Hearing Member for review.

Step 2: Prehearing Conference and Discovery

The Board may schedule a prehearing conference to narrow the issues and discuss timelines. Both sides may request documents, submit medical records, or conduct depositions. This stage allows the worker to provide updated evidence or new testimony to support the claim.

Discovery may include:

• Medical expert reports
• Surveillance footage (if any)
• Job descriptions
• Treatment plans and prognosis evaluations

Step 3: Hearing Before the Board

If the matter is not resolved during prehearing discussions, a formal hearing will be held. Both parties can present witnesses, including treating physicians and coworkers. The evidence is reviewed, and the Hearing Member issues a decision.

The decision is based on the totality of the evidence. The worker may receive backdated benefits, wage replacement, and medical expense coverage if the claim is approved.

If the claim is denied again, further appeals may be filed with the Full Board or the Indiana Court of Appeals, depending on the facts and procedural history.

Independent Medical Exams and Denials

Insurance carriers and third-party administrators often request an independent medical examination (IME) when there is a dispute about the severity, cause, or duration of an injury. The IME is conducted by a physician selected by the employer’s insurance company, not the worker’s treating doctor.

While the purpose is to obtain a neutral assessment, IME results frequently lead to disputes. The examining doctor may offer conclusions that conflict with those of the primary physician. 

For example, the IME provider may state that the injury has fully resolved, that the condition is unrelated to work activities, or that no further treatment is required. These findings can influence the insurer to deny or terminate benefits.

Workers preparing for an IME should take several precautions:

• Review all medical records in advance
• Be consistent when describing symptoms and work activities
• Avoid exaggeration or speculation
• Request a copy of the IME report after the examination

If the IME report contains factual errors or conclusions that contradict long-standing treatment records, it may be challenged during the appeals process. Workers may also obtain a second medical opinion to challenge the findings.

Legal counsel can assist by identifying inconsistencies, submitting counter-evidence, and preparing for questions at the hearing. While not every IME leads to denial, the risk increases when the examination is based solely on referrals from the insurer.

Employer and Insurance Company Disputes

Employers and insurers each review workers’ compensation claims. Disputes may arise when the employer disagrees with the account of the injury or believes the claim falls outside the scope of employment.

Some of the most common employer-based objections include:

• The injury occurred off duty or off-site
• The worker was engaged in horseplay or misconduct
• The worker violated company policy or safety procedures
• The injury was caused by intoxication or drug use

If the employer disputes the claim, the insurer may place the claim on hold or deny it outright. In such cases, the worker must provide documentation that supports their position, such as witness statements, video footage, or evidence that they were performing work duties at the time of injury.

Insurance companies may also raise procedural objections. These include:

• Late submission of required forms
• Incomplete or inconsistent medical documentation
• Conflicting statements from providers or the injured worker

Sometimes, the insurer may approve part of the claim but deny wage loss benefits or future treatment. Disputes about partial compensation can be appealed, just like complete denials.

Maintaining detailed records, consistent communication, and prompt response to requests helps reduce disputes. When disagreements persist, filing a formal appeal may be the only way to pursue benefits.

When to File an Appeal vs. Refile a Claim in Indiana

Not every dispute requires a formal appeal. In some cases, the denial stems from a technical issue that can be corrected with a revised submission or an updated report. However, filing an appeal may be the most effective path forward when the claim is denied based on factual or legal grounds.

Appeals are typically filed when:

• The denial is based on a disagreement about work-relatedness
• The insurer relies on an unfavorable IME report
• There is a dispute about impairment ratings or wage loss

Refiling may be appropriate when:

• The initial claim was withdrawn or dismissed for incomplete paperwork
• The worker suffered a new or worsened injury after the original claim
• A procedural deadline was missed, but a new event occurred that supports a separate filing

Workers should not attempt to refile simply to avoid the appeals process. Doing so may lead to additional delays or procedural complications. Legal counsel can help assess whether an appeal or a new claim is more appropriate based on the facts and procedural history.

It is also important to monitor the statute of limitations. In Indiana, most workers’ compensation claims must be filed within two years of the date of injury or the date of the last payment of compensation, whichever is later. Appeals or filings submitted after this period may be barred.

Preventing a Denial Before It Happens

For workers still in the early stages of a claim, several steps can reduce the risk of denial:

• Report the injury to the employer as soon as possible, preferably in writing
• Seek medical treatment right away and inform the provider that the injury occurred at work
• Follow all recommended treatment plans without interruption
• Maintain consistent and accurate records of symptoms, absences, and work restrictions
• Respond promptly to requests from the insurer or employer

Providing detailed and timely documentation supports the claim and makes it harder for the insurer to dispute eligibility. Even minor inconsistencies in reports can lead to further review or rejection. Workers should also avoid posting on social media or making other public comments that could be misinterpreted.

Workers unsure how to handle communications or paperwork during the process can consult a legal representative early, even before a denial occurs.

Contact an Indiana Workers’ Compensation Lawyer if Your Claim Was Denied

A denied workers’ compensation claim can disrupt recovery and delay financial stability, but it does not have to end your pursuit of benefits. Indiana law allows injured workers to appeal claim denials, present new evidence, and pursue the compensation they are owed. 

Whether the issue stems from a reporting delay, a disputed medical opinion, or an employer challenge, timely action increases the chance of a successful outcome.

We Wrote the Book on Workers’ Compensation
When looking for representation, hire the firm that wrote the book. The attorneys at Klezmer Maudlin, PC, authored the Workers Compensation Practice Manual, a trusted resource on administering and practicing workers’ compensation law in Indiana. 

Our Indianapolis personal injury lawyers also frequently speak at professional seminars on workplace injury law, contributing insight and leadership to the field.

If your claim has been denied or delayed, Klezmer Maudlin is ready to help. We have guided over 31,000 Indiana workers through the compensation process and provide tailored legal support during appeals, hearings, and negotiations.

For a free consultation, call 317-569-9644 or fill out the contact form on our website. A member of our team will review your case and explain your legal options.

Schedule a Free Consultation