Denied Workers’ Compensation Claims

Our Philadelphia Workers’ Compensation lawyers fight for injured workers facing denied claims. Workers’ Compensation is an insurance program that employers are required to carry. This is a no-fault protection plan created to provide injured workers the necessary compensation for treatment of their injuries. Sometimes, an employer’s insurance company will deny work injury claims. As an employee, it is important to know one’s rights.

Denied claims can be especially distressing for workers who believed they would be covered if they were hurt on the job. Our legal team can help accident victims and their families recover the money they need to pay for medical bills and lost wages. Some of these cases can be complicated by what an employer or insurance company has done, and we will uncover the truth if the claim has not been managed properly.

One of the most important parts of this process is recovery for the worker. We will take over the legal process so that workers and their families can recover. We work quickly to ensure that coverage is guaranteed, and we will keep our clients updated throughout the process. At Freedman & Lorry, P.C., we pride ourselves on excellent client care and securing settlements for our clients.

Does Everyone Need to Report an Injury?

Workers must report their injuries as soon as possible. An employer should make it easy for employees to report injuries, but employees should not assume that injuries are public knowledge. The employee must report the injury directly to their supervisor. A supervisor is not required to remind the employee to report their injury officially. Employees must take the time to report the injury as soon as they can.

The most common concern among workers is that they will be fired for reporting an injury. It is illegal for an employer to fire anyone for reporting a workplace injury. If workers believe they were wrongfully terminated, contact our office right away. Even if employees were not fired, they may experience retaliation in the workplace that makes the job uncomfortable to perform. Victims must report any latent or subtle retaliation that they experience after reporting an injury.

What are the Eligibility Requirements?

Workers’ Compensation is a no-fault system that provides benefits to victims regardless of how they were injured. However, certain conditions must exist for a claim to be processed successfully:

  • The employer carried Workers’ Compensation insurance. If the employer did not carry insurance on the date of the injury, they are in violation of existing federal and state laws. Workers, however, should ask about Workers’ Compensation before they begin. We recommend that workers who start a job with a company that does not carry insurance report that violation anonymously to the state. When the worker does this, they are protecting themselves and anyone else who could be hurt on the job.
  • An employee-employer relationship existed at the time of the injury. Some employers claim that they did not establish an employer-employee relationship because the victim was an independent contractor. Employees can prove that they were engaged to work with that company, and we will use all the communication provided to show they are due coverage.
  • The employee’s injury occurred while performing the duties of their employment. The employer might claim that the injured employee was not performing their job duties when they were injured. We will show that the victims were working when they were hurt. We also work with clients who were traveling on behalf of their employer when they were injured.
  • The employer did not receive notice of the injury within the required time period. Problems often arise when employees fail to notify their employer of the injury or the employer contests the nature of the injury. If the employee did not report the injury within the allotted time, they cannot be compensated properly. However, employees should note the date, time, and the supervisor they spoke with. If employees do not have this information, their supervisor can claim they never reported the injury.

Workers must use these tips to report the accident properly, note the employer’s response, and file a claim for damages, if necessary. We will review the case thoroughly so that we know why the denial was issued. There are also instances in which the manager misreported the injury, or the insurance company might have improperly denied the claim. We hope to get our clients coverage quickly, but that is not always the case.

What is the Time Limit for Reporting an Injury?

In the Commonwealth of Pennsylvania, employees must report a workplace injury within 21 days of the injury. If employees surpass the 21-day limit for reporting the injury, they are eligible for wage loss benefits on the date they reported the injury, not the date the injury occurred. If employees wait over 120 days to report the injury, employees are barred from receiving benefits. Some workers feel uncomfortable reporting their injuries, and they can ask us how to report the injury properly. When this fear has caused the worker to avoid reporting their injury, we will help show that the employer caused the delay.

In Pennsylvania, there is a time limit of three years for these claims. While a worker may not receive the full benefits they would have been entitled to within 21 days of the injury, we can help a worker gain coverage. The only injuries that will be eligible for compensation after three years are occupational diseases that may not present themselves until many years after the worker is exposed to toxic chemicals or substances.

What If an Insurance Company Claims the Injury is Not Work-Related?

An insurance company may claim that an employee’s injury did not occur during the course of employment. Workers may be surprised by this denial, but they must provide us with the denial letter. For example, the employee may have been driving from one location to another when they were injured in a car accident. If they were on the clock and performing their job duties, even if they were not physically in an office or facility, they should be able to receive benefits.

The insurance company may also claim that the injury was pre-existing, but workers can show that they were not injured before the date they reported the injury. We will work with the doctor to obtain the documentation needed showing that the injury was not pre-existing. Workers may also have re-aggravated an old injury; the doctor can speak on this matter. Additionally, if a worker was goofing off or engaging in horseplay, they will not eligible for compensation. We can show that our clients were doing their jobs as required and explain why the insurance company made this false claim.

Can My Claim be Denied Due to the Type of Injury that was Sustained?

Although most states have similar rules when it comes to types of injuries covered, the Pennsylvania Workers’ Compensation Act specifically states that injuries that occurred due to illegal activity will not be covered; this includes injuries caused by intoxication or illegal drug use. Workers’ Compensation insurance also covers diseases and illnesses caused by exposure to toxic substances in the workplace. However, certain occupational illness must fall within strict guidelines for a claim to be valid.

For example, lung disease claims will not be valid unless the claimant suffered occupational exposure to a known toxin, such as silica or asbestos, for at least two years during the 10 years prior to diagnosis of the disease. We will use timecards and paychecks to prove that employees were exposed for the required amount of time and investigate how the business was handling toxic substances.

What If My Employer Did Not Have Insurance?

Employers must carry Workers’ Compensation insurance. Exceptions include those who are self-employed and those classified as independent contractors. Maritime workers and federal employees are covered for work injuries under separate laws. There are families that do not know what to do to obtain coverage for an incapacitated loved one. We can explain to our clients and their families how they should be covered.

In rare instances, an employer may fail to acquire mandatory coverage. This is illegal, but it does happen. Employees injured at work have guaranteed rights to collect compensation for their injuries and should speak to an attorney regarding their options. As mentioned, we recommend that workers report their employers to the state anonymously if Workers’ Compensation is not available. Do this to protect anyone who could be hurt on the job.

Should I Contact the Insurance Company?

Complaining to the insurance company is easy. Workers may accidentally make statements that will allow the insurance provider to deny coverage. Clients should let us do the talking for them. We will investigate the claim and create a statement that accurately reflects what happened when our clients were hurt. Providing contradictory statements to the insurance company allows them to deny coverage for several reasons.

At the same time, workers should not complain to their employers. We know that managers involved often do not have much control over the coverage that someone will receive. We will interact with the necessary parties on the worker’s behalf. Clients may receive letters or phone calls from outside entities. Injured employees and their families should not speak to lawyers or representatives, or sign anything that might infringe upon their rights. Everything that is signed relating to the case should be reviewed by one of our lawyers. We will speak to all parties involved in the case so that we can come to a satisfactory conclusion. We understand the law of the land. This is especially important when an insurance company believes they are dealing exclusively with the injured employee.

How Will a Workers’ Compensation Lawyer Help?

Workers’ Compensation lawyers advocate for injured workers, seeking justice and full benefits. Employees whose claims were initially denied should not give up. With the help of a skilled lawyer, denied applicants can appeal. Our attorneys can gather the necessary evidence to prove a claim is valid, including:

  • Witness statements: Talk to everyone who was present for the injury. Employees should take pictures and ask for witness statements from their co-workers. There are several things that could be revealed about the accident when multiple people speak up. We know that other employees may be afraid to speak on the injury, and we can protect them from retaliation.
  • Medical records: Provide all medical records pertaining to the injury. Ask the doctor to create a treatment plan that shows how much continuing medical care will cost in the future; we will use that information when calculating damages. Some workers go back to work while they are still in treatment or attending physical therapy. We need to know when the treatment started, when it will end, and how many components are involved.
  • Physician reports: We will request that the doctor send a letter stating what happened, how the client was injured, and how this has personally affected the patient. We may also use this letter to show that employees have been disabled or their earning potential has been limited. We will also ask a doctor if they know when the worker should return to work. There are times when the worker is pressured to go back to work, and that could hamper their recovery. A physician’s report should show that the injury was aggravated at work, that the company forced the worker to return, or that the doctor did not provide the proper treatment.
  • Expert medical testimony: We will call in medical experts when needed to explain how and why these injuries occurred. We will also show that these injuries have been debilitating to the worker and that the care needed was not sufficient, if necessary.

Our lawyers also help workers file claims against third parties. We will determine who was to blame for the accident, even if it was due to another employee. We might discover that a manufacturer caused the accident, and we can show that the worker should have been covered. We will investigate where the breakdown occurred that did not allow for coverage. For example, a secretary or manager might have told the worker they were not covered because they were driving between work locations. We might discover that the insurance department is falsely denying claims or not handling the claims properly.

When we take on cases, we are willing to negotiate as much as possible to get the employee what that they need. We can walk away with the coverage that is needed and even ensure that the employee can keep their job. We are also willing to take the case to court. Injured employees cannot represent themselves because the insurance company or business will have a team of lawyers ready to defend them.

Are There More Damages That Workers May be Owed?

Workers cannot file claims for punitive damages, they can only file a claim for intentional harm, but that can be difficult to prove. This type of claim would come about when a worker has proof that their manager, for example, forced them to work on scaffolding without safety equipment as punishment for an offense. The issue can be complicated if the worker was doing something they were ordered to do that could also nullify their claim.

In any other case, we will only request payment for all medical bills that have resulted because of the injury. When we speak to medical experts, as mentioned above, we want to know if the lack of care caused any other injuries. We will use the doctor’s testimony to show that the worker continued to suffer, and we will ask that the insurance company pay for the required treatment.

In an extreme case, the worker might have passed away because they did not receive the care they needed. In these instances, we will help family members file a wrongful death suit on behalf of the deceased. These cases also have a three-year statute of limitations. Families should consult with us as soon as possible to determine how to proceed with their case.

Philadelphia Workers’ Compensation Lawyers at Freedman & Lorry, P.C. Protect the Rights of Injured Workers

If your Workers’ Compensation claim was denied or your payments have suddenly stopped, contact a Philadelphia Workers’ Compensation lawyer at Freedman & Lorry, P.C. We can help you through the process of filing or disputing a denied claim. We also help our clients understand Pennsylvania laws and interact with everyone involved to ensure accurate and efficient communication. Call us today at 888-999-1962 or contact us online for a free consultation. From our offices in Philadelphia, Cherry Hill, New Jersey, and Pinehurst, North Carolina, we serve injured workers throughout Pennsylvania.