workers comp claim denied suspected fraud Denial?
The insurance company is betting on your silence. They hope you see their "No" as final. We know better. Follow this tactical guide to force a reversal.
The Insurer's Playbook
Context: Workers' Compensation
This isn't just insurance; it's a legal system. Denials here are often about "course and scope" of employment (did it happen *at* work?) or pre-existing injuries.
Their Strategy
Attrition. They expect you to give up after the first denial letter. 40% of people do.
Your Counter-Move
Persistence. A formal, evidence-backed appeal shifts your claim from the "auto-reject" pile to "needs legal review."
Strategic Analysis
Breaking Down Your Denial
"Suspected Fraud" or SIU Investigation
WARNING: This is serious. The Special Investigations Unit (SIU) thinks you are lying.
Action:
- Cooperate fully but carefully.
- Provide all requested proofs immediately.
- If they drag this out specific timelines, consult a lawyer. Bad faith laws punish insurers for using "fraud investigations" just to delay valid claims.
The Path to Victory
Execute these maneuvers precisely. Timing is everything.
"DO NOT ignore this or delay responding - it's serious."
"Cooperate fully with documentation requests but keep copies of everything."
"Consider consulting an insurance attorney before speaking with SIU investigators."
"Gather all evidence proving the legitimacy of your claim (photos, receipts, witnesses)."
"If the investigation drags past policy timelines, file a bad faith complaint."
"Document every interaction with dates, names, and what was discussed."
The Evidence Vault
Insurance companies use "insufficient documentation" as their #1 denial loophole. Don't give them the chance. Weaponize your appeal with these files:
Activate Your Professional Appeal
Our engine will synthesize everything into a formal legal challenge. No fluff. No begging. Just the facts they can't ignore.
Generate Your Appeal Letter
Free, personalized, and ready to send
Step 1 of 4
What type of insurance denied your claim?
Select the type of insurance so we can customize your letter.
Intel Recap: Common Queries
They sent my claim to 'SIU'. What does that mean?↓
Can they ask for my personal bank statements and phone records?↓
Can a fraud investigation lead to criminal charges?↓
Integrity Officer
Sarah Jenkins, CIC
"People ask why I do this for free. It's because I spent 15 years on the other side. I know how the machine works. I know how they calculate settlements. And I know that when a policyholder fights back with the right data, the machine breaks and the policyholder wins."
Read my full story →