Work Injury Denied by Insurance. Should I Call a Workers’ Comp Attorney?
If you were injured on the job and your workers’ comp claim was denied, you don’t have to take no for an answer! Navigating the Pennsylvania workers’ comp system is challenging and complex – you have the right to benefits for your injuries. If you were denied, get an experienced workers’ comp attorney on your side today to help you with the appeals process.
Even though your claim was denied, you can still fight for your benefits. Let’s take a look at:
- Common Reasons Workers’ Comp Claims are Denied
- What to Do After an Accident to Ensure Best Chance for Compensation
- Why It’s Important to Talk with a Workers’ Comp Attorney from the Start
Common Reasons Workers’ Comp Claims are Denied
Your employer and its workers’ compensation insurance company can deny a claim for a number of reasons. Workers’ comp claims often cost employers a lot of money, so they may try to do what they can to avoid paying claims. As an injured worker, you have rights and are entitled to benefits for a valid claim. The workers’ compensation system is there for you with the right to seek compensation for your lost wages and medical bills.
Common reasons an insurance company may deny your claim:
- Injury Did Not Happen at Work: This is one of the most common reasons a workers’ comp claim is denied. To be eligible for benefits, you must have been injured at work and on the job. If you were injured on your way to or from work, you are not eligible for benefits.
- Injury Was Not Reported Promptly: In Pennsylvania, you are required to report your injury to your employer within 120 days of the injury. The insurance company may claim you did not report the injury soon enough and deny your benefits.
- Claim Was Not Filed by Employer: Even if you reported your injury promptly to your employer, your employer might not report the claim to its workers’ compensation insurance company, thus jeopardizing your benefits. This is why it is extremely important to engage an experienced workers comp law firm from the beginning, so that they can make sure your claim stays on track.
- Employer Disputes Injury: Your employer may claim that your injuries were a result of horseplay or non-work-related activities while on the job. Any injuries that resulted from practical jokes or roughhousing may disqualify you from workers’ compensation benefits.
- Pre-Existing Condition: Pre-existing conditions are not covered by workers’ comp. If you filed a claim for an injury that you were already struggling with, the insurance company will fight hard to get your claim rejected. There are some extenuating circumstances here, however—for instance, a material aggravation of a pre-existing condition is a compensable work injury—and that is why it is so important to talk with a workers’ comp attorney when you are injured on the job. Employers and insurance carriers almost always try to classify injuries on the job as “pre-existing” as opposed to “aggravations.”
- You Weren’t Treated by An Approved Doctor: Aside from immediate emergency medical treatment, injured workers are required to seek medical attention from an employer-approved health provider for the first 90 days. Payment for your medical treatment may have been denied if you sought treatment from a doctor not on the approved list of physicians.
Even if your claim was denied, that doesn’t mean you aren’t entitled to benefits. You have the right to file a Claim Petition with the Bureau of Workers’ Compensation. The best chance of prevailing is having a seasoned and successful workers’ comp attorney represent you. You’ve worked hard for your employer and deserve someone working hard for you!
What to do After an Accident to Ensure Best Chance for Compensation
The workers’ compensation system is complicated. There are specific steps to take and tasks to complete to receive benefits. To ensure your best chance for benefits after a work injury, immediately report the injury to your employer, seek medical attention, document everything, and engage with a workers’ comp lawyer.
- Report the Injury: To receive full benefits in PA, you should report your injury within 21 days. You are still entitled to benefits if you report your injury after 21 days, however, your chances for full compensation decrease the longer you wait. After day 120, benefits may be denied altogether.
- Seek Medical Attention: As previously mentioned, seek medical attention from your employer’s list of approved physicians. Even if you do not feel the injury is serious, you should still go to the employer-approved doctor for an exam. Ask for copies of your medical records. It is important to know that you may choose and medical provider on the panel list; your employer cannot direct you to any specific one. Additionally, if the type of doctor you need is not on the panel list, you may go outside of the list to treat with such a doctor, so long as the treatment is reasonable, necessary and directly-related to the work injury. Be advised, though, the having the right legal team by your side while seeking out this treatment can make things much smoother for you.
- Start and Complete Paperwork: After you’ve reported your injury to your employer, ask to fill out a written report and for the name and contact information of the employer’s workers’ compensation insurance company. Do not rely on your employer to do the right thing – be proactive about filing your claim!
- Consult with a Workers’ Compensation Law Firm: Whether or not you feel you are being ignored or that your employer and its insurance company may try to fight your claim, consult with an experienced attorney. The right workers’ comp attorneys will fight hard for you and your rights and make all of the difference in the world.
Why It’s Important to Work with a Workers’ Comp Attorney from the Start
The best chance of winning your workers’ comp case in Pennsylvania is to consult with the best workers comp attorneys around. A solid, reputable, and aggressive firm can help you prove your claim, gather medical evidence, negotiate a settlement, and represent you at your workers’ comp hearing.
If you were hurt on the job, an attorney will give you a much better chance of getting the benefits you deserve to cover your medical bills, lost wages, and related expenses. The process is so complex and intricate, engaging a lawyer for your injury can help you relieve the stress of the legal system.
Remember – insurance company claims adjusters work for the employer – and not for you. They have the financial interest of the company in mind and will work hard to disprove your claim.
An attorney will:
- Develop medical and vocational evidence to support your claim, including gathering medical records, arranging treatment with a provider, and conducting depositions of medical experts.
- Negotiate settlement agreements that consider the extent of your injuries, your medical costs, and whether your injury has lasting impairments.
- Represent you at your hearing or trial to argue your case.
Even if you have already filed a claim or your claim has been denied, it’s not too late to consult with an attorney. A workers’ comp attorney gives you the best chance of obtaining benefits and getting the most value from your claim.
Workers’ Compensation Law Firm in Lancaster, PA
At Georgelis Injury Law Firm, our attorneys are experienced in the workers’ comp process and fight hard for the rights of injured workers. Don’t let the insurance company deny your claim without reaching out to us first. We know the legal system inside and out and are prepared to help you win your case and get the benefits you deserve after your injury.
We understand a work accident and injury can be stressful and expensive. Let us take on the burden of the legal system so you can recover. Reach out today for a free consultation. We are available 24/7 to help you with your claim. We will put our wealth of knowledge and experience to work for you. You will never receive a bill for our time, and we are only compensated if and when we win your case. Call 1-800-HURT-NOW for a free and no-obligation discussion of your workers’ compensation case.