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Reasons a claim for workers’ compensation may be denied

This blog recently discussed the important benefits available to injured workers and their families through workers compensation. There are many different requirements and timelines associated with a claim for workers’ compensation that injured workers and their families should be familiar with.

A denied claim for workers’ compensation benefits can delay badly-needed benefits for injured workers and their families. Reasons a workers’ compensation claim for benefits may be denied include:

  • The injury or claim was not reported in time. The injured worker has 120 days in Pennsylvania to report their workplace injury to their employer.
  • The employer disputes the claim. The employer has 21 days in Pennsylvania to accept or deny a claim for workers’ compensation benefits. Employers may deny the claim alleging the injury occurred outside of the workplace, resulted from horseplay on the job or for some other disqualifying reason.
  • The injury is not compensable. Some injury claims me more difficult to prove than others. As a result, it is important for the injured worker to know how to use medical evidence and their medical record when making their claim for workers’ compensation.
  • No medical treatment. In most circumstances, injured workers must obtain medical treatment to receive benefits. In all circumstances, it is important for injured workers to seek the medical care and treatment they need for their workplace injury or occupational illness. The employer is required to provide the worker with a list of medical providers from which they can seek medical care and treatment.
  • Insufficient evidence that the injury the worker suffered is work-related. The worker can provide evidence that the injury was work-related and an independent medical evaluation may be required.

Injured workers in Pennsylvania who have been denied workers’ compensation benefits should be familiar with how they can challenge a denial of their workers’ compensation benefits. Injured workers may rely on workers’ compensation benefits following a workplace accident and should understand the reasons a workers’ compensation claim may be denied and what they can do about it.