Common reasons that workers’ comp claims are denied

Unfortunately, it is often not easy to secure workers’ compensation benefits here in Pennsylvania. Since your employer’s workers’ compensation insurance provider makes money by limiting the amount of money it pays out, claim denials are not surprising.

There are several common reasons that your employer or its insurance carrier may deny your claim for workers’ comp. benefits:

• Insufficient medical evidence: When you are hurt on the job, it is important that you seek medical treatment. You cannot simply tell your employer that you were hurt and cannot work. You will have to provide evidence of treatment and proof of the severity of your injury.
• Missed deadlines: You will need to report your injury to your employer and file a claim for workers’ comp. benefits within a specific amount of time to qualify. A missed deadline can greatly harm your claim.
• Injury not work-related: Your employer may question if you even sustained the injury at work. For instance, if you fall off a ladder at home or hurt your back playing pickup sports with friends and have to miss work, you cannot claim it is work-related.
• Injury not covered: Even if you sustained the injury at work, your employer may try to claim that the injury was your fault, because of not following procedure, through horseplay or because you were working under the influence of drugs or alcohol.
• Injury not severe enough: Your employer may try to claim that the injury does not warrant missing work. Again, this is why it is important to have proper medical evidence when filing a workers’ comp. claim.

If your employer or its insurance company denies your claim, it is not the end of the road. Pennsylvania law allows for a multi-level appeals process. While it may seem frustrating at times, do not give up hope. Instead, contact an experience attorney who understands Pennsylvania’s complex workers’ comp. laws and how to help you navigate them and prepare a strong appeal. It could make all the difference.