What Are Your Chances of Winning a Workers’ Comp Denial in Massachusetts?

Workers’ Compensation is common after workplace injuries and mishaps. While Workers’ Compensation covers a wide variety of employees and injuries, not all injured workers are approved.

If your claim for Workers’ Compensation is denied, you may appeal the denial, but your odds of success vary depending on your circumstances. To determine the likelihood of your success when appealing a denied Workers’ Compensation claim, we should first figure out why you were denied. Often, a denial results from a simple mistake that can be corrected through the appeals process. Other times, insurance companies might incorrectly believe your injuries are related to a pre-existing condition or that your accident is not covered. To improve your odds of winning your case, we should have reasonable explanations for possible mistakes and evidence of your injuries and how the accident happened.

To book an appointment for a free case review at the Law Office of John J. Sheehan, call our Massachusetts Workers’ Compensation attorneys at (617) 925-6407.

Your Odds of Winning Your Workers’ Compensation Denial Case in Massachusetts

It is difficult to say how likely you are to win an appeal on a denied Workers’ Compensation claim without evaluating your unique situation. Claims are sometimes denied because of minor filing mistakes or clerical errors. Cases like these are often easily fixable, and your odds of success might be higher.

Unfortunately, many denied claims are the result of more complex issues. For example, your employer might request that you are evaluated by a doctor they select. That doctor might confuse your injuries for a pre-existing condition and submit their erroneous findings to the insurance company. As a result, your claim might be denied. We can file an appeal and have you evaluated by a different doctor who can verify that your injuries are unrelated to a pre-existing condition.

Your odds of winning also depend on what kind of evidence our Boston Workers’ Compensation attorneys have to support your claim. For example, perhaps your claim was denied due to a filing mistake, but we do not have evidence of the mistake. This is not uncommon when the mistake is the fault of the insurance company rather than the claimant. Convincing an insurance company that they messed up is rarely easy, and your odds of success might not be as good as you would want.

Why Your Workers’ Compensation Claim Was Denied in Massachusetts

While there might be various reasons for a denied claim, some common reasons include mistakes, pre-existing conditions, and disputes over coverage. Bear in mind that some reasons for a denied claim are easier to appeal than others, but that does not mean difficult claims are invalid or impossible to resolve.


Mistakes and errors are one of the most common reasons for denied claims. Filing mistakes might be the fault of the person submitting the claim or the insurance company. For example, someone submitting a claim might mistakenly leave out crucial information about the accident, leaving the insurance company with no other option than to deny the claim. Alternatively, the claimant might do everything right, but the insurance company denied the claim because of a clerical error.

Your odds of success here depend on what kind of mistake led to the denial of your claim. Minor clerical mistakes can often be resolved by following paper trails to where the mistake occurred. As such, they might easily be fixed.

Pre-Existing Conditions

Often, a pre-existing condition makes a person more vulnerable to injuries from an accident on the job, thus making overall injuries and damages even more severe. However, pre-existing conditions might be entirely separate from the injuries sustained at work, and insurance companies will deny coverage for injuries that they do not believe were caused by a workplace accident.

Perhaps your claim involves a back injury at work, but you already have a pre-existing back injury. The insurance company might try to deny your claim because they believe your pain is solely from your pre-existing condition and not the accident at work.

Your Accident is Not Covered

Claims are usually covered if the accident happened at work and within the scope of your job duties. The insurance company might deny a claim if they have reason to believe the accident was not work-related.

Often, claimants run into trouble when their claims involve accidents outside the workplace but are still work-related. For example, a worker that travels for work and is injured on their way to the airport might have trouble getting a claim approved. We need evidence showing that you were on the job during your travels and your accident should be covered.

How to Increase Your Chances of Success in a Massachusetts Workers’ Comp Denial Case

Once we understand why your Workers’ Compensation claim was denied, we can prepare for your appeal in a way that maximizes your chances of success. We should be prepared to explain why the denial was wrongful or incorrect and provide evidence that supports your claim for compensation.

Reasonable Explanations for Errors

If mistakes or errors played a role in why your claim was denied, we should be prepared with reasonable explanations for the mistakes. For example, suppose the insurance company denied your claim because it was filed too late. Next, suppose the claim was filed on time, but there was a mistake made when your claim was processed, and the insurance company mistakenly believed it was filed on the wrong date.

We should be able to explain how the mistake might have happened and provide evidence that your claim was filed on time. Often, there is a paper trail and time stamp that can help us establish when your claim was filed.

Evidence of Your Injuries

We should also be prepared with evidence of your injuries. This is important if your claim was denied because the insurance company does not believe your injuries prevent you from working. Not only can we explain how your injuries interfere with your ability to work, but we can also present your medical records as solid proof of the severity of your injuries.

Evidence of the Accident

The insurance company might believe your accident is not covered because they do not think it was work-related. We can use certain records from your job, such as records regarding job descriptions and assignments, to show that you were on the job when your accident happened.

We can rely on your own testimony and even testimony from coworkers to prove that you were in furtherance of your job duties when your accident happened. We might also use things like security camera footage to show where and how the accident happened, especially if you were not in your office or workplace at the time.

Contact Our Massachusetts Workers’ Compensation Attorneys to Fight Your Denial

To set up a date and time for a free case review at the Law Office of John J. Sheehan, call our Cambridge Workers’ Compensation lawyers at (617) 925-6407.