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Common Reasons for a Denied Workers’ Compensation Claim  

When you are injured on the job, your employer should have workers’ compensation coverage to pay for your medical care and lost wages. You’ll need to report to your supervisor and fill out a form, and your employer will then send it for processing.

It may seem cut and dry, but sometimes your claim will be denied. Here are the most common reasons you may have trouble claiming your workers’ compensation benefits.

Failing to Report on Time

In order to obtain your benefits through workers’ comp, you must report your work-related illness or injury within 30 days. Waiting too long means that you will likely be denied your claim.

Not Getting Medical Treatment

If you are injured or have an illness caused by your working conditions, it only makes sense that you would seek medical treatment. Avoiding treatment might lead the workers’ comp insurance company to think your injury isn’t real. Even if your injury is minor, you still need to visit a doctor from the list of physicians provided by your employer.

Conflicts Between the Accident Report and the Initial Medical Report

What you report needs to be consistent with what the physician reports. This will raise suspicions with the insurer and cause them to view the claim as inconsistent.

Pre-Existing Condition

While a pre-existing condition will not forbid you from collecting your benefits, if you try to claim that your workplace injury is responsible for this condition, you will be denied. In some cases, a new injury can exacerbate a pre-existing condition, which should be covered but may still be denied.

Refusal or Failure of Drug Tests

Even though workers’ compensation is a no-fault system, meaning you will still be covered even if you were careless and caused your injuries, you will be denied if you were under the influence. Refusal to take a drug or alcohol test is just as bad as failing it, and you will not receive coverage.

Willful Negligence or Recklessness

Everyone makes mistakes, which is why workers’ compensation is not fault-based. However, if you were willfully negligent or reckless, you can be turned down for your coverage

Filing After Job Termination

Workers’ compensation benefits are available to you from the first day you start your job until your last day of employment. If you filed your claim after you were terminated, it may be viewed as retaliation. Your claim would then be irrelevant since you didn’t make this report while you were still employed.

However, if your employment was terminated as retaliation for filing a claim for worker’s compensation, you should speak to an attorney to find out your legal options.

Paperwork Errors

When filing for workers’ compensation, you must fill out all the required forms completely. They must also be accurate in every detail, with factual reports that relate to the illness or injury you sustained on the job. Missing information, even if you accidentally skipped a section, can cause the insurer to deny your claim, but you will likely have the chance to fix it.

What Can You Do When Your Claim for Workers’ Comp Is Denied?

The first step is finding out why you were denied your claim. For example, if you simply missed a section on your form, you can fix it to get everything in proper order.

However, if the situation is more serious, such as the insurer doesn’t believe your injuries are real, you can file an appeal. This requires going before an administrative judge for a hearing, which may have better results if you have a workers’ compensation attorney in Philadelphia or a city near you to help you navigate the legal process.


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