After suffering an injury on the job, you and your family expect—and deserve—to recover benefits to help support you while you recover. And then, you find out that your employer or their insurer has denied your claim.
Unfortunately, this is a frustration that many workers face. And there are a few common reasons why they are left facing a denied claim.
1. Delayed reporting
Workers must report their injury to their employer within 120 days. This may seem like a considerable amount of time. However, it is usually better to report an injury sooner rather than later.
Reporting an injury later or missing the deadline to report it altogether are some of the top reasons that insurers deny workers’ compensation claims.
2. Lack of evidence
Workers’ compensation claims require extensive evidence, including:
- A report of the accident or injury
- Witness statements of the accident
- Official medical records of the injury
- Employment records
The accident report and the medical records are the most important elements of evidence. And unfortunately, if the details vary, many insurance companies will deny the claim.
3. The injury is not covered
The Pennsylvania workers’ compensation system covers a wide range of injuries. So, many people might wonder why their employer’s insurer denied their claim—even if the code clearly includes their injury.
Insurance companies might say that an injury is not covered for two common reasons:
- It is too difficult to connect the injury to your work activities.
- The medical evidence does not prove the injury is severe enough to make you eligible for benefits.
For example, individuals who sustain repetitive stress injuries (RSIs) from their work should be able to collect workers’ compensation benefits. However, it can be difficult for medical professionals to connect RSIs to your work activities since they are so common.
4. An employer dispute
It is also possible that your employer could dispute your claim for workers’ compensation benefits.
Unfortunately, many employers have ulterior motives for disputing a workers’ compensation claim. And those motives usually revolve around money. They often cite the reasons listed above, but workers may be right to be suspicious if they do have a valid claim.
Employers often have to pay higher insurance premiums when more employees file workers’ compensation claims. And most employers—and insurance companies, for that matter—prioritize saving money over protecting their employees.
If your employer disputes your valid claim, you always have the option to fight that dispute. You also have the option to appeal any denial to recover the benefits you deserve.
It can be frustrating to deal with a denied claim. However, it is important to remember that employers and their insurers might deny many claims at first, but more than half of denied claims end up paid.
