When Can a Workers’ Compensation Claim Be Denied in Pennsylvania?

If you are employed in Montgomery, Pennsylvania, and you sustain an injury or develop an illness due to a situation or condition on the job, workers’ compensation benefits may be available to help you with medical bills and lost wages that occur as a result. Benefits are covered by your employer’s workers’ compensation insurance, and cases that are not covered are rare. However, there are some instances where you may receive a denial of benefits.

According to the Pennsylvania Department of Labor and Industry, in order to receive workers’ compensation benefits, you must not create the medical issue intentionally, or because of impairment due to the use of illegal drugs or alcohol. You may also be denied coverage if you do not report a legitimate medical issue within 120 days of the injury. If the health problem is the result of exposure to a hazard such as asbestos, it must be reported within 300 weeks of your last day of employment where you were subjected to that environment.

Even after your benefits have begun, there are instances where continued coverage may be denied while you are still unable to return to your previous position. Your employer has the right to offer you a different job based on your restrictions, and if you refuse it, a workers’ compensation judge will review the case. If it is determined that you are able to do the job, your wage loss benefits will probably be ended.

A judge may reinstate your benefits if you file a petition stating that they were wrongfully denied or discontinued and you are able to provide evidence. In mediation or an informal conference, you have the right to be represented by an attorney. This information about workers’ compensation in Pennsylvania is for educational purposes only and is not intended to be taken as legal advice.

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