In Pennsylvania, work-related injuries are common. I frequently hear frustrations from clients over why their claim was denied. In Pennsylvania, employers have the right to deny a workers compensation claim. They may do so for several reasons. Here is a list of the TEN most common reasons a workers compensation claim is denied.
1. Lack of witnesses. Many times a work injury occurs while an employee is working alone. Lack of witnesses to corroborate the occurrence of a work injury draws skepticism from employers and insurance carriers. There is not much you can do about it.
2. Timely reporting of an Injury. Often times, an injured worker has a ‘tough guy’ mentality when injured on the job. The injured worker may believe at the time they suffered nothing but a simple strain and the pain will just go away in a few days. Some injured workers try and just ‘gut’ through the pain. Some injured workers do not report the injury immediately out of fear for their job. Failing to report a work-related injury immediately will likely lead to the issuance of a workers compensation denial. Reporting a work injury immediately is essential.
3. Insufficient information. An insurance carrier will deny a work injury because they do not have sufficient information or documentation regarding the work injury. Sometimes, the insurance carrier or employer will deny a work injury because they had no idea a work injury even occurred. If the injured worker fails to report the injury; the employer can’t know about the injury. Frequently, the injured worker does report the injury to their supervisor, but then the supervisor never reports the injury to human resources or management. Insist on a incident report. If your employer refuses, call Mooney Law.
4. A pre-existing condition: Many employers deny claims involving pre-existing conditions. Perhaps your supervisor or co-employee knew of a prior condition. Perhaps the insurance carrier saw reference to a pre-existing condition in your medical records. Perhaps you were open and honest about a pre-existing condition (which you always should be). Perhaps you are an older worker and your employer just simply draws assumptions. The important point is that a pre-existing condition is covered under the Act if the pre-existing condition was worsened by the work injury. It won’t stop denials though.
5. Employer is simply skeptical: If the employer’s investigation reveals information contrary to the injured worker’s report, the claim will likely be denied. An employer may also have contradicting video surveillance or written statements from co-workers and /or witnesses. An employer may just have a skeptical mentality on any report of a work-related injury. This is more typical in small employers, who may not have much exposure to work-related injuries.
6. Statutory exclusion: Perhaps the employer denied the claim because they feel it falls under a statutory exclusion. These can involve horseplay that resulted in the injury, intoxication or positive drug test after the injury, personal animosity between two employees, harming oneself, and others.
7. A doctor states that an injury is not disabling. Perhaps the injured work treated with a panel physician that did not provide any work restrictions. In many of these instances, the employer may accept the injury, but only as a Medical Only, meaning, they agree to pay medical expenses, but not wage loss benefits. That can be quite confusing to an injured worker, but the employer has the right to do it.
8. Outside the course and scope of employment: The employer may believe that the injured worker sustained an injury, but not in the course and scope of employment.
9. Employee status: The employer does not consider the injured worker to be an employee. In other words, the employer classifies the employee as a an independent contractor. Often times, the employer is just plan wrong. There are statutory requirements that must be met to be an independent contractor. Legislation and case law have narrowed this classification even more so over the last several years.
10. Medical disputes. Employers will deny work injuries if injured workers do not seek medical care for the injury in a timely manner. Employers will deny work injuries if the description of how the injury occurred is different in the medical records than what was reported to the employer. Employers will deny work injuries if the medical records do not reflect an injury or change in condition. Employers will deny work injuries based on what body part was injured. Medical disputes are frequent reasons an employer will deny a work injury.
These are the top ten reasons why work injuries may be denied. These ten reasons are certainly not exclusive of all reasons.
If your work injury is denied, we can help. Injured workers have a right to appeal a denied workers’ compensation claim. There are specific procedures and timelines to appeal a denial. The best thing to do if your work injury is denied is call Mooney Law at 833-MOONEYLAW for a FREE consultation. Handling it on your own can be quite costly to you. Trust the court room experience and proven results of Mooney Law. We handle both Pennsylvania and Maryland workers compensation claims. Call today for your FREE consultation.