Can Workers' Compensation Claims Be Denied in Pennsylvania?
Workplace safety remains a serious cause of concern in our region. The Bureau of Labor Statistics (BLS) reports that more than 100,000 people were hurt on the job in Pennsylvania in 2023 alone. The good news is that our state has a no-fault workers’ comp system. If you are injured on the job, you can file for benefits. Unfortunately, claims may be denied for many reasons.
Common Reasons for Claim Denial
Our experienced workers’ compensation lawyers in Delaware County (commonly known as Delco) can explain the most common reasons why claims are denied in Pennsylvania.
The Work Injury Was Not Reported on Time
A proactive approach is a must after a job-related accident in Delaware County. In Pennsylvania, you must report a workplace injury to your employer within 21 days to get full benefits. If you wait more than 120 days, you lose your right to claim workers’ comp. Many workers miss out because they don’t report the injury fast enough. You should always tell your boss when you get hurt, even if the injury seems minor.
The Accident Was Not Proved to be Work-Related
Workers’ comp is no-fault coverage designed to cover job-related injuries and illnesses. Your claim could be denied if you were hurt on break, commuting, or during horseplay. However, some injuries that happen outside your regular workplace, like driving for work errands or attending a job-related event, can still qualify for benefits.
There is Not Enough Medical Evidence to Support the Claim
Workers’ comp claims need strong medical proof. If you do not see a doctor or don’t follow medical advice, the insurance company may deny your claim. You should always go to a doctor right after your injury, follow treatment plans, and keep records of your visits. Also, you may be required to see a company-approved doctor for the first 90 days (if their list of doctors is ‘valid’).
The Worker Committed Misconduct (Intoxication, etc.)
In Pennsylvania, workers’ compensation does not cover injuries caused by employee misconduct. If you were drunk, high, fighting, or breaking safety rules when you got hurt, your claim will likely be denied. In some cases, an employer or insurance company may even drug test you after an accident. If you test positive, they may refuse to pay your claim. However, if you were injured while doing your job, even if you made a mistake, you could still qualify for workers’ comp benefits.
Speak to Our Workers’ Comp Lawyers in Delco Today
At Schmidt, Kirifides, Rassias & Rio, our workers’ comp attorneys are standing by, ready to help anyone in Delaware County. If you have any questions about a workers’ comp claim, we are here to help. Contact us today for a fully confidential, no-obligation initial consultation. We handle claims and appeals throughout Delco, including Chester, Upper Darby Township, Radnor Township, Ridley Township, and Yeadon from our office in Media, PA.