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4 reasons workers’ comp may deny your claim

On Behalf of | Jun 17, 2024 | Workers' Compensation |

In Pennsylvania, navigating the workers’ compensation system is complex and frustrating. It becomes more challenging when your claim gets denied. Understanding the common reasons for denial can help you address potential issues proactively and improve your chances of a successful claim. 

1. Late reporting

Timeliness is everything in workers’ compensation claims. Employees must report any workplace injury or accident to their employer as soon as possible. Pennsylvania law requires that this report happen within 21 days of the accident to ensure full benefits, although it must be reported within 120 days to be eligible for any benefits. Failing to report within this timeframe can jeopardize the ability to receive workers’ compensation benefits.

2. Lack of witnesses

Claims can be denied if there are no witnesses to corroborate your injury. While not always necessary, witness statements can strengthen your case by providing independent verification of the incident. Detailed documentation and immediate medical reports become even more critical when injuries occur without witnesses.

3. Discrepancies in your story

Inconsistencies in your account of the injury can lead to denial. If your description of the incident changes over time or conflicts with medical records or witness statements, the insurance company might question the legitimacy of your claim. 

4. Pre-existing conditions

If the insurance company determines that your injury happened because of a pre-existing ailment rather than an occurrence at work, they may deny your workers’ compensation claim. 

Even if you have a pre-existing ailment, it’s important to note that you can still claim compensation. You just need to show that your employment worsened the condition or resulted in new damage. 

Understanding these common reasons for denial can help you better prepare and avoid potential pitfalls in your workers’ compensation claim. Contact your Workers’ Compensation Specialist free of cost. Call 610-892-9300 or reach us online.