Workers’ compensation provides crucial support to employees who suffer work-related injuries. However, not all claims receive approval. Understanding why a claim faced a denial can help employees navigate the process more effectively. Below are six potential reasons for a denied workers’ comp claim.
1. Late reporting
In Pennsylvania, employees have 21 days to notify their injury to their employer. Failure to do so may result in a denied claim. Prompt reporting ensures the proper documentation of the injury and that is when the claims process begins.
2. Lack of medical evidence
A claim needs strong medical evidence. The claim may face denial without proper documentation from a healthcare provider that links the injury directly to work. Ensure all medical records and treatment details are thorough and complete.
3. Disputed injury origin
If an employer disputes that the injury occurred at work or during work-related activities, the chances for a denial are high. Accurate reporting of how and where the injury happened is crucial.
4. Pre-existing conditions
A claim may face a denial if the injury proves to be related to a pre-existing condition. While pre-existing conditions do not automatically disqualify a claim, demonstrating that work aggravated the condition is necessary.
5. Failure to seek immediate medical treatment
Delaying medical treatment after an injury can lead to a denied claim. Immediate treatment establishes a clear connection between the injury and work activities.
6. Non-compliance with medical advice
Ignoring or failing to follow medical advice can result in a denied claim. Compliance with all prescribed treatments and recommendations supports the legitimacy of the injury.
Preparing for an appeal
Understanding a denied worker’s compensation claim helps employees take proactive steps. Knowing these potential pitfalls allows for better preparation and increases the likelihood of a successful claim. Additionally, if you are considering an appeal, you may want to seek help from a legal professional who can guide you through the process.