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Common Causes of Denied Workers’ Compensation Claims


Workers’ compensation cases can be frustrating to deal with, especially when you find out the news that your claim was denied. Unlike in most states, Texas employers are not required by law to provide workers’ compensation coverage to their employees. However, victims should consult an experienced workers’ comp lawyer even if they’re not covered. Physical injuries that occurred as work as well as diseases, injuries, or illnesses that resulted from work conditions may all be legitimate reasons for victims to make claims.

Denied workers’ compensation claims can be a difficult area to navigate on your own, and attorneys can help you find other ways to seek compensation for your case. To better understand how workers’ comp cases work, here are a here common reasons why claims do not get approved.

You Weren’t Covered by Your Employer.

Not all employers in Texas provide workers’ compensation, but most do. It’s important to know when you are hired whether your employee offers those insurance benefits in case you are ever injured at work. These sorta of instances can be difficult for victims to navigate alone, and it’s usually in their best interest to seek an experienced workers’ comp lawyer to discuss other options for seeking compensation.

The Injury Did Not Take Place at Work.

One of the most common reasons that a workers’ comp claim is denied is because the injured party was not physically present at work when the injury occured. However, employees are covered if they were performing a job duty outside of work, such as travel or meeting with clients. If this was a reason your workers’ comp claim was denied, you should contact a workers’ comp attorney for further advice and instruction.

The Injury Was Not Reported in Time.

There is a time limit to how long injured employees can wait to report their injuries and make a claim for workers’ compensation. In Texas, workers must file injury reports within 30 days of when the injury was sustained. However, if the injury is not fully known until later, the employee has 30 days to file from when the injury was officially known. After initially reporting the incident, you have a year to to file formal workers’ compensation paperwork from the time of the incident. In addition, your employer also has a responsibility to send an initial report of injury to their insurance company within eight days of the incident.

Your Doctor Wasn’t Covered by Your Employer.

Legally, you need to visit a doctor and receive a proper diagnosis in order to legally qualify for workers’ compensation. Under state law, you must go to one of the doctors provided under your employer’s workers’ compensation plan. For your own evidence later and if you have the resources, you can also go to a doctor you trust so you know your injuries will be evaluated properly. These appointments can act as evidence later to help prove your case.


If your claim was denied and you believe you are entitled to a workers’ compensation, you can file a dispute resolution through the Texas Division of the Division of Workers’ Compensation Insurance. If you are not satisfied with the decision, you can then appeal to the Texas State Court. At this point, it’s strongly recommended that you hire an attorney.

We know every workers’ compensation case is different, so it’s imperative to contact an attorney who has experience in this field of law who can help you navigate your case, investigate why your workers’ comp claim was denied, and help come up with a solution for your case.

Call our firm at (210) 807-3178 to discuss your potential workers’ comp case.

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