Understanding Your Rights When a Workers Compensation Claim Is Denied

Suffering a work injury is always a painful and distressing experience, with the threat of financial hardship looming due to the inability to return to work at the same time the injury victim needs medical care. Knowing there’s always the cushion of workers’ compensation to fall back on is invaluable. But what happens when an employee sustains a serious on-the-job injury in Missouri and workers’ compensation denies the claim? What rights and options does a work injury victim have when Missouri workers’ compensation denies their claim?

Missouri’s Workers’ Compensation Law

There were 12,997 workers’ compensation claims filed in Missouri in 2023. Missouri requires employers to carry workers’ compensation insurance if they have five or more employees. Employers in the construction industry must have workers’ compensation available even if they have only a single employee. In Missouri, workers’ compensation provides employees injured on the job with the costs of their medical treatment through an employer’s list of authorized providers, ⅔ of their average weekly pay, and disability benefits—including temporary total disability benefits or permanent partial or permanent total disability benefits. It also provides wrongful death compensation for specific close family members of fatally injured employees.

What Types of Injuries Occur in the Workplace?

According to a breakdown of the nearly 13,000 Missouri workers’ compensation claims in 2023, there were 30 head injuries, 8 neck injuries, 229 injuries to the upper extremities, 143 injuries to the lower extremities, 69 injuries to the trunk, and an astonishing 12,518 injuries involving multiple body systems. Injuries commonly cited in workers’ compensation claims in Missouri include the following:

• Head injuries and traumatic brain injuries
• Neck injuries
• Back injuries
• Fractures
• Soft-tissue (muscle and ligament) injuries to shoulders, knees, ankles, wrists, and trunk
• Burns
• Electrocutions
• Chemical exposure illnesses
• Internal organ damage
• Spinal cord injuries
• Repetitive motion injuries

The most common causes of injuries in the workplace include slip-and-fall accidents, falls from heights, struck-by accidents, equipment injuries, and toxic exposures. Workplace injuries make it difficult or impossible for the injury victim to return to work at the same time they may have additional expenses; for instance, when an injury victim needs hired help to accomplish daily tasks at home or other out-of-pocket costs. A workers’ compensation claim provides essential relief to workers, but an estimated 7-13% of claims result in a denial of benefits.

How Do Workplace Injury Victims File Claims?

In Missouri, injured workers must report their injury to their employer in writing, listing the date, time, and place where the injury occurred in addition to the type of injury and their name and address. The employer must report the injury to their workers’ compensation insurer within five days and to the Division of Workers’ Compensation within 30 days. The injured worker must fill out and file detailed paperwork to begin the review of their claim within the statute of limitations, which expires two years from the last payment they made toward the injury. Workers’ compensation insurance adjusters may schedule a pre-hearing and mediation to determine a settlement amount or an award of benefits. A final hearing occurs when the injury victim reaches their maximum medical improvement.

Why Are Some Missouri Workers’ Compensation Claims Denied?

Not all claims are approved by workers’ compensation insurance. The most common reasons cited by workers’ compensation for claim denials include the following:

• Missed deadlines
• Workers’ compensation disputes that the injury or illness is work-related
• Workers’ compensation attributes the symptoms to an injury victim’s  pre-existing condition
• The employee didn’t seek medical treatment through an authorized provider
• There are inconsistencies or discrepancies in eyewitness statements
• The injury victim failed to follow their doctor’s orders
• The employee failed to cooperate with insurance adjusters or failed to follow proper protocol
• The employee was using alcohol or drugs at the time the injury occurred
• The condition doesn’t meet the state’s guidelines for compensation
• The employee quit their job or was fired before they filed for workers’ compensation

It’s disheartening to receive a dispute or denial notice after filing a workers’ compensation claim, but it’s important to note that injury victims may appeal a denial.

What Are My Rights and Options After a Workers’ Compensation Claim Denial?

After you receive a denial from workers’ compensation, you don’t have to leave it at that and give up on your compensation claim. You have specific rights, including the following:

• You have a right to hire a St. Louis workers’ compensation attorney if you haven’t already done so
• You have a right to contact your employer and discuss the denial with your company’s Human Resources department to seek clarification, particularly if the denial stemmed from an employer who missed a deadline in your case
• You have a right to file an appeal

When an injury victim and their attorney file an appeal after a workers’ compensation denial, there’s a good chance of approval. One study shows that close to 70% of denied claims are approved after an appeal.

Another option open to injured workers in some circumstances is a personal injury lawsuit to recover compensation from a liable third party. When a third party like a contractor, subcontractor, or property owner acts negligently and the result is an injury to a worker, a third-party lawsuit can recover compensation after a workers’ compensation denial as long as it’s filed within the state’s statute of limitation.

How Can a St. Louis Workers’ Compensation Attorney Help?

Few legal matters are as significant as a successful workers’ compensation claim when a serious injury makes it difficult to return to work during a significant recovery time, or at all. If workers’ compensation denied your claim, it’s critical to file a well-executed appeal to avoid a second denial. An attorney with years of experience navigating workers’ compensation claims in Missouri is the best ally in moving forward with the greatest likelihood of a successful claim, or to walk you through other options that might be available in your unique case. Call an injury lawyer at The Floyd Law Firm today for a free consultation so we can begin strategizing your appeal.