If you receive an injury while on the job, you are typically eligible for workers’ compensation benefits. These help to cover medical costs and loss of pay due to missed work.
However, the employer or insurer may deny the claim, and there are various reasons why that may be. If you feel you have a right to compensation, there is an appeal process you can go through.
Common reasons for denial
According to FindLaw, there are various reasons why there may be a claim denial. Two have to do with informing the employer of the injury and with filing the claim. In Pennsylvania, the employee must inform the employer of the injury as soon as possible, but definitely within 120 days of the incident. The employee must also file the workers’ compensation claim by a specific deadline.
This insurance does not cover every injury that occurs at work. If the injury happened while the employee was performing something outside of their scope of work, there may be a denial. Employers can also deny coverage for injuries caused by horseplay, alcohol use or self-infliction.
The insurer may deny the claim if it deems the injury or condition was pre-existing. It can also deny the claim if there is no need for medical treatment or if the employee did not attend required medical appointments.
Appeal process
The Pennsylvania Department of Labor and Industry, Bureau of Workers’ Compensation discusses the appeal process. You can contest the denial by filing a petition, and you must file it by the deadline stated in the denial letter. You and your employer will testify in front of, and present evidence to, a worker’s compensation judge. Prepare to present medical evidence and any other relevant documents, and you can also present witnesses that back up your claim.
