When you submit an application for workers’ compensation benefits, you probably are in desperate need of them. Someone who gets hurt on the job or who develops an occupational illness will likely have medical expenses to worry about.
Additionally, if your condition leaves you unable to return to work, you may also require temporary disability benefits to replace the wages you aren’t earning because of your injury or illness. Receiving a denial for an initial application for benefits can feel catastrophic, but it doesn’t mean you are out of options.
If you have already applied or have applied and gotten denied, understanding common reasons for denied workers’ compensation claims can help you better plan for your litigated claim.
Were you too slow to report the issue to your employer or file a claim?
There are certain rules related to workers’ compensation in Pennsylvania that obligate workers to make timely reports about injuries and other medical conditions related to their work. In most cases, it is ideal to report an incident or diagnosis within 21 days, although people can potentially make reports for as long as 120 days after the date of the incident that left them hurt or their diagnosis with a work-related injury.
Is there reason to suspect the condition wasn’t related to work?
Certain injuries or illnesses that people can develop because of work can have other explanations as well. Some people, especially those without insurance or with high-cost policies, might pretend to slip and fall on the job in order to treat an injury like a workers’ compensation claim.
Sadly, the inappropriate behavior of a few people always seems to affect the rights of the general population. If there is any reason for your employer or their insurer to suspect that you may have incurred your injury outside of work or that an illness has an alternative explanation, you will likely have to find a way to connect your condition to your workplace, such as getting testimony from witnesses who were there at the time of an accident.
Have you failed to follow up after your diagnosis?
Both illnesses and injuries often require ongoing care and the cooperation of the patient in order for optimal recovery. Whether your physician recommended that you take certain medications or participate in physical therapy, if you don’t comply with those requirements, that could very well complicate your case and open the door for insurance representatives to claim that the lasting impact of the condition is due to your current non-compliance with medical orders.
Regardless of the reason that your employer denies your claim, when you need benefits, you will have to consider the process of litigating your claim in order to get the benefits that you need to support yourself.