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How do I know if my condition counts as a 'work-related injury'?

As we've discussed before on this blog, the Pennsylvania Workers' Compensation Act was passed in an effort to create a system that could give fair results when a worker was injured on the job, but which didn't require workers to sue their bosses.

The old system relied on personal injury lawsuits to compensate victims of workplace injuries, and it didn't work very well. Many workers couldn't obtain compensation at all because they couldn't prove their employers' negligence caused their injuries. When they could prove that, juries often awarded them so much money for pain and suffering that their employers were forced out of business.

The Pennsylvania workers' comp system was set up to end the ruinous litigation and ensure that most injured workers would be taken care of without having to prove their employers were at fault for their injuries. In exchange, workers can no longer bring personal injury lawsuits against their employers for work-related accidents and illnesses.

The result may be a better system, but many cases still involve at least some litigation. Some of the main reasons workers' comp claims are denied include:

  • The insurance company says you're not an employee but a contractor.
  • The insurance company denies your illness or injury occurred at work or during work-related activities.
  • The insurance company claims the injury was your fault.

While any of these claims by an insurer could result in a workers' comp claim being denied, that denial might be wrongful. Even if your claim was denied because the insurance company says you weren't an employee, for example, the company could easily be wrong if they have misinterpreted the law defining "employee."

Don't doubt yourself if you were hurt at work

Insurance companies deny claims all the time, and it's pretty common for them to be wrong. For example, workers' comp insurers have tried to deny claims when an employee's behavior at work wasn't perfectly safe. On the one hand, your claim would be properly denied if you intentionally inflicted an injury on yourself in an effort to obtain compensation. On the other hand, if you were injured during some ill-considered "horseplay" with co-workers, your claim is probably valid.

Most people aren't out to make a buck via self-inflicted injuries. If you were hurt while performing your ordinary job activities, you probably qualify for workers' comp -- so trust yourself and don't give up.

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