If you spend your days working in an industry in which the likelihood of suffering a debilitating on-the-job injury is high, you may naturally be concerned about providing for your family if you are unable to return to work. Your employer might reassure you about workers' compensation benefits that will be available to help you financially by paying medical expenses and lost wages.
However, did you know that your employer or the insurer could deny your workers' compensation benefits claim? There is no guarantee that you will receive the benefits to which you might be entitled. Insurers tend to treat every claim with suspicion, and yours might be one of those they decide to reject.
For what reasons could benefits claims be denied?
The rejection of your workers' compensation claim can jeopardize your ability to care for your loved ones. The severity of your injury may prevent you from returning to work until you have recovered, and along with the loss of income, you will have to cope with high medical expenses. Upon the denial of your claim, the insurance company will notify you, and they will provide the reason for the rejection. Here are some of the many reasons they may cite:
- Time limits: There are two time limits to meet. Under Pennsylvania laws, you must report the injury to your employer within a specific time after it occurred, and your boss has a limited time within which he or she must file the claim with the insurer.
- Employer dispute: Some employers will do anything to stop claims that may cause increased premiums. Your boss might argue that you were not on duty when your injury occurred or that you were horsing around when you hurt yourself.
- Injury does not qualify for compensation: It is typically tough to prove that invisible injuries such as repetitive stress, back problems and even post-traumatic stress disorder after witnessing a traumatic work accident are work related.
- No medical record: Doctors' bills and other medical reports must accompany claims to make them valid. No proof of medical expenses will certainly cause the denial of a benefits claim.
You are entitled to file an appeal
You need not take the rejection of your claim lying down. With the help of an experienced workers' compensation attorney who is skilled in navigating the intricacies of the workers' compensation appeals process, you might receive all the compensation to which you are entitled.
Your legal counsel might start by consulting with your employer and the insurance company to determine whether the denial might have resulted from a misunderstanding that could be easily resolved. However, you attorney will be ready to appeal the decision with the Pennsylvania Workers' Compensation Appeal Board if necessary.