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    Denied Workers Comp Claim in Philadelphia: What Are the Most Common Reasons?

    Denied workers comp claims can be frustrating and overwhelming, especially if you were counting on the benefits to help you recover from a workplace injury. Unfortunately, it’s not uncommon for insurance companies to deny claims, leaving injured employees struggling to pay medical bills and make ends meet. 

    If your workers’ comp claim was denied in Philadelphia, don’t lose hope just yet. In this blog post, we’ll explore some of the most common reasons why claims get denied and how a Philadelphia workers compensation lawyer can help you fight back.

    Insurance Companies Evaluate Your Case, Not Your Employer

    When you file a workers’ comp claim, it’s important to understand that the insurance company is evaluating your case, not your employer. This means that even if your employer believes you were injured on the job and supports your claim, the insurance company may still deny it.

    Insurance companies have a vested interest in minimizing payouts for claims. That’s why they carefully evaluate every aspect of a claim before making a decision. They’ll review:

    • medical records, 
    • accident reports, 
    • witness statements, 
    • other evidence.

    It’s also worth noting that insurance adjusters are often trained to find ways to deny claims. They may look for pre-existing conditions or argue that an injury was caused by something outside of work in order to avoid paying out benefits. This is why having an experienced Philadelphia workers compensation lawyer on your side can be so helpful when fighting denied claims.

    However, in most of the cases your workers comp claim may be denied for the following reasons:

    You Waited Several Days before Reporting the Workplace Accident

    Reporting a workplace accident immediately is crucial to your workers’ compensation claim. Waiting several days or even weeks can significantly hurt your chances of getting approved for benefits. Insurance companies may question the severity and legitimacy of your injury if you wait too long to report it.

    The longer you delay reporting an injury, the more difficult it becomes to prove that it happened at work. The insurance company may argue that the incident did not occur in the workplace or that you were not injured as severely as you claim.

    Moreover, waiting to report an injury may lead your employer and coworkers to believe that the incident was not serious enough or did not happen at all. It’s essential to document every detail of what occurred soon after the accident so that there is no room for doubt.

    You Refused to Take a Drug Test

    One of the most common reasons for a denied workers comp claim is when an employee refuses to take a drug test after a workplace accident. Employers may ask employees to take drug tests following an injury at work, as drugs or alcohol could have contributed to the accident. Refusing to take this test can be seen as suspicious behavior and may lead insurance companies to deny your claim.

    It’s important to understand that refusing a drug test doesn’t automatically mean you were under the influence at the time of your injury. However, it raises red flags and makes it more difficult for you to prove that your injury was solely caused by the workplace accident.

    In some instances, employers may attempt to use refusal of a drug test as grounds for termination. It’s crucial that you know your rights as an employee and don’t let any unjust actions go unchecked. An experienced workers compensation attorney can also assist with wrongful termination claims if necessary.

    some workers comp claims raise red flags

    Your Employer Believes You Were Hurt While Off Duty

    One of the most common reasons for a denied workers comp claim in Philadelphia is when your employer believes that you were hurt while off duty. This can happen if you reported an injury that occurred outside of work hours, such as during a weekend or on vacation.

    If your employer denies your claim based on this reason, it’s up to you to prove that the injury did occur while you were working. It’s important to provide documentation and evidence, such as witness statements or medical records, showing that the injury was related to your job duties.

    If you find yourself facing a denied workers comp claim due to this reason, it’s crucial to seek out legal representation from an experienced Philadelphia workers compensation lawyer who can help navigate through these complex issues and fight for the benefits you deserve.

    There Are No Witnesses to Support Your Claim

    One of the most frustrating reasons for a denied workers’ comp claim in Philadelphia is when there are no witnesses to support your claim. Employees rarely work on their own, away from colleagues. Thus, the lack of eyewitnesses may appear suspicious to your employer and their insurance company.

    Firstly, it’s important to remember that not having witnesses doesn’t automatically mean your case will be denied. Insurance companies take many factors into account and often use other evidence such as medical records and accident reports to make their decision.

    However, if you don’t have any witnesses to back up your story, it can be harder to prove what happened and why you deserve compensation. This is where hiring an experienced Philadelphia workers’ compensation lawyer comes in handy.

    A skilled attorney knows how to gather evidence and build a strong case even without eyewitness testimony. They may be able to use expert opinions or other forms of proof such as photos or videos from the scene of the accident.

    A Philadelphia Workers Compensation Lawyer Can Help You File an Appeal

    If your workers’ compensation claim has been denied, don’t lose hope. There are several common reasons why claims get denied, and most of them can be overcome with the help of an experienced Philadelphia workers’ compensation lawyer.

    By hiring a knowledgeable attorney, you can appeal the denial of your claim and fight for the benefits you deserve. They will evaluate your case and gather evidence to support your claim. The right lawyer can also ensure that all deadlines are met and that you have access to the medical treatment you need.

    If it seems like an uphill battle fighting against insurance companies or employers, don’t give up just yet. You owe it to yourself to seek out professional guidance from an experienced Philadelphia workers compensation lawyer who has in-depth knowledge of Pennsylvania’s complex workers’ compensation system.

    Being injured on the job is stressful enough without having to worry about getting compensated for lost wages or medical bills. If your workers’ comp claim has been denied due to any of these common reasons above or others not mentioned here, reach out today for a consultation with a reputable Philly-based attorney who will fight tirelessly on behalf of their clients for justice and fair financial settlements: 267-314-8024!

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