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Why some workers' compensation claims are denied

Pursuant to Pennsylvania workers' compensation laws, most employees who experience an occupational injury or disease have a right to certain benefits. To obtain these benefits, the injured employee must immediately file a workers' compensation claim; however, the employee must wait until the insurance company investigates the claim before he or she can receive the benefits.

Under some circumstances, however, some workers are not eligible to receive these benefits. For instance, independent contractors who injure themselves while working for a company, even though the accident was purely the fault of the company, cannot file for the benefits because they are self-employed and not considered actual company employees. Further, it is vital that employees notify their employer immediately after they are injured. If an employee or the employee's doctor, spouse or another third party fails to give the worker's employer notice within a certain amount of time, either in writing or verbally, the claim could be denied. The deadline typically ranges from 30 to 90 days, depending on state laws.

Other injuries that are non-compensable are self-inflicted injuries, injuries that resulted from a physical fight started by the claimant and non-work related injuries. Further, employees who claim their illness or injury prevents them from returning to their regular work duties will receive reduced benefits and be obligated to return to work earlier if it is proven this is incorrect. These benefits will also be denied to workers who were injured because they were involved in horseplay or willful negligence at the work site, or if they were intoxicated.

While many employees may try to cheat the system in order to get workers' compensation benefits, other employees truly need them. Those who have been injured on the job and need help applying for the benefits might want to call an experienced attorney for help with filing the claim and understanding their rights.

Source: Findlaw, "Common Workers' Compensation Defenses", Aug. 17, 2016

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