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Reasons for a denial of your workers’ comp claim

On Behalf of | Oct 6, 2023 | workers' compensation |

Workers’ compensation serves as a safety net for employees who suffer injuries or illnesses in the workplace. It provides financial support and covers medical expenses for those affected.

However, providers of workers’ compensation sometimes deny claims, and understanding the reasons behind a denial can help you access the compensation you deserve.

Failure to report the injury

One of the most common reasons for claim denial is the failure to report the injury promptly. For example, Pennsylvania workers must make an injury known to their employers within ten days of it occurring. Delaying the reporting of an injury can make it difficult for employers and insurance companies to investigate the incident properly.

Lack of medical evidence

To support your workers’ compensation claim, you must provide adequate medical evidence of your injury or illness. If your medical records do not clearly document the extent of your injury or its connection to your work, the insurer may deny your claim. That is why you should seek immediate medical attention after an injury and follow your doctor’s advice to ensure proper documentation.

Pre-existing conditions

Workers’ compensation covers new injuries or illnesses that occur because of your job. If you have a pre-existing condition, it can complicate your claim. Insurance companies may argue that your condition existed before the workplace incident and was not caused by your job. Accordingly, it is important to establish a clear link between your job and the new injury to avoid denial.

Injuries outside of work duties

You may also receive a denial of your workers’ compensation claim if the injury occurred while you were not performing your job duties. If you were participating in personal activities or violating workplace policies at the time of the injury, the insurance company may question the validity of the claim.

Disputes over the cause of the injury

Sometimes, employers and insurance companies dispute the cause of the injury or illness. They may argue that your condition is not work-related or that it occurred due to your own negligence. You must provide clear and consistent information about how the injury happened and gather witnesses who can support your claim.

As reported by the Pennsylvania Department of Labor & Industry, the Bureau of Workers’ Compensation received 167,254 injury and illness reports in 2022 alone. Following pertinent rules and guidelines when making a report can ensure a timely receipt of important funds.

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