Ten “Worst” Reasons to Deny a Workers’ Compensation Claim

Earlier this year, the Lockton Group published a white paper which set out the top ten reasons for denying a workers’ compensation claim, based upon a nationwide study of claims from 2014-2017.  A link to the study can be found here

According to the Lockton study, the top 10 most common reasons for workers’ compensation claim denials were:

1. No medical evidence of injury.
2. No injury per statutory definition.
3. Reservation of rights.
4. Pre-existing condition.
5. Idiopathic condition.
6. Intoxication or drug-related violation.
7. Stress non-work related.
8. Failure to report accident timely.
9. Doesn’t meet statutory definition of employee.
10. Misrepresentation

Of more interest to me was the list of the top ten types of claims which led to “reconversions”.  These are claims that were initially denied but which converted to paid claims within 12 months.  Those reasons (followed by the “reconversion” percentage) were:

1. Misrepresentation 90.3%
2. Willful intent to injure oneself 88.9%
3. Reservation of rights 87.5%
4. No jurisdiction 80.6%
5. Intoxication or drug-related violation 76.9%
6. No injury per statutory definition 71.6%
7. Recreational or social activity 71.4%
8. Elected other coverage, i.e., opted out 70.3%
9. No medical evidence of injury 69.2%
10. Pre-existing condition 68.9%

According to the Lockton study 67 percent of all initially denied claims converted to paid claims within 12 months.