Certified Workers’ Compensation Specialist*

Certified Workers’ Compensation Specialist*

Why are workers’ compensation claims denied?

When you’re hurt on the job, one of the things you should be able to do is file a claim with your employer for workers’ compensation coverage. At the very least, this coverage normally covers your medical care and the costs associated with it. If you need to miss time from work and miss several days, then you may be able to get compensation for your lost wages as well.

Unfortunately, not all injury claims are approved. There are times when legitimate workers’ compensation claims are denied leading to workers who have to fight to get the benefits that they are entitled to.

Why would a legitimate workers’ compensation claim be denied by the insurer?

There are a few reasons why a workers’ compensation claim would be denied by an insurer. These reasons might include that:

  • The insurer, or your employer, have stated that they don’t think the injury happened at work or while you were performing your job. As a result, you would not be eligible for workers’ compensation
  • You were reckless and caused your own injuries due to impairment. If you were on drugs or impaired by alcohol, your claim may be nullified
  • You didn’t file your claim for compensation quickly enough. The Pennsylvania Workers’ Compensation Act requires you to report your injury to your employer within 21 to 120 days depending on the circumstances. Then, you have up to three years to make your workers’ compensation claim before reaching the statute of limitations
  • You didn’t need medical attention. If you got hurt but didn’t need medical care, then you wouldn’t have a claim for your injury because you’d have no financial losses

These are just a few reasons why your workers’ compensation claim could initially be denied. You have the option of appealing that denial and asking that the workers’ compensation insurance provider reconsiders the case. You may want to look into providing additional information to the insurance provider, or you may need legal assistance to fight against an employer or insurance company that is claiming your injuries don’t qualify for the benefits that you should receive.