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Common Reasons Workers’ Comp Claims Get Denied in Pittsburgh
When you’ve been injured on the job in Pittsburgh, the expectation is clear: you report the injury, get medical treatment, and receive the wage and medical benefits promised under Pennsylvania’s workers’ compensation law. But this process doesn’t go as smoothly as it should for many injured workers. One of the most frustrating moments comes when your workers’ comp claim is denied.
A denial doesn’t mean the end of your case, but it is a critical moment that requires swift action. At Munley Law Personal Injury Lawyers, we’ve helped countless Pittsburgh workers turn denied claims into approved benefits. In this article, we break down the most common reasons workers’ comp claims get rejected and what you can do to fight back.
One of the top reasons for denial is that the injured worker didn’t report the injury promptly. In Pennsylvania, you have 120 days from the date of injury to notify your employer. However, the longer you wait, the more likely the insurer is to question the validity of your claim.
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Ideally, you should report your injury immediately, preferably within 21 days. Report it in writing and keep a copy. Failure to do so gives the employer and insurer grounds to argue that your injury isn’t work-related or didn’t happen as you said it did.
To receive workers’ comp, you must demonstrate that your job caused your injury or illness. The insurance carrier may deny the claim if there’s any confusion or contradiction, such as if the accident happened off-site or during non-work hours.
Additionally, injuries from long-term exposure or repetitive motion (like carpal tunnel or back strain) may be denied initially due to the difficulty in pinpointing a specific incident. Proving these types of injuries often requires detailed medical records and, in some cases, expert testimony.
Another common reason for denial is the argument that your injury was the result of a pre-existing condition. For example, if you previously injured your knee and now claim a knee injury at work, the insurance company may assert that your job didn’t cause it.
However, under Pennsylvania law, workers’ compensation still applies if your work duties aggravate or worsen a pre-existing condition. An experienced attorney can help gather medical evidence to prove that your job worsened your condition and that you’re entitled to benefits.
In Pennsylvania, your employer can require you to seek treatment from a panel of approved doctors for the first 90 days after your injury. If you seek treatment outside this network during that period, the insurer may deny coverage for those bills.
Sometimes, claims are denied because the employee did not follow prescribed medical treatment, missed follow-up appointments, or returned to work too early. Keeping consistent medical records and following all treatment instructions is essential.
A surprising number of denials are based on mistakes in paperwork. This includes:
Incomplete injury reports
Incorrect or missing dates
Lack of medical documentation
Failure to file a claim petition on time
Even small administrative errors can derail your claim. That’s why having legal guidance from the start can make a major difference. We ensure that every form, deadline, and document is submitted correctly.
If you were under the influence of drugs or alcohol at the time of the incident, or if your injury resulted from horseplay, intentional self-harm, or violating company safety rules, your claim may be denied.
However, these are not always straightforward issues. The insurance company must prove that misconduct or intoxication was the direct cause of the injury. If you’ve been denied for these reasons, you still have the right to a hearing and to defend yourself with legal support.
Many insurance companies deny claims to discourage workers from pursuing benefits. They know that many workers won’t fight back. But you don’t have to accept their decision without a fight.
If your claim has been denied, here’s what you should do next:
Review the denial letter carefully. It should state the reason for denial and your right to appeal.
Contact an experienced workers’ compensation attorney as soon as possible.
Gather all relevant documentation, including medical records, injury reports, and witness statements.
File a Claim Petition with the Pennsylvania Bureau of Workers’ Compensation within three years of the injury.
Attend a hearing before a workers’ compensation judge. You and your attorney will present evidence and argue your case.
The appeals process can take several months; missing a deadline or document can set you back. That’s why it’s crucial to have a knowledgeable attorney on your side.
At Munley Law, we fight for injured workers who’ve been wrongfully denied the benefits they deserve. We’ll investigate the reason for your denial, collect strong evidence, consult medical experts, and represent you throughout the hearing process.
Our team knows insurance companies’ tactics and how to counter them effectively. We prepare every case for trial, and we don’t get paid unless we win for you.
If your workers’ compensation claim in Pittsburgh has been denied, don’t give up. You have rights—and we’re here to protect them.
Contact Munley Law Personal Injury Lawyers today for a free case evaluation. We’ll help you understand your options and start building your appeal immediately.
More Great Work Accident – Injury / Workers’ Compensation Blogs here:
https://houston-auto-accident.com/third-party-liability-in-work-accidents/
https://san-antonio-auto-accident.com/the-role-of-vocational-rehabilitation-in-workers-compensation-claims/
https://corpus-christi-auto-accident.com/the-role-of-a-workers-compensation-lawyer-in-philadelphia-work-injury-cases/
https://mcallen-auto-accident.com/pre-existing-conditions-on-workers-compensation-claims/
https://austin-auto-accident.com/what-happens-if-youre-injured-on-a-construction-site/
https://el-paso-auto-accident.com/permanent-disability-and-workers-compensation-claims/
https://laredo-auto-accident.com/workers-compensation-appeal-process-in-philadelphia/
https://beaumont-personal-injury.com/work-related-mental-health-injuries/
https://victoria-auto-accidents.com/protect-your-rights-during-your-recovery-in-philadelphia/
