Why Michigan workers' comp claims get denied
Insurance carriers deny or terminate workers' comp claims for a handful of predictable reasons. Most of them are contestable:
The most common denial reasons
- Injury is not work-related. The carrier argues the injury happened somewhere else, or that a pre-existing condition explains the symptoms.
- Late notice to employer. The carrier claims you didn't report the injury within the 90-day window under MCL 418.381.
- Gap in medical treatment. Any period without documented care becomes a talking point.
- Independent medical exam (IME) opinion. A hired IME doctor releases you to full duty or says the disability isn't work-related.
- Alleged intoxication or safety violation. Uncommon, but always investigated when a positive drug test or safety report exists.
- Ability to work "reasonable employment." The carrier claims you can perform some other job within your restrictions.
The appeal path: mediation → trial → appellate review
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1
Application for Mediation or Hearing (Form WC-104A). Filed with the Workers' Disability Compensation Agency. Identifies the parties, the injury, the benefits sought, and puts the WDCA on notice that you're pursuing the claim.
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2
Mediation. A WDCA mediator holds an informal settlement conference. Many cases resolve here. If not, the case goes to trial.
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3
Pre-trial and medical depositions. Both sides depose the treating doctors and IME doctors. The medical record is where the case is usually won or lost.
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4
Trial before a Workers' Compensation Magistrate. A one-day (typically) evidentiary hearing at a Board of Magistrates hearing site. Live testimony, exhibits, and argument. The magistrate issues a written opinion.
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5
Michigan Compensation Appellate Commission (MCAC). Either side can appeal the magistrate's decision to the MCAC, which reviews for legal error and factual support in the record.
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6
Michigan Court of Appeals. Discretionary review is available from an adverse MCAC decision, and Michigan Supreme Court review may follow in rare cases.
What to do the moment you receive a denial
- Do not stop treating. A gap in medical care is the single most damaging thing you can do to a workers' comp claim. Use your own health insurance if you have to — and put the workers' comp carrier on notice that you're doing so.
- Save the WC-107 denial notice. The stated reason for the denial defines the fight to come.
- Preserve evidence. Photos of injuries, incident reports, texts with your supervisor, witness names, and any surveillance the employer may have.
- File the WC-104A immediately. Every month you wait to file caps another month of back benefits under Michigan's 2-year-back rule.
- Talk to a workers' comp lawyer. Statutory attorney fees mean nothing out-of-pocket. Once the case is contested, the insurer will have counsel — you need to as well.
Retaliation is illegal
Under MCL 418.301(13), it is unlawful for an employer to discharge or discriminate against an employee for filing a workers' comp claim, testifying, or exercising rights under the Act. If you're demoted, fired, or harassed after filing, that's a separate civil claim on top of your workers' comp case.
Got a denial letter?
Call Jay Trucks & Associates. We'll review the WC-107, pull the medical record, and tell you exactly how to fight the denial — free of charge and with zero obligation. Attorney fees are set by statute and only paid out of benefits we recover.