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5 common reasons for a claim rejection

On Behalf of | Oct 18, 2016 | Workers' Compensation

If you have been following our blog, you are familiar with the dangers present at the workplace. Those at construction sites, refineries and factories are aware of the perils connected with operating heavy machinery. Even with the proper training and safety gear, however, accidents happen. While you may have been educated about maintaining a safe workplace, you may not have received the same caliber of instruction in taking care of yourself after an injury occurs.

Should you suffer injuries at work, the manner in which you document the claim and treat the injury can make a difference in the amount of the workers’ compensation payment that you receive. In some cases, there will be no reimbursement for medical treatment, rehabilitation or compensation for lost wages if certain requirements are not met.

By law, employers are required to post information regarding the name, address and telephone number of the insurer responsible for the workers’ compensation policy. In locating this information, you can learn about policy requirements so that you can reduce the likelihood of claim rejection.

These are common reasons workers’ compensation benefit claims are rejected:

1. Claims filed too late

While you may be concerned about retaining your job should you report an on-site injury, it is important that you report your injury within the time allotted by Pennsylvania law. Section 311 of Workers’ Compensation declares that notice must be provided within 120 days of the accident. It’s best to report an on-site accident when it occurs so that it is documented promptly. Should the accident occur without a record of the incident, long-term injuries resulting from the initial accident may not be covered by workers’ compensation.

2. Treatment provided by a doctor not covered by the benefits plan

In seeking medical care, the injured should know which doctors and hospitals are covered by the workers’ compensation policy. Identifying the appropriate physician or specialist is not a task that can be effectively completed on the way to the hospital when the worker is in need of immediate assistance. For those concerned about receiving the proper benefits, research into workplace benefits should be conducted whenever policy updates occur or upon beginning a new job.

3. Injury not treated by a doctor

If you treat your injuries at home and fail to see a doctor, wages you lost during your convalescence may not be repaid. You must be treated by an approved doctor and document the treatment in order to receive benefits.

4. Injury not caused on the work site

If you are injured while running errands to complete an assigned task, your injuries will be covered by workers’ compensation. Those who have an accident during a commute to work will not have coverage for the injuries sustained. Workers’ comp benefits are provided when an employee is hurt while completing a task to benefit an employer. In the first scenario mentioned, the employee is doing something to benefit the employer. In the second scenario, the employee is serving his needs by driving himself to work.

5. Injuries sustained as a result of playing on the worksite

Your employer may support camaraderie within the workforce; however, those impacted by accidents that occur as a result of rough housing or playing pranks will not have their injuries covered by workers’ compensation. Playing on the worksite is not working on the worksite.

Workers’ compensations benefits claims are routinely rejected. Those who have had their claims rejected are advised to speak with a knowledgeable attorney to determine the best course of action.


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