By Dennis Plank, Attorney
When a person is hurt on the job, the pain and suffering can extend beyond the injury itself. Injured employees may have to cope with lost wages, large medical bills, and the stress of supporting a family. While most Lancaster County workers who suffer injuries on the job qualify for compensation under the Pennsylvania Workers’ Compensation Act, some employers choose to lawfully or unlawfully deny compensation. PA law 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, but it also allows employers to refuse claims in some situations.
Additionally, injured employees often find the workers’ compensation claim process complicated and time-consuming. Some employers take advantage of employee error and deny claims. However, an experienced workers’ compensation attorney can often appeal a denied claim and get it approved. In this article, we’ll explore some common reasons for denied claims and discuss how a workers’ comp lawyer can help.
Workers’ Comp Claim is Denied Because of a Missed Deadline
In Pennsylvania, employees must report a work-related injury to employers within 120 days of the date of injury to receive workers’ compensation benefits. Additionally, if an employee is suffering from a work-related condition or illness that occurs over time, the law requires that this condition must be reported to the employer within 120 days of the diagnosis if workers’ compensation is sought.
It’s always smart to report an injury as early as possible in order to give the employee the best chance for maximum compensation for medical bills and lost wages. It’s smart to put the report in writing, describe the injury, and note when and where it occurred. Submit one written copy to the employer and keep a personal copy.
Even if an injured worker misses a deadline, they may be able to appeal a denied claim. Exceptions may be made if the employer was already aware of the injury, if the employee was incapacitated and unable to notify the employer on time, or if the employer did not clearly post workers’ comp rules. A workers’ comp lawyer can determine if the employee qualifies for an exception in Pennsylvania.
Errors in Paperwork or the Filing Process
Filling out and filing a workers’ comp claim involves a lot of documentation and detailed record keeping. It’s easy to make mistakes. Because many workers’ comp insurance companies look for ways to avoid paying benefits, they often deny claims as a result of paperwork errors.
However, injured workers can appeal. An experienced workers’ compensation lawyer can file a claim petition, get documentation, obtain medical records, gather testimony, and prepare the evidence necessary to appeal a claim before a workers’ compensation judge.
No Witnesses to the Injury
Workers’ compensation insurance companies prefer eye-witness accounts of an injury and sometimes deny workers’ comp claims because no one saw the accident happen. The insurance company may suggest that the accident never happened or deny the claim because it might have happened outside the workplace.
However, in some cases, a workers’ compensation attorney can successfully appeal a denied claim if they can prove the employee told a coworker or supervisor about the injury, if people saw the employee at work before or after the accident, or if the injured employee left work to seek medical attention. Every case is different, so it’s smart to consult with an attorney.
Claim Denied After Termination
Some workers’ comp insurance firms choose to deny claims filed after an employee leaves a company, claiming that the filing is unfounded or based on revenge. However, these employees have options. A workers’ compensation attorney can gather eye-witness accounts and medical evidence to support the workers’ comp claim.
It’s important to note that employees who quit may not qualify for benefits covering lost wages since they gave up their wages voluntarily.
It’s also important to remember that it is illegal to terminate an employee for reporting a workplace injury. While Pennsylvania is an at-will state, meaning an employer can fire an employee at any time and for any reason, workers who believe they have lost their job because they reported an injury should contact a workers’ compensation lawyer immediately.
Doctor Will Not Classify Injuries as Work-Related
In Pennsylvania, workers’ compensation laws require injured employees to seek treatment from employer-approved physicians within the first 90 days. Insurance companies could deny a claim if that doctor reports that the injury occurred outside the work environment or that the injury happened because of a preexisting condition.
However, some injuries incurred outside the workplace do qualify for benefits. Injuries sustained while traveling to a remote worksite, while working from home, while traveling for business, or while making deliveries for an employer can all qualify for workers’ compensation.
Even with preexisting conditions in place, if the work-related activity resulted in a new injury, a workers’ compensation lawyer can help prove that the injury qualifies for workers’ comp coverage.
Get Experienced Legal Representation
Lancaster County employees who are denied workers’ compensation benefits should consult with an experienced attorney. The Law Offices of Going and Plank in downtown Lancaster can help. We help clients meet deadlines, secure evidence, and document testimonies to ensure maximum benefits. Contact us today for a free consultation to review options for an appeal.
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