Cause for Denial
March 5, 2019
Most employees in Pennsylvania are entitled to workers’ compensation. Under the Pennsylvania Workers’ Compensation Act, they may be eligible for several benefits to help pay for the work injury or illness, including compensation for medical expenses and lost wages.
However, employers may deny workers’ compensation claims for many reasons. The most common reasons for denial that our Philadelphia workers’ compensation lawyers have seen include:
- Injury is not compensable: To be compensable under the Act, an injury must have been sustained while the employee was within the course and scope of their employment. If the injury occurred outside of work, an employer may deny the worker benefits. While the workers’ compensation system is no-fault, there are some things that may render an employee ineligible for benefits, such as if they were engaging in horseplay, ignored safety procedures, or were under the influence of drugs or alcohol at the time of the accident.
- Insufficient information: The report should include pertinent details, such as when and where the accident occurred, whether there were any witnesses, and what injuries were sustained. Employers may be skeptical if there were no witnesses to the accident or if the proper information was not included on the required forms.
- Not an eligible employee: Some employees are not eligible for state workers’ compensation benefits, including federal workers, railroad workers, longshoremen, and sole proprietors. However, they may be able to receive alternative forms of benefits, such as those established under the Federal Employers Liability Act of 1908.
- Outside the reporting deadline: Injured workers should report their injuries to their employers as soon as possible, but the Act states that injuries must be reported within 120 days of the incident. Those who fail to report their injuries within the 120-day limit may be rendered ineligible for benefits and therefore denied.
- Pre-existing condition: Employers will often try to deny claims involving pre-existing conditions. However, this is not a valid cause for denial; pre-existing conditions are covered under the Act if the condition was worsened by the employee’s work activities or environment. Common pre-existing injuries include arthritis, back injuries, knee injuries, and broken bones or fractures.
- Suspected fraud: If the employer’s investigation reveals information counter to that provided by the employee in their report, the claim may be denied. An employer may also have contradicting video surveillance, written statements from co-workers, or witness accounts.
What to Do If Your Workers’ Compensation Claim is Denied
In Pennsylvania, employees have several rights to appeal a denied workers’ compensation claim. However, specific timelines and procedures must be adhered to. Therefore, it is advisable to consult with a qualified attorney who can help to navigate the complex appeals process and increase the chances of a successful appeal.
Reading Workers’ Compensation Lawyers at Larry Pitt & Associates, P.C. Help Workers Appeal Denied Claims
If your employer denied your workers’ compensation claim, contact a Reading workers’ compensation lawyer at Larry Pitt & Associates, P.C. An initial denial does not mean you are permanently barred from receiving benefits; you have the right to appeal. Our experienced attorneys can help you receive the benefits you deserve. For a free, confidential consultation, please complete our online contact form or call us at 888-PITT-LAW.
Located in Philadelphia, our team provides skilled representation to those residing in and around Pennsylvania, including Abington, Ambler, Ardmore, Bala Cynwyd, Bensalem, Clifton Heights, Crum Lynne, Darby, Downingtown, Doylestown, Drexel Hill, Essington, Folcroft, Glenolden, Haverford, Havertown, Holmes, Kutztown, Lansdowne, Media, Merion Station, Morton, Narberth, Norristown, Norwood, Philadelphia, Prospect Park, Quakertown, Reading, Roxborough, Sharon Hill, Upper Darby, West Chester, and Wynnewood.