4 reasons for workers’ compensation claim denials

On Behalf of | Apr 17, 2024 | Workplace Accidents

Workers’ compensation could help an employee recover from a workplace injury. An injured employee who files for worker’s compensation benefits could receive medical coverage and lost wages no matter who caused an accident. 

Just because an employee filed for worker’s compensation does not guarantee them benefits. There are a few reasons why a claim could be denied. Here is what you should know:

Missed statute of limitations

In Pennsylvania, an injured worker has 21 days to report a workplace injury to their employer or manager. They also have 3 years to start a claim. The longer a worker waits, the less likely they are to receive benefits. If a worker misses the statute of limitations after 120 days of not reporting an injury, there may be very few chances left to make a successful claim.

Bad faith insurance

A claim could be denied simply because an employer or insurance company does not want to pay for medical coverage or lost wages. A claim could be denied under bad faith.

Missing documentation

Most successful workers’ comp claims are supported by documentation of the injury. Medical records and an accident report can help prove how an accident happened and how an employee is affected.

Ineligible injury

Not all injuries are eligible for workers’ comp. Employees typically must have suffered an injury that makes them unable to work. Bruises and cuts may not qualify a worker for benefits.

If a claim is denied, injured workers can appeal a decision. Workers who understand their legal rights can challenge a denial so they can receive the benefits they deserve.