Your job is an essential part of your life. If an accident happens to you at your job, however, you may be unable to work, which means you may not be able to provide for your family. Workers’ compensation benefits are supposed to be there to provide you with medical coverage and lost wages during such times.
Small issues, however, can lead to a denied workers’ comp claim — and stop those benefits from getting to you. However, a denied claim does not mean that you’re actually ineligible. Below, you can learn about some of the common reasons a workers’ comp claim may be denied and how you can avoid or overcome those issues:
Understand why your claim was denied
There are many common reasons why a workers’ comp claim would be denied. Your claim could be denied for the following reasons:
- Missed deadlines: In Pennsylvania, the deadline to report your injury to your employer is within 120 days from the date of the accident. If litigation is necessary, you must also file any necessary petition within 3 years from the date of the accident. Missing these deadlines can prevent you from obtaining benefits.
- Medical examination and treatment: You often must seek a medical examination after a workplace accident. A doctor can make a report on your injuries and provide you with an initial diagnosis and treatment plan. However, a claim could be denied if you do not seek treatment from an approved doctor. The rules about panel physicians are tricky and not well-understood by most people, either employees or employers.
- Non-work-related injury: You would not be eligible for benefits if you were injured outside of the course and scope of your employment. Your claim could be denied if your employer suspects your accident happened off the clock. However, some off the clock injuries are in fact compensable. You need to consult with a certified workers’ compensation specialist to be sure.
You may receive a denial letter shortly after you put your employer on notice of a work injury. It is important to understand why a claim was denied before filing an appeal. Sometimes a denial happens because of a small mistake that can be easily fixed. However, you may need to seek professional legal guidance to help ensure that your claim is approved, or you might need to go to court to force the issue. Either way, contact a certified specialist workers’ compensation attorney so that you can understand all of your rights and options.