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Reasons Why a Workers’ Compensation Claim May Be Turned Down

Reasons Why a Workers' Compensation Claim May Be Turned Down

In the aftermath of a work-related injury, one of your first courses of action will typically be to notify your employer and initiate the necessary steps to obtain workers’ compensation benefits. Though your claim may often seem pretty straightforward, it’s not at all uncommon for your application for benefits to be denied. Here are some of the more typical reasons why so many workers’ compensation claims are initially rejected.

You Waited Too Long to Notify Your Employer

Under the Pennsylvania workers’ compensation laws, you must provide notice to your employer within a specific time period. Accordingly, you’ll want to let your employer know about an injury or illness as soon as you know about it. Not only will you risk having your claim rejected outright for failure to timely file, but you also give opposing attorneys grounds for arguing that your injury wasn’t that serious or that it was caused by another event.

Your Claim Is Challenged

There are a number of reasons your employer or the workers’ compensation insurance company may contest your claim. Your employer may argue that the injury was not work-related, that you suffered the trauma while away from the job. Your employer may allege that your injuries are not as serious as you say they are, and may introduce evidence from a company doctor to support that claim (you will be required to submit to an “independent” examination from a company-selected doctor once you’ve notified your employer of the injury or illness).

Your employer may also claim that your injury was pre-existing. Under Pennsylvania law, a pre-existing injury will not bar you from eligibility for workers’ compensation benefits, provided you sought treatment for and fully recovered from the prior injury.

You Engaged in Wrongful Conduct

As a general rule, workers’ compensation benefits are available irrespective of fault. However, if you intentionally violate safe work practices, or if you intentionally self-inflict injuries, you will likely be disqualified for workers’ compensation benefits.

Contact Our Experienced Workers’ Compensation Attorneys

Send us an e-mail or call our office to schedule an appointment to learn how we can help with a workers’ compensation claim. Evening and weekend consultations are available upon request.

Third Party Claims for Work-Related Injuries

Work-Related Injuries

In Pennsylvania, as in other states, when you are injured on the job, your first course of action will be typically to file a workers’ compensation claim. In many instances, it will be your exclusive remedy, meaning it will be the only method of recovery for your injuries. There are, however, situations where you won’t be limited to what you can recover through a workers’ compensation claim, and there may even be times where you can file a workers’ compensation and a personal injury lawsuit simultaneously. Here’s how it works.

One of the goals of state workers’ compensation laws—often referred to as the “great bargain,” is to provide a benefit for both workers and employers when a worker is hurt because of the carelessness or negligence of the employer. For a worker, there’s easier and quicker access to benefits, provided your claim is approved. For an employer, because the benefits are based on the worker’s wages, there’s no risk of an exorbitant damage award from an over-sympathetic jury.

The important thing to understand, though, is that workers’ compensation benefits are designed to cover situations where the employer or a co-employee was negligent. It does not limit your rights if your injury was caused by an unrelated third party. Some common situations where workers are hurt by the carelessness of an unrelated third party include:

  • Where your injury was sustained in a motor vehicle accident involving an at-fault party who is neither your employer nor a co-worker
  • Where your injury is caused by the malfunction, breakdown or negligent design of a tool, machine or other product
  • Where your injury was caused by a person on an adjoining work site, or by an unrelated bystander or third party

It is possible, if your injury was caused in part by the carelessness of your employer or a co-employee, and in part by an unrelated third party, to simultaneously seek workers’ compensation benefits and damages in a personal injury lawsuit. It’s important to recognize, however, that you cannot recover twice for the same loss. For example, if your medical expenses were covered by workers’ compensation, you cannot recover for the same medical expenses in a lawsuit against a third party.

Contact Our Experienced Workers’ Compensation Attorneys

Send us an e-mail or call our office to schedule an appointment to learn how we can help with a workers’ compensation claim. Evening and weekend consultations are available upon request.

Will a Pre-Existing Injury Prevent You from Recovering Workers’ Compensation?

Will a Pre-Existing Injury Prevent You from Recovering Workers' Compensation?

In Pennsylvania, when you have been hurt on the job, you have a right to pursue workers’ compensation benefits if you can prove two things: that you were hurt and that the injury occurred while you were working. What happens, though, if you had suffered an unrelated injury in the past, off the job, and you have an accident at work that causes that old injury to flare up? Can your employer deny you benefits because the original injury was not work-related?

In Pennsylvania, an injured worker cannot be denied workers’ compensation benefits solely because the injury relates to a pre-existing medical condition. If the old injury never healed, and that’s was causing your current disability, you may find it difficult to get your claim approved. However, if it’s an aggravation of a prior injury, you may be able to recover benefits.

The key, in most cases, is whether you can show that some current activity or accident at work made the condition worse. If you played baseball in college and suffered a torn rotator cuff, limiting movement in your shoulder, you may not be able to recover workers’ compensation if you take a job that requires a lot of heavy lifting and you experience pain in the old injury. However, if you fall at work or are involved in some traumatic accident that causes new pain or injury, that claim may be approved.

Contact Our Experienced Workers’ Compensation Attorneys

The workers’ compensation process can be complex and intimidating, and many legitimate claims are initially denied. Don’t risk the denial of benefits to which you are entitled. Send us an e-mail or call our office to schedule an appointment to discuss your rights related to a workplace injury. Evening and weekend consultations are available upon request.

Was Your Injury Work-Related? – Part Two

Is Your Injury Work-Related—Part Two

In the aftermath of a workplace injury in Pennsylvania, you have a right to seek workers’ compensation benefits, provided you can show that you suffered an injury and that the injury occurred while you were on the job. In an earlier blog, we looked at whether injuries suffered on a break or while traveling are covered by workers’ compensation. Here are couple other situations where your employer may try to deny your workers’ compensation claim by alleging that your injury did not happen during the course of your employment.

Injuries Sustained at a Company Outing

Many companies have team-building events, such as golf outings or trips to concerts, shows or other attractions. Unfortunately, people are often hurt on these excursions, and employers will attempt to argue that no work was conducted at the event, so any injury suffered was not work-related.

As a general rule, you are entitled to pursue workers’ compensation benefits for injuries you receive at a company event or outing, whether or not attendance is mandatory. Your claim may be denied, though, if your employer can show that you behaved unreasonably and that behavior caused your injury. For example, if you became inebriated at a company function and fell and hurt yourself, you may have a difficult time recovering workers’ compensation benefits. If your employer provided the alcohol, though, you’ll have a better chance of recovery.

Injuries Caused by Your Own Carelessness or Misconduct

As a general rule, workers’ compensation is available regardless of fault—your employer must provide you with benefits regardless of who caused the accident. However, if you intentionally injure yourself, or if you engage in behavior that you know is in violation of company policies or safety guidelines, you could lose your right to recover workers’ compensation benefits.

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Send us an e-mail or call our office to arrange a meeting to discuss your work-related injury. Evening and weekend consultations are available upon request.

Is Your Injury Work-Related: Part One

Is Your Injury Work-Related—Part One

In Pennsylvania, to qualify for workers’ compensation benefits, you must show that the injury suffered occurred during the course of your employment. In many instances, there’s little doubt that the accident was tied to your job. There are, however, some situations where the connection may not be as clear, or where your employer may try to argue that the injury wasn’t work-related.

Injuries that Happen When You Are on a Scheduled Break

Labor laws require that most employees be given periodic breaks, including time off for meals. If you slip and fall when in the break room or while grabbing some lunch in the company cafeteria, can your employer argue that you were off the clock and, therefore, not entitled to workers’ compensation?

The answer, as with most things, depends to some degree on the circumstances of your case. As a general rule, if you are still on company premises and taking an authorized break, you can file a workers’ compensation claim for any injuries suffered, even if you were required to punch off the clock for your break. On the other hand, if you leave company premises for a meal or for any other reason during a break, any injuries sustained would not be covered by workers’ compensation, unless you can show that you were on a company-related errand at the time.

Injuries Sustained While Traveling for Work

Any injuries incurred on your way to or from work are generally excluded from eligibility for workers’ compensation benefits. If you travel daily for work, any injuries sustained in a motor vehicle accident or other mishap while traveling will probably be covered, unless you were engaged in a wholly or primarily personal task at the time. For example, if you work as a traveling salesperson, injuries in accidents while you are traveling from one customer to another are covered. But if you make a diversion to pick up dry cleaning or go to a medical appointment, injuries suffered on the diversion most likely would not be covered.

Contact Our Experienced Workers’ Compensation Attorneys

Send us an e-mail or call our office to schedule an appointment to learn how we can help with a workers’ compensation claim. Evening and weekend consultations are available upon request.

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  • B&D Law Group 1110 Kennebec Dr, Chambersburg, PA 17201

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