What Are the Odds of Winning a Workers' Comp Case?

If you’ve filed — or are getting ready to file — a workers’ comp claim, it’s likely that you have concerns about winning benefits. Many disability benefits programs can be difficult to get approval for, and injured workers often think workers’ comp will be similarly challenging. 

The good news is the odds of winning a workers’ comp case are higher than you might think. To help you understand what to expect, we’ll walk you through your odds of winning, what to do if your case gets denied, and how a good lawyer can make a difference for your case. 

The odds of winning a workers’ comp case

The odds of winning a workers’ comp case are actually quite high. Roughly 50-90% of workers’ comp claims get approved, but your chances of approval vary depending on which state you live in. Several factors influence a state’s approval rate for workers’ compensation, including the size of the jurisdiction, the leading industries in the state, the medical review processes in place, and the type of injury or illness you experienced.

In California, for example, approval rates are as high as 94.1%, following recent legislative changes that improved the medical review process. The approval rate in Oregon is slightly lower, but 86-89% of claims were approved in 2022 and the number of denials is decreasing. In New York, the Workers’ Compensation Board targets a 90% approval rate.

On the other side of the spectrum, Massachusetts only approves about half of workers’ comp claims since employers and insurance companies often dispute the claims. Approval rates also depend on several other factors, including the type of injury or illness. For example, Ohio only approved 51% of COVID-19 claims made to self-insured employers in 2022. 

What to do if your workers’ comp claim is denied

Many workers’ comp claims are denied for reasons unrelated to the case. The National Institutes of Health found that the majority of claims that get denied are denied because either the worker or their medical provider had incorrect information for the workers’ comp insurance carrier. 

If you do get denied, your state will have an appeals process you can go through to try and reverse that decision. That process is slightly different in every state, but you can generally expect to:

1. Find out why you were denied. It is important to understand why your application wasn’t approved. States deny workers’ comp claims for a variety of reasons and knowing what happened will help you understand your appeal options. 

2. Submit an appeal form or application. Most states need a form to initiate your appeal. In Pennsylvania, for example, it’s submitting Form LICB-2526 either online or by mail, while California residents will need to deliver an Application for Adjudication of Claim to their county office. 

3. Attend a hearing. Most states have an appeals board. You will likely have to appear for a hearing to explain why you qualify for workers’ comp benefits. Some states, like California, require additional paperwork to request this hearing. 

4. Get a decision. The appeals board will either approve or deny your appeal. If you get approved, you can start collecting benefits. If you get denied at this stage, that’s considered the final decision on your case.

Get help winning your workers’ comp case

If you’re injured at work, you’re entitled to wage replacement and medical care. But getting approved isn’t always easy. Even if you live in a state where the odds of winning your case are high, the best way to get relief quickly is to submit your claim on time with thorough and accurate documentation.

Many injured workers find that working with a lawyer is the best way to keep the process on track. If you’re struggling to understand the application process, your employer or the insurance company aren’t cooperating, or you need help making sense of your denial, a lawyer’s guidance and expertise can make all the difference. 

If you’d like help finding a qualified workers’ comp lawyer, start with our 2-minute workers’ compensation quiz. We’ll help review your case and, if you’re eligible, we can quickly match you with an experienced lawyer who will treat you with respect. You won’t pay your lawyer unless you win your case, and it’s ultimately up to you whether you work with one of our lawyers.

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Related resources:

What Is Workers' Comp & How Does It Work?

By Victoria Muñoz

What to Do if You're Injured at Work

By Victoria Muñoz