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Q: I was hurt at work. Why was my workers’ compensation claim denied?

A:

While it would be nice if workers’ compensation claims were as simple as receiving benefits after you were hurt, it is rarely that simple. As with any insurance claim, there are important deadlines, rules, and exceptions that will determine if you will receive the benefits you are seeking.

There are several reasons why your claim may have been denied, but many denied claims share one of these common factors. This is not an exhaustive list, and an experienced Pennsylvania workers’ compensation attorney will be able to assess your case in detail in your consultation.

Denied Workers’ Comp Claim? Here’s Why You May Have Been Turned Away

After a workplace injury, you were counting on your workers’ compensation benefits to help you pay your medical bills and get by financially until you are able to return to work. Unfortunately, your employer (or your employer’s workers’ compensation insurance carrier) had different plans. You may have been turned down because:

  • Your employer or their workers’ compensation insurer made a mistake or are being difficult. Many times, employees can follow procedure by the book when it comes to reporting their injuries and filing claims, but they are still denied benefits. Whether the employer or their carrier overlooked a key detail, made a mistake, or are just trying to evade their duty, an attorney can help you appeal your denial if your case is sound.
  • You did not report your injury to your employer within the deadlines given. In Pennsylvania, you have a longer time than most to report your injury to your employer—120 days from the date of the injury. Of course, it is always advisable to report your injury immediately, as this will only help your case. If you report an injury outside of these deadlines, you will be unable to collect benefits.
  • No one witnessed your accident. Whether your witness was a coworker or a surveillance video, any proof that can verify how you became injured can help your case. If you know that your accident had no witnesses, it should encourage you to report your injuries to your employer immediately, and get prompt medical attention.
  • Your accident report or medical records were suspicious. Your employer’s workers’ compensation insurance carrier will be going through your claim with a fine-toothed comb. If your report differs from those of your employees or your doctor, or if your medical records show that you had drug or alcohol in your system at the time of the accident, it will be very challenging to get workers’ compensation benefits.
  • You refused to cooperate during the claims process. Being cautious when dealing with insurance companies is always advisable, and it is a good idea to consult with an attorney before signing or recording any statements or documents. Many times, your signature or recorded statements are not required to obtain benefits, but many insurers will use this as an excuse to deny your claim. This is usually not a valid reason to deny a claim, and an attorney can help you sort this out in an appeal.

One of your most important rights as an injured worker in Pennsylvania is your right to appeal a workers’ compensation claim denial. If you have been denied benefits for any reason, the Pennsylvania workers’ compensation attorneys can help—schedule your free consultation with us today to discuss your case.

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