Why are Workers’ Comp Claims Denied in Pennsylvania?

plank-dennis-Lancaster-County-PennsylvaniaBy Dennis L. Plank, Attorney

Some jobs are more dangerous than others, but injuries can happen in the workplace, no matter what type of work you do. Most often, when we think of workplace injuries, we think of accidents on the job, but you can also develop injuries over time or illnesses related to your work environment. Fortunately, there is workers’ compensation, a type of insurance that offers benefits to those who suffer workplace injuries.

Each state has different workers’ comp laws. If you’re employed in Lancaster County, you are protected under the Pennsylvania Workers’ Compensation Act, which requires 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.

In 2018, 8,660 workers’ compensation claim petitions were filed in Pennsylvania. However, every year many claims in Pennsylvania are denied. An experienced workers’ comp lawyer can guide you through the claims process and help you avoid the common pitfalls that can result in a denied claim.

Your Workers’ Comp Claim Was Denied Because You Didn’t Report the Injury Immediately

Pennsylvania requires you to report a work-related injury within 120 days of the date of injury to receive workers’ compensation benefits. To ensure you receive the maximum compensation for medical bills and lost income, it’s best to report an injury immediately. Reporting an injury as soon as it occurs establishes a foundation for your case. Waiting any amount of time to report a workplace injury could give your employer reason to doubt that the injury happened at work. More importantly, waiting to report an injury could have serious medical consequences.

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What seems like an innocent bump on the head or simple sore back could develop into something more significant and costly down the road, when proving how it occurred becomes more difficult. There is more leeway in reporting 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 fail to meet the reporting deadline, you may still be able to collect workers’ compensation if you have witnesses, if your employer was aware of your injury, if you were incapacitated and unable to file a report, or if your employer didn’t post notices about workers’ comp rules.

Accounts of Your Workplace Injury are Inconsistent

An insurer may deny your claim if your statements about the injury are inconsistent or if your version of what happened differs from accounts given by witnesses, co-workers, supervisors, or medical professionals.

Always make sure you are consistent when discussing the details of your injury, whether you are talking to your employer or your doctor. If you feel others are deliberately misrepresenting your injury or that you are being treated unfairly consider seeking the advice of an experienced workers’ compensation attorney. Contact the Law Offices of Going and Plank for a free consultation.

You Filed A Claim After Termination

Another reason to report a work-related injury immediately is to avoid the possibility that you will be fired or laid off before filing your claim. Insurance companies often deny claims filed after termination because they view them as an attempt at revenge. Of course, some employers may try to avoid a claim by firing you because you were hurt on the job.

While some employers legitimately terminate employees for reasons unrelated to their work injury, it is illegal to fire an employee because they were injured at work or because they filed a worker’s comp claim. Seek the advice of a workers’ comp lawyer if you feel you were fired due to your injury.

You Lacked Witnesses to Your Workplace Injury

It’s much easier for an insurance company to question the location of your accident if no one else saw it happen. That’s why an insurer will often deny a worker’s comp claim when there are no witnesses. If you had an accident on the job when no one is around, you can still build a workers’ compensation case if you tell your supervisor and co-workers immediately, if you have witnesses who saw you before and after the injury, or if you had to leave work to seek medical attention.

You Refused to Issue a Recorded Statement

When you suffer a workplace injury, your employer may ask you to make a recorded statement for the insurance company. While these statements are often simple, straightforward accounts of how the injury occurred, they are sometimes a means for the insurance company to avoid paying benefits. During a recorded statement, an insurer may ask leading questions designed to elicit inconsistencies about the nature or cause of the injury or details about past medical problems, all in an effort to deny your claim.

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Although you are under no legal obligation to make a recorded statement or answer invasive or leading

questions, insurance companies can use your refusal as a basis for denying your claim. It may seem like a no-win situation, but an experienced workers’ comp attorney can help. A request for a recorded statement may indicate that the insurer is looking for a reason to deny your claim. Never agree to a recorded statement without first consulting a lawyer.

Illegal Drugs Were Detected in a Medical Exam

Some employers may require a drug test for illegal substances when a workplace injury occurs. An insurance company may deny your claim on the grounds that drug use led to an increased chance of an accident. Under Pennsylvania law, if an employee’s intoxication or illegal drug use is the sole cause of a workplace injury, then the employee is not eligible for workers’ compensation benefits. However, an employer must have reasonable cause to request a drug test following a work-related accident. If your claim was denied due to illegal drug use, you may still have options, especially if the injury would have occurred regardless of impairment.

If your workers’ comp claim has been denied, don’t lose hope. In many cases, a qualified attorney can get you the compensation you deserve. Going and Plank has decades of experience handling workers’ comp cases. Contact us today for a free consultation to review your case. It could be your first step toward a settlement that protects you from financial hardship.

Want to learn more about how to deal with denied Workers’ Compensation claims? Check out these blogs.

5 Common Reasons Workers’ Comp Claims are Denied

Denied Workers’ Comp Claims

9 Important Facts About Workers’ Comp

Why are Workers’ Comp Claims Denied in Pennsylvania?

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Theresa Wagner

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