5 Common Reasons Workers’ Comp Claims are Denied (and What you can do to Challenge Them.)

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By Dennis Plank, Attorney

If you work in Lancaster County and you are injured on the job, you are usually entitled to compensation under The Pennsylvania Workers’ Compensation Act. Our state laws require most employers to carry insurance that will pay benefits to cover medical bills, lost wages and possibly a lump-sum settlement to employees who are injured or disabled in connection with their job.

However, not all claims are approved upon the first submission. Some businesses and their insurance companies look for ways to save money and will sometimes deny claims based technicalities. A good workers’ comp attorney can often help you fight a denied claim to get the payments you deserve.

There are many reasons for denying a claim, but here are 5 common reasons. Take a look and let our team know if any of these apply to your case.

Did Not Report the Work-Related Injury in a Timely Manner

Even the most minor work injury, such as a bump on the head or a sore back, should be reported immediately in the event it turns out to be something more significant. In Pennsylvania, you must report your injury within 120 days of the date of injury to receive workers’ compensation benefits. However, it’s much better to report the injury within 21 days to ensure you get the maximum compensation for medical bills and lost income.

There is more leeway if a work-related condition develops over time, such as arthritis or a lung condition. Such cases should be reported within 120 days of the date your doctor diagnoses your condition and its connection to your work. Even if you miss the deadline for reporting, you may still be able to collect workers’ compensation if there were witnesses to your injury or your employer was aware of it, if you were incapacitated and unable to file a report, or if your employer didn’t post notices about workers’ comp rules. Contact Going and Plank to review your case and pursue your legal options.

Errors in the Workers’ Compensation Claim Forms

Filing a workers’ compensation claim can require significant documentation and detailed information. Many workers’ compensation claims are initially denied because they were not properly or completely documented, or because there was a paperwork error. Remember, the insurance company’s goal is to avoid paying claims if possible.

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An experienced workers’ compensation attorney can make sure your initial claim is filed correctly and give you the best chance of receiving the benefits you deserve. However, if your claim has already been denied due to a paperwork error, contact the Law Offices of Going and Plank. We can guide you through filing a claim petition and collecting the necessary documentation, medical records, testimony, and evidence necessary to prepare for a hearing before a workers’ compensation judge.

Missing Medical Information or No Accident Report

It’s important to include medical information and an accident report as evidence in workers’ compensation claims in Pennsylvania. Even if an injury seems minor, you should seek medical attention promptly. If your claim is missing the details of how the injury occurred, or a medical evaluation verifying the injury and its cause, it may be denied. Your doctor’s records should include physical limitations and work restrictions that will affect your benefits. Always indicate to medical professionals that the injury occurred at work to ensure that information becomes part of your medical records.

Did Not Complete the Required Medical Exam

As part of the investigation process for a workers’ compensation claim, an employee may be asked to take part in an independent medical examination by a doctor of the insurer’s choice. The insurer’s physician will perform a physical exam and may also order additional tests to determine the degree of injury, if the injury is consistent with the work-related accident reported, and if the treatment prescribed by the employee’s physician is appropriate.

Injured employees may be required to receive an independent medical examination once every six months to evaluate their progress and their ability to return to work. Failure to take part in these medical examinations can result in an initial denial of a claim or an end to benefits down the road. If you’ve received a request for an independent medical examination, contact the Law Offices of Going and Plank and let us ensure that your benefits are protected.

A Doctor Says Your Injuries are Not Work-Related

In Pennsylvania, injured employees must seek treatment from a list of employer-approved physicians for the first 90 days. Should a doctor decide that your injuries occurred outside the work environment or that they are the result of a pre-existing condition, your workers’ compensation claim may be denied. However, there are instances in which an injury can be considered work-related, even if it did not occur in the workplace. For example, if you were injured while traveling for work or while working from home, your injuries may still be covered under workers’ compensation. Additionally, having a pre-existing condition does not exempt an employee from filing a workers’ comp claim, especially if work-related activities resulted in a new injury.

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If You’ve Been Denied, Contact an Attorney

Getting a fair workers’ compensation settlement isn’t always automatic or easy. A claim can be denied for many reasons. If you feel there has been an error, or that your employer or their insurance company has submitted false information that may have hurt your claim, contact the Law Offices of Going and Plank in downtown Lancaster for a free consultation.

We can review your case and determine if you have additional options for pursuing your claim. Contact us today for a free consultation if you’ve been injured on the job. We can review your case and help you receive a settlement that protects you from long-term financial hardship.

Want to Learn More about Denied Workers Comp Claims?

Check out these blogs to learn more;

9 Important Facts About Workers’ Comp

Denied Workers’ Comp Claims

Why are Workers’ Comp Claims Denied in Pennsylvania?

Maggie Vergenes

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