What does Accepted Claim mean?
An accepted claim, also referred to as an admitted claim, is a work injury claim which the claims administrator agrees is covered under the employer's workers' compensation insurance. Workers' compensation is provided to some qualifying employees who have been injured in the course of their employment while performing their normal job duties.
The most common accepted claims include overexertion from pulling, lifting, pushing, holding, carrying, slips and falls, falling from ladders, highway incidents, being struck by an object, machinery accidents, repetitive motion accidents, and assaults and violent acts perpetrated by other employees or employers.
Occupational diseases may also be covered under workers' compensation and can include certain lung diseases, carpel tunnel syndrome, or pathological conditions of the neck, back, shoulder, hip or knee.
Accepted claims are reviewed by the insurance company and may eventually be denied. The time allowed to review previously accepted claims varies by state. Accepted claims may also be delayed while the insurance company conducts an investigation or reviews medical evidence related to the workers' compensation case.
There are several reasons an accepted claim may be denied. For instance, claims may be denied if the worker did not file the injury report within a specified period of time, the accident or injury did not occur at work, the claim is not severe enough or the injury was determined not to be work-related.
If the accepted claim is denied, the insurance company is supposed to send a letter detailing why the claim was denied. Unfortunately, some employers or insurance companies will deny valid workers' compensation claims to ensure their liability and insurance costs remain low. If the accepted claim is denied you have the right to consult with a work comp lawyer.