You are eligible for workers\u2019 compensation benefits if you suffer an injury on the job or if you develop an illness or injury due to your work conditions. However, just because you file a claim, this does not mean it will be approved. There are several reasons why a workers\u2019 compensation claim may be denied.<\/p>\n\n\n\n
There are specific rules when it comes to filing a workers\u2019 compensation claim, including deadlines.<\/p>\n\n\n\n
Per the Pennsylvania Department of Labor & Industry<\/a>, you must report an injury or illness to your employer within 21 days of sustaining it. From there, your employer must notify its workers\u2019 comp insurer about the situation immediately.<\/p>\n\n\n\n If the insurance company denies the claim, it must provide notification of the denial within 21 days. Alternatively, it can opt to pay compensation temporarily and extend its investigation period to 90 days.<\/p>\n\n\n\n Depending on the specific circumstances of your claim, there may be further filing requirements and deadlines thereafter.<\/p>\n\n\n\n In order for you to qualify for workers\u2019 compensation, your illness or injury needs to result from your workplace activities.<\/p>\n\n\n\n Disputes may arise over whether your injury or illness is actually work-related. An employer may claim that you weren\u2019t working when the injury occurred, that you were involved in some kind of misconduct at the time of the injury, or that your condition wasn\u2019t a result of your work environment.<\/p>\n\n\n\n You should note that this doesn\u2019t <\/em>mean your condition needs to arise from a single workplace incident. If you become sick or injured because of repeated exposure to a certain condition at work (such as constant keyboard use causing a repetitive strain injury<\/a>), you should still be entitled to workers\u2019 compensation.<\/p>\n\n\n\n For a claim to be successful, you must provide sufficient proof that your injury or illness is directly related to your work. Relevant evidence typically includes medical records, witness statements, and documentation of the workplace conditions.<\/p>\n\n\n\n Conflicting evidence can be as damaging as a lack of evidence. If descriptions of the incident from eyewitnesses do not align with the injuries listed in your medical reports, for example, this might undermine the credibility of your claim.<\/p>\n\n\n\n For this reason, it\u2019s crucial to keep detailed records of everything related to your claim. Document your own symptoms regularly, file copies of all your medical records, and request any evidence you need from your employer promptly (and follow up as many times as you need to).<\/p>\n\n\n\n As discussed above, an illness or injury needs to arise from workplace activities in order to qualify you for workers\u2019 compensation. If you had an existing condition before you became sick or injured at work, and the symptoms of the two conditions are potentially similar, you may have a harder time proving your case.<\/p>\n\n\n\n Say, for example, you suffer a fall at your construction job and complain of debilitating leg pain afterwards. You file a workers\u2019 comp claim on this basis, but your medical records show that you\u2019ve previously received treatment for sciatica<\/a>. Your employer\u2019s insurer may try to use this to defeat your claim, proposing that your accident was not the true reason for your inability to work.<\/p>\n\n\n\n Cases involving medical disputes like these will require input from expert consultants. Your attorney<\/a> will be able to identify this need and pick the right person for the job.<\/p>\n\n\n\n In just about every personal injury blog post we write, we tell readers to seek medical attention as soon as possible after an accident. This is primarily important because of your health \u2013 some injuries, including serious brain injuries<\/a>, don\u2019t become apparent right away \u2013 but also because of any legal action you might decide to file later.<\/p>\n\n\n\n If you fail to seek medical attention within a reasonable period of time after something happens to you at work, your employer\u2019s insurer may interpret this as evidence that your condition isn\u2019t serious enough to qualify for compensation.<\/p>\n\n\n\n Also, according to the Pennsylvania Department of Labor & Industry, no compensation is allowed in cases where it takes longer than 120 days to report an injury or illness (unless it\u2019s a progressive disease).<\/p>\n\n\n\n What happens if you have an accident at work, but you\u2019re intoxicated when it happens? If you consume alcohol, prescription drugs, or recreational drugs, and sustain an injury in the workplace afterwards, it may negatively affect your workers\u2019 compensation entitlements.<\/p>\n\n\n\n Section 301(a) of the Pennsylvania Workers\u2019 Compensation Act<\/a> states that exceptions to an employee\u2019s right to workers\u2019 compensation may occur where:<\/p>\n\n\n\n Many employers conduct mandatory drug and alcohol tests after workplace accidents to determine whether alcohol and drugs were involved.<\/p>\n\n\n\n However, the law in this area can be murky. For example, when it comes to testing for the presence of cannabis in the body, it can be difficult to get a reliable result from physical evidence, as cannabis takes a long time to pass<\/a> fully through your system.<\/p>\n\n\n\nWork-Relatedness<\/h2>\n\n\n\n
Lack of Evidence<\/h2>\n\n\n\n
Pre-Existing Conditions<\/h2>\n\n\n\n
Failure to Seek Medical Treatment<\/h2>\n\n\n\n
Alcohol or Drug Abuse<\/h2>\n\n\n\n
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