In Pennsylvania, the workers’ compensation program allows injured employees to qualify for insurance coverage for medical care and lost income due to a workplace injury or illness. These financial benefits are available without requiring the worker to prove fault. However, it is not always easy for workers to receive fair compensation; many claims initially get denied.
Insufficient Evidence
A successful workers’ compensation claim in Pennsylvania requires certain documentation and evidence that supports the claim the worker is making. This typically includes an accident or injury report and medical records.
If the initial workers’ comp claim does not contain adequate information or evidence, the insurer may deny coverage. The worker would be required to submit additional information or documentation to appeal the denial.
Injury or Illness Not Related to Work
The workers’ compensation insurance program offers no-fault benefits to workers who are injured within the “course and scope of employment.” It does not pay for events that occur outside of the individual’s job duties.
If there is not enough evidence demonstrating that the claimed injury or illness arose out of work-related tasks, the insurer may try to argue that the injuries were pre-existing or caused elsewhere. This is especially common if there were no witnesses to the incident.
Failure to Notify
Workers’ compensation claimants in Pennsylvania have a duty to notify. Before an employee will be eligible for workers’ comp benefits, he or she must notify the employer in writing of the injury within at least 120 days. Prompt reporting is critical to qualify for coverage.
Missing this deadline will typically bar a worker from financial compensation through a workers’ comp insurance claim. If the worker did not discover an injury or illness right away, however, the time limit may be extended to 120 days from the date of discovery.
Failure to Seek Medical Care
Medical documentation is a key element of a workers’ compensation claim. With inadequate medical evidence, a claim is much more likely to get denied. The insurer may try to argue against the type, severity, cause and nature of the worker’s injuries. Going to a hospital immediately can help document the injury, connect it to the victim’s workplace, demonstrate severity and establish the costs of required treatments.
Insurance Bad Faith
Sometimes, an insurance company rejects a workers’ compensation claim for no valid reason or with no explanation at all. This is known as insurance bad faith, and it is done in an attempt to save money on claim payouts. Insurance bad faith could result in an additional lawsuit being brought against the insurance company for failing to handle the claim in good faith.
What to Do if Your Workers’ Compensation Claim Gets Denied
You are not out of options if an insurance company denies your workers’ compensation claim the first time around. Contact a skilled Pittsburgh injury attorney to help you with the appeals process. Through an internal review, a complaint filed with the Pennsylvania Department of Insurance or an official appeal, your lawyer may be able to have the decision reversed.
Hiring an attorney from the beginning of your workers’ comp case can decrease the odds of a denial and lead to expedited benefits. An attorney will fight to help you receive maximum financial compensation for a work-related injury or illness, even if this means bringing your case to court. For more information, contact Dallas W. Hartman P.C. at (800) 777-4081.