Top 5 reasons for workers’ compensation claim denials

On Behalf of | Nov 22, 2019 | Workers' Compensation

Although construction and warehouse workers experience more injuries than office workers, work injuries can occur in virtually any Pennsylvania industry. From torn ligaments and back spasms to carpal tunnel, you may qualify for workers’ compensation if your injuries prevent you from working. The team at Cullen legal often assists clients in filing claims. 

According to PayScale, there are several requirements for workers’ compensation claims. Depending on the circumstances, you may receive denial notification even your injuries qualify for compensation. Once you understand why your application was not accepted, you can file an appeal. Here are the top five denial reasons. 

  1. Injuries unrelated to the job – Injuries outside the completion of official tasks, but that occur while at work are often denied. For example, in a round of breakroom trash can basketball, a co-worker goes in for a lay-up, catches his foot on a table leg and breaks his ankle. The injury likely will not qualify for workers’ comp. 
  2. Delay when reporting the injury – Failure to immediately notify your employer about the job-related injury in writing makes proving that the injury occurred on the job difficult. 
  3. Seeing an out-of-network doctor – The medical professional you see must be in your employer’s insurance network to have the medical bills covered by workers’ comp. If you see your personal physician and he/she is outside that network, you may be responsible for the fees. 
  4. Clear communication – Provide a complete list of all injuries, aches and pains to the physician. Without the full story, including details about the situation that caused the damage, the doctor does not get the whole picture and some treatment may not have insurance coverage. 
  5. Pre-existing conditions – If you have an existing injury made worse by your job requirements, you may not receive compensation. 

The claims process can be tedious and time-consuming. Filing for benefits, meeting all the deadlines and keeping documentation current is challenging. A professional, experienced in working with workers’ compensation claims can help you understand the process and maximize benefits. Visit our webpage for more information on this topic.