Avoiding Workers’ Comp Claim Denials

Under the Pennsylvania Workers’ Compensation Act (the “ACT”), most workers are eligible for workers’ comp benefits to help pay for their work-related injury or illness, including compensation for medical expenses and lost wages. However, employers may deny workers’ comp claims for many reasons. The trick is to avoid giving your employer any reason to deny your claim. Let a Lancaster workers comp lawyer at Vanasse Law LLC help.

The Most Common Reasons for Denial

To avoid the pitfalls of fighting through a denied claim, you should be aware of the most common reasons for denials. Such reasons include:

• The Injury is Not Compensable. To be considered “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. 
• Worker Behavior. While the workers’ comp system is “no-fault” (which means you have no obligation to show the employer was negligent), there are some types of employee behavior that may cause a claim denial, such as horseplay, ignored safety procedures, or being under the influence of drugs or alcohol at the time of the accident.
• Insufficient Information. Your claims paperwork should include all relevant details, such as when and where the accident occurred, whether there were any witnesses, and what injuries were sustained. It is better to be over-thorough rather than merely supplying the bare minimum.
• Not an Eligible Employee. Some employees are not eligible for state workers’ compensation benefits, including federal workers, railroad workers, longshoremen, independent contractors, and sole proprietors. However, they may be able to receive alternative forms of benefits.
• Outside the Reporting Deadline. Injured workers should report their injuries to their employers as soon as possible. The Act states that injuries must be reported within 120 days of the incident, but you should file well before that limit — preferably immediately. Those who fail to report their injuries within the 120-day limit may be denied.
• Pre-existing Condition. Employers have been known to deny claims involving pre-existing conditions, but 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 back injuries, knee injuries, arthritis, broken bones, asthma, and even chronic anxiety.
• Suspected Fraud. If the employer’s investigation reveals information that contradicts the employee’s information, the claim may be denied. Employers may even seek to back up their information with video surveillance, written statements from co-workers, or witness accounts.

If Your Claim is Denied, Call a Lancaster Workers Comp Lawyer for Assistance

In Pennsylvania, employees have several rights to appeal a denied workers’ compensation claim. Employees may also have alternative options, such as a personal injury lawsuit or a third-party claim. Still, the appeals process is complicated, and personal injury lawsuits can be quite tricky. That said, we encourage you to speak with our Lancaster workers comp lawyer as soon as possible to learn more about your rights and options under the law.

Contact a Lancaster Workers Comp Lawyer at Vanasse Law LLC for Help With Your Claim

If you are dealing with a claim denial, you do not need to handle it on your own. Contact a Lancaster workers comp lawyer at Vanasse Law LLC. Workers’ comp is what we do. Our experienced workers’ comp attorneys will help you examine your options and file any claims that are required.

If you have suffered a work-related injury or illness, contact us online for a same-day response.