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Unveiling the why behind workers’ compensation denials

On Behalf of | Aug 9, 2023 | Workers Compensation

Suffering a work-related injury can be a daunting experience, especially when you’re counting on worker’s compensation to provide the necessary support during your recovery. However, it’s essential to be aware that not all claims are approved.

Here’s what you should know about some of the most common reasons why your workers’ comp claim might be denied in Pennsylvania and how you can proceed with your claim.

Failure to report promptly

One of the leading causes of denied worker’s comp claims is the delay in reporting the injury to your employer. Pennsylvania law requires injured workers to report their injuries within 120 days of the incident. Failing to do so could lead to a claim denial, as the employer might argue that the injury occurred outside of work.

Lack of medical evidence

Proper medical documentation is crucial when making a worker’s comp claim. If your medical records don’t clearly connect the injury to your work activities, the insurance company might question the validity of your claim. You should seek medical attention promptly and provide accurate information about the incident to your healthcare provider.

Pre-existing conditions

You may face denial of your claim if the insurance company believes your injury was pre-existing or not directly caused by your work. It’s important to be transparent about any pre-existing conditions you have that might have been aggravated by your work activities. Medical evaluations and professional opinions can play a vital role in proving the connection between your job and the injury.

Disputes over the cause of injury

In some cases, employers or insurance companies may dispute whether the injury actually occurred at the workplace. This is where clear documentation and eyewitness accounts become crucial. Reporting the injury to your supervisor immediately and having colleagues who can testify on your behalf can strengthen your claim.

Missed deadlines

Apart from the initial reporting deadline, Pennsylvania also has a statute of limitations for filing worker’s comp claims, which is generally three years from the date of the injury. Failing to file within this timeframe can result in a denied claim.

Not following medical advice

If you refuse or fail to follow the prescribed medical treatment for your injury, the insurance company might argue that your actions contributed to the severity of the injury or prolonged your recovery. This can lead to claim denial or a reduction in benefits.

Navigating Pennsylvania’s worker’s comp claim process requires attention to detail, promptness and adherence to guidelines. Awareness of the common reasons for claim denials can help you take the necessary precautions to ensure your claim is approved. If your claim does get denied, remember that you have the right to appeal the decision. Working with a skilled professional who can help you present a strong case and make any appeals is important.