Injured employees rely on workers’ compensation benefits to pay for medical treatment and cover lost wages following a workplace incident.

But while you’re entitled to file a claim for work injury benefits, there’s a chance your workers’ comp claim could be denied.

This can be frustrating, stressful, and even frightening, as it keeps you from getting the financial support you need and deserve.

Denials are quite common. In fact, 47% of people who ultimately receive a settlement have their initial workers’ comp claim denied.

But in most cases, you can successfully appeal a denied workers’ comp claim with trusted legal support.

Let’s take a look at why your workers’ comp claim might be denied and what you can do about it, with specific advice for appeals in Kansas and Missouri.

Why do workers’ comp claims get denied?​

Missed deadlines

Different states have their own deadlines for reporting workplace injuries and filing for workers’ comp benefits.

The 2024 Kansas workers’ comp bill gives you 30 days to report a workplace injury to your employer. However, if you no longer work for that employer, you must provide notice within 20 days of the accident. You then have three years from the date of injury to file a workers’ comp claim under the Kansas statute of limitations.

When you’re injured at work in Missouri, you also have 30 days to report it to your employer. But under the Missouri statute of limitations, you only have two years from the date of injury to file a claim.

If you miss either of the deadlines in your state, you’ll lose the right to claim for compensation. And if you try, expect your workers’ comp claim to be denied.

Lack of medical evidence

You need to prove your injuries with medical evidence to qualify for workers’ compensation.

Insurers require detailed records such as physicians’ notes, diagnostic test results, and treatment plans showing the nature and severity of your injuries.

Without clear evidence linking your condition to a documented accident or work activity, your employer’s insurance carrier can deny your claim.

Even if you have evidence of your injuries, the insurer might request an independent medical examination (IME) to get a second opinion.

If the IME report differs from your initial diagnosis, it’s likely the insurer will use it as evidence to deny your claim.

Employer disputes claim

Every time an employer accepts a workers’ comp claim, their insurance premium goes up and their safety record goes down.

So your employer might look for any reason they can find to deny your workers’ comp claim.

Evidence such as eyewitness testimonies or security camera footage can suggest that you were behaving recklessly, not conducting a work-related task, or injured off-site.

If the insurer finds such evidence credible, your workers’ comp claim could be denied.

Injury not deemed work related

You only qualify for workers’ compensation benefits if your injuries arise out of and in the course of employment.

If the insurer believes your injury occurred outside of work-related tasks, while off-site, off the clock, or due to a pre-existing condition, they’ll deny your claim.

Car accidents are also usually excluded unless you had a special work-related errand or were travelling between multiple jobsites.

When making a claim, you’ll need to explain how a specific step in your work duties led to your injuries.

If you can’t tie the accident directly to a work task, the insurance carrier will view it as a personal incident and deny your claim.

Pre-existing condition

Having a pre-existing condition such as carpal tunnel syndrome or a chronic back injury doesn’t necessarily prevent you from making a claim.

However, blaming a pre-existing condition for your current injury is an easy way for insurers to justify denying your claim.

Both Kansas and Missouri allow you to recover benefits for work-related aggravation of an existing condition. But you need to prove the aggravation was work related with medical evidence.

The importance of understanding the insurance company denial letter

If the insurance company denied your work injury claim, you’ll receive a workers’ compensation denial letter.

This isn’t just bad news though. It’s actually a roadmap for your next step.

That’s because the insurer is required to specify the exact reasons why they rejected your claim and cite the evidence or policy provisions they relied on.

Carefully reviewing this information with your workers’ comp attorney helps you pinpoint the weaknesses in your case.

You can then gather targeted evidence to address each citation.

For example, if you’re faulted for insufficient medical proof, you know to gather additional doctor’s reports or test results.

Understanding the denial also ensures you can file an appeal within the deadline and follow the correct procedures for filing a workers’ comp lawsuit.

But you can only appeal a workers’ comp denial a limited number of times. So it’s essential to seek legal help for workers’ comp as soon as you’re denied.

Why to hire a workers’ compensation lawyer

Working with a trusted and experienced workers’ comp attorney from Phalen Law ensures you can file the strongest possible appeal.

We strengthen your case by gathering medical evidence, hiring expert witnesses, negotiating with the insurance company, and representing you at hearings.

And since we handle all the complex paperwork on your behalf, you don’t need to worry about missing deadlines or getting something wrong.

Professional legal support also tends to significantly increase your compensation.

That means you’re likely to end up with more money even after paying your legal fees.

With Phalen Law by your side, you can have confidence in a higher payout with minimal stress, leaving you free to focus on rest and recovery.

How to appeal a workers’ comp denial in Kansas

Getting started

The first step to filing a workers’ compensation appeal in Kansas is to submit an Application for Hearing with the Kansas Division of Workers Compensation.

This is a formal request to review the denial.

You need to file an application within three years of your injury.

Once filed, your case is assigned to an Administrative Law Judge (ALJ).

If a formal hearing is necessary, the ALJ will review evidence, listen to testimony, and issue a decision based on the facts presented.

Informal and formal hearing process

Before the formal hearing, you’ll take part in a prehearing settlement conference.

This is an opportunity for both parties to discuss the case along with their attorneys and reach a fair settlement agreement without a full hearing.

If a fair settlement can’t be reached, your Kansas workers’ comp case proceeds to a formal hearing.

During the formal hearing, both parties present their arguments, submit evidence, and question witnesses before the ALJ.

The judge then issues a decision as to whether the original denial is upheld or you’re entitled to compensation. 

Further appeals

If the ALJ denies your claim, you can appeal once more with the Kansas Workers Compensation Appeals Board.

You need to appeal within 10 days of the ALJ’s decision, or you’ll lose your right to do so.

If the Board also denies your claim, you can appeal to the Kansas Court of Appeals by filing a petition under the Kansas Judicial Review Act within 30 days.

The Court doesn’t reconsider factual evidence. Instead, it examines whether the decisions previously made follow state law.

If the Kansas Court of Appeals rules against you, you have one final chance to request a review by the Kansas Supreme Court within 30 days.

However, the Supreme Court only agrees to hear select cases involving significant legal issues.

At Phalen Law, our goal is to win you a suitable payout as quickly as possible. That’s usually during the informal hearing or through alternative dispute resolution such as mediation.

But we have a history of fighting cases to the Supreme Court when necessary. So when you have a Phalen Law attorney by your side, you know every effort will be made to get you the compensation you deserve.

When to hire a workers’ compensation lawyer

Knowing when to hire a workers’ comp lawyer is essential for making a successful claim.

If your injuries are minor, you have indisputable evidence, and your employer accepts responsibility on record, you might be able to handle your workers’ comp claim yourself.

But in more complex cases, you should hire a workers’ compensation attorney immediately.

Disputed injuries

Speak to a lawyer if your employer or their insurance company claims that your injury:

  • Didn’t happen at work
  • Isn’t serious
  • Is due to a pre-existing condition

Disputed claims are often denied based on technicalities or lack of clear evidence.

Your attorney will help you gather medical records, secure expert opinions, and present a strong argument that ties your injury directly to your job duties. 

Employer retaliation

It’s illegal for an employer to punish you for filing a workers’ comp claim.

But that doesn’t mean it never happens.

If you’ve been demoted, had your hours cut, or even been fired after reporting an injury, your attorney can step in quickly to protect your rights.

We can help file a retaliation claim, document your case, and ensure your employer is held accountable under state labor laws.

Large medical bills or serious injuries

When your injury requires surgery, necessitates long-term treatment, or results in a permanent disability, the financial stakes are high.

Insurance companies might try to settle for less than you need or even delay payments.

Your workers’ comp lawyer will fight to make sure you receive full medical coverage, compensation for lost wages, and, when appropriate, a fair disability rating.

We also ensure that any settlement you accept fully accounts for future treatment and ongoing care, which can be tough to estimate without experience.

By hiring a Phalen Law attorney, you can get the payout you need to make the best possible recovery without fear for your financial stability.

Tips for strengthening your workers’ comp appeal

Get a second medical opinion

If your claim was denied because the insurer’s doctor downplayed your injury or linked it to a pre-existing condition, a second medical opinion can be crucial.

Your lawyer can help you find an insurer-approved physician who understands your type of injury and is experienced in workers’ comp cases.

A well-documented independent medical assessment can carry significant weight during an appeal, especially when it directly challenges the insurer’s version of events.

Keep a detailed log of symptoms and missed work

The more evidence you can provide for how your injuries affect your quality of life, the stronger and more convincing your claim for compensation.

Document your recovery day by day, and write down:

  • Your symptoms
  • Your pain levels
  • Treatments received
  • How your injuries interfere with work or daily tasks

Also, track every day you miss work due to your injury, including part-time hours and light-duty restrictions.

These records help prove the ongoing impact of your injury and support your request for wage loss benefits or further treatment.

Organize your paperwork

Gather every document tied to your injury to submit as evidence in your favor.

This includes:

  • Your original accident report
  • Medical records
  • Test results
  • Prescriptions
  • Pay stubs showing lost income
  • Any emails or letters from your employer or their insurance provider

Keeping all this information in one place makes it easier to respond to denial reasons and build a clear, complete, and compelling appeal file.

Stay within the deadlines

Workers’ comp appeals in both Kansas and Missouri have strict deadlines that you must meet to retain your right for compensation.

As soon as you receive your denial letter, check the deadline for filing your appeal and take action immediately.

If you’re unsure of the next step, consult your attorney to avoid critical delays.

File a compelling appeal with Phalen Law

If your initial workers’ comp claim is denied, don’t give up your rightful benefits by simply accepting the decision.

Reach out to the trusted local workers’ comp attorneys at Phalen Law for support building a powerful case for compensation within the appeal deadline.

We have over 50 years’ experience in helping injured workers throughout Kansas and Missouri get the compensation they deserve for workplace injuries.

Our trial lawyers have a comprehensive understanding of workers’ comp law in both states. And we know how to defend against the strategies insurance companies use to deny or diminish your claim.

Your attorney will handle every aspect of your case on your behalf, gathering evidence and completing paperwork while you recover in peace.

And if we face a denial from an ALJ, we’re prepared to fight for your rights all the way to the Supreme Court.

When it comes to workers’ comp appeals, there really is no time to lose.

Call us now toll-free or fill out our Free Case Evaluation form online to give us the details of your case and start your appeal process as soon as possible.