Prepared To Meet Your Legal Needs

3 reasons your workers’ comp claim may be denied

On Behalf of | Oct 25, 2024 | Workers' Compensation |

Workers’ compensation benefits are essential for covering medical expenses and lost wages after a workplace injury. However, not all claims are approved, leaving injured workers without the support they need. 

Understanding the most common reasons for claim denials can help you avoid mistakes and take proactive steps. If your claim is denied, knowing your options—and getting legal help—can be the key to securing the benefits you deserve.

1. Failure to report the injury on time

Most states have strict deadlines for reporting workplace injuries. In Pennsylvania, injuries that result in death must be reported by the employer to the Bureau of Workers’ Compensation within 48 hours, while all other injuries must be reported within seven to ten days. Injured workers should report their injuries to their employer (a supervisor, not a co-workers) right away, ideally within 21 days of the injury, but at a minimum within 120 days of when they knew or should have known that they are suffering from a work injury.

Missing this window can give insurers a reason to deny your claim, as they may argue the injury was not work-related or was exaggerated. Prompt reporting ensures your injury is properly documented from the start. Even if you believe the injury is minor, you should report it to a supervisor and, if available, fill out an accident report.

2. Inconsistent or incomplete medical records

Medical documentation is essential for proving the connection between your injury and your job. If your records are incomplete or contain conflicting details about when or how the injury occurred, insurers may question the legitimacy of your claim. Clear, consistent medical records strengthen your case.

3. Pre-existing conditions

If you have a pre-existing condition, insurers may claim your injury wasn’t caused by your job but was related to that condition. However, if a workplace incident aggravated or worsened your pre-existing condition, you still have a right to benefits. 

Don’t navigate the claims process alone if your workers’ comp claim has been denied. A Pennsylvania certified specialist workers’ compensation attorney can help you gather evidence, meet deadlines, and fight for the benefits you deserve. Contact our office today for a free consultation, and protect your rights.

Archives