Five Reasons Why Employees Lose Workers’ Compensation Benefits
December 9, 2021
Pennsylvania Law requires that all employers carry workers’ compensation insurance. Employees who are injured on the job or contract an illness due to working conditions have the right to seek Workers’ Compensation benefits.
Workers’ Compensation can help the employee pay for medical bills and recover some of their lost wages. Under Pennsylvania law, the following conditions are considered compensable under Workers’ Compensation:
- Specific incidents that cause an injury at work.
- Repetitive activity resulting in an injury, such as carpal tunnel syndrome.
- A pre-existing condition aggravated by work activities, such as arthritis or heart disease.
- Specific diseases recognized as occupational diseases or illnesses.
Some employees miss out on the benefits they desperately need when they are injured and out of work. This can happen when an injured worker is unaware of their rights, or they are not familiar with the process of filing for Workers’ Compensation. Workers may not know that they can potentially sue a third party, such as a general contractor or manufacturer, to recover additional damages. Galfand Berger LLP wants all workers to know their rights so they can avoid missing Workers’ Compensation or other benefits.
An adjuster from your employer’s Workers’ Compensation insurer will investigate the claim and approve or deny coverage. The following is a review of the top five reasons why insurers reject Workers’ Compensation claims.
Report Your Injury Promptly
Under Pennsylvania law you must notify your employer of the injury within 120 days of the date you were injured. You must report illness or disease within 120 days after you discover the disease or condition.
The law also states that you must give notice within 21 days of the date of your injury to be paid from the first day of your disability. If you give notice between the 21st and 120th day following your injury, compensation is payable only from the date you gave notice.
Always give notice immediately upon a workplace accident or discovery of an occupational illness. It helps your credibility and prevents the insurer from denying your claim due to a missed deadline.
Employers may deny claims for purely procedural reasons. For example, they may claim that you did not report your injury as a work injury. In addition to the timeliness issues stated above, an injured worker must report that the injury occurred at work, not merely tell the employer that he is injured or hurt.
When you suffer an injury due to a workplace accident, the best practice is to notify your supervisor immediately. Always report the injury verbally or in writing, even if you do not think you were hurt or anticipate missing work time.
If required by your employer, complete an incident report. If you need medical treatment, seek care from your employer’s list of designated health care providers if they have one, or see your own physician if possible. Be sure to inform your physician that your injury happened at work. There are strict requirements about seeking care for 90 days with the same medical provider.
Any error, omission, discrepancy, or failure to follow a required procedure will give an insurer a reason to deny your claim. A lawyer will ensure you comply with laws, policies, and deadlines.
Employers Claim That You Were Not Injured at Work
Some insurers claim that the illness or injury was caused by some other event or circumstance outside the workplace. They may claim that the employee was not performing work duties when the accident occurred.
Your employer may claim that you were not clocked in or on a break. Alternatively, they may claim that you were not performing your job duties at the time you were hurt. However, injuries that occurred while in the course and scope of employment are covered. This generally includes injuries that occur on the employer premises so long as the employee was required to be there. This may include during breaks, and entering and exiting the premises at a reasonable time before or after your shift.
In addition, if you are injured in an auto accident while traveling to an offsite business meeting, the injury is generally compensable. Injuries that occur while you are on your way to or from work may not be compensable.
These are some examples of injuries that an employer may deny as work related when; they may well be considered compensable injuries. Consult with a lawyer for guidance on your case. They know how to defend against denials.
No Medical Attention
An injured employee may deny medical attention after an injury for many reasons. For example, they may not feel that the damage was severe because they have no aches, pains, or other symptoms. This could be a mistake.
Many injuries take time to surface and show symptoms. Refusing medical attention could signal to an insurer that you were not hurt. For this reason, always seek medical attention directly after a workplace accident and whenever new symptoms appear.
Some employees who are injured on the job return to work immediately. They may work while hurt to avoid loss of pay or other benefits. Again, this signals to the insurer that you were not injured. It is always best to take as much time as you need to heal.
Do not let your employer tell you that you are not entitled to Workers’ Compensation due to a prior back or heart problem or some other medical issue. Every worker has a right to Workers’ Compensation, regardless of previous medical conditions.
An insurer cannot deny a Workers’ Compensation claim based on your past medical history or a pre-existing condition. In fact, you can file a Workers’ Compensation claim if you aggravate a pre-existing condition due to the nature of your work.
What Are Third-Party Claims?
If someone other than your employer is responsible for your injury or disease, you may be able to sue that third party in addition to collecting Workers’ Compensation benefits. Possible third parties include a manufacturer of unsafe equipment, a seller of dangerous chemicals, or a contractor working on your employer’s premises.
Making a claim against a third party responsible for your accident does not affect your Workers’ Compensation claim. Third-party claims allow you to pursue coverage for damages not available under Workers’ Compensation, such as pain and suffering.
Third-party products liability claims are common. Thousands of workers are injured in accidents caused by poorly designed workplace machines, tools, and equipment every year.
You may be able to sue machinery and equipment manufacturers if you are injured while using a product that malfunctions, is poorly designed, or if there were no proper warnings or instructions for use. Examples include:
- Machinery without point of operation guards, such as punch presses, press brakes, shears, lathes, and milling machines.
- Machinery with unguarded in-running nip points, shafts, or any unguarded moving part.
- Toxic chemicals where the manufacturer did not warn of dangers, precautions, symptoms, personal protective equipment, and first-aid measures.
- Defective gauges, valves, switches, and controls.
- Ineffective personal protective equipment or safety devices that fail to prevent injury or disease.
- Unsafe industrial equipment, such as vehicles, power tools, ladders, electrical equipment, lifting devices, or forklifts that cause an accident.
A worker may also have a valid legal claim against a property owner if they are injured while working because of a dangerous situation on their premises. These dangers include electrical hazards, failure to provide safety equipment, and lack of safety measures, such as handrails, adequate lighting, and safe surfaces.
Contractors, subcontractors, and even other employees can also be held liable in some workplace accidents. A lawyer will help you build a strong case against a liable third party when necessary.
How Can a Lawyer Help Me After a Workplace Accident?
Workers’ Compensation claims can be complex. A Workers’ Compensation lawyer can evaluate your claim and help you through the process, deadlines, and compliance with the many requirements of seeking care.
You can file a Workers’ Compensation claim on your own, but it may be worthwhile to seek legal assistance in filing an appeal if you are denied. Workers’ Compensation insurers want to minimize how much they must pay out, so they may try to deny or devalue your claim.
You may have a legal claim against a third party in addition to a Workers’ Compensation claim. A lawyer can get to the real cause of your injury.
Philadelphia Workers’ Compensation Lawyers at Galfand Berger LLP Fight for Your Rights When You Are Injured at Work
Every worker who is injured on the job has a right to file for Workers’ Compensation benefits. Our Philadelphia Workers’ Compensation lawyers at Galfand Berger LLP can help if your claim is denied. To schedule a free consultation, call us at 800-222-USWA (8792) or contact us online. From our offices in Philadelphia, Bethlehem, Lancaster, and Reading, Pennsylvania, we proudly serve clients throughout Pennsylvania and New Jersey, including Allentown and Harrisburg.