Philadelphia Workers’ Compensation Lawyer Explains When You Can Sue Your Employer for Denying WC
You have been injured on the job and know that Pennsylvania uses a “no fault” system of benefits under the law called workers’ compensation. Whether you are hurt working for the City of Philadelphia (one of the largest employers in Philly) or at one of the hundreds of other private businesses around town, you expect for your claim to be approved to reimburse you for your medical bills and lost wages. Unfortunately, our workers’ comp lawyer in Philadelphia, PA at HGSK knows that does not always happen.
Sometimes claims get improperly denied. An employer or WC will not work with you and you still do not know what happened and why your claim was denied. The process seems unfair—oftentimes because it can be. Your family is impacted by this too, and you are not sure of your options.
One of the most common out of this scenario is can you sue your employer because they denied your workers’ compensation claim? The short answer is yes; however, it is unsurprisingly much more complex than that. Our experienced Philadelphia workers’ comp attorneys at HGSK know this to be true, as we have many years of experience handling WC claims throughout Pennsylvania and Philadelphia. We can help you navigate the legal nuances of workers’ compensation so you get the full justice you deserve. Learn how we can help you during a FREE consultation with our law firm.
What is Workers’ Compensation?
Workers’ compensation provides benefits to workers who have been injured, regardless of if the worker was at fault or the employer was at fault. This is why it is often referred to as a “no fault” system of benefits.
Workers’ compensation is designed to prevent employees from suing their employers for a workplace injury that resulted from the employer’s negligence. In other words, by working for the employer, the worker is agreeing to not sue the employer but instead receive workers’ compensation benefits as the exclusive remedy for a workplace injury in lieu of suing. But there are exceptions to this rule.
What are Workers’ Compensation Benefits?
Workers’ compensation benefits vary in nature and are typically tailored to the particular individual’s needs and circumstances surrounding the claim. Specifically, they can include the following: medical expenses, such as doctor visits, physical therapy, and prescription and over-the-counter medications; vocational rehabilitation; and disability benefits.
Can Workers’ Compensation Claims Be Denied?
The short answer to this is, again, yes, however, many exceptions can apply. There are several commonly seen reasons as to why an employer would deny an employee’s claim.
One reason a WC claim may be denied is that the accident and injuries did not occur within the workplace, otherwise referred to as happening outside the scope of employment. This means that the accident did not happen while the employee was working for the employer. The discrepancies here can get murky, as sometimes you are technically working for the employer, while off-site, for example. If the accident occurs while the employee is running an errand for the employer, for instance, that would be considered within the scope of employment.
If it is determined that the accident occurred within the scope of employment, then it should be assessed whether the accident report and medical records match up. In other words, the accident report and medical records match up in terms of the magnitude of the accident and injury. Sometimes employees tell their doctor that the accident happened in a way that it did not, and a doctor can easily see through that with today’s expertise and technology. What an employee reports in the accident report must be substantiated by a medical provider, or it may prove ineligible.
Likewise, it is crucial to file a workers’ compensation claim immediately after the incident at hand. Even if the injury seems minute, it is worthwhile to report it to your employer because it may be significant or become significant later. Documenting everything throughout the WC claim process is vital. If you file the claim too late, it may get denied, even if it would have otherwise been valid.
This may also be the case if you file the claim after you have been terminated or laid-off, because the claim may look retaliatory. As previously stated, it is best to file the claim as close to the incident as possible. If there were witnesses to the accident, it is best to report the injury to them as well.
Additionally, you may be ineligible for workers’ comp benefits if you were under the influence of drugs or alcohol at the time.
Finally, if you refuse to provide a statement concerning the incident to the insurance company, this may also preclude you from receiving benefits.
When Can You Sue an Employer for Denying a WC Claim?
Despite the reasons why a claim was denied, you have the option of hiring an experienced workers’ comp lawyer in Philadelphia to fight back. Each of the common causes for a claim to be denied above could be contested. Sometimes a carrier or an employer twists the facts to paint you in a bad light or affect your claim. This is often done to save money on premiums or costs, all at your expense.
Other times you can sue your employer for denying a WC claim in Pennsylvania include the following:
- If the employer does not have WC insurance and should have under the law
- For intentional torts like assault, battery, or sexual offenses
- When the employer failed to timely file your claim with the WC carrier
- Against negligent third-parties
- For inherently dangerous and reckless conduct, and
- Some other rare exceptions.
Unsure What Your Legal Rights Are? Ask HGSK in Philadelphia, PA for Help
If your employer denied your workers’ compensation claim in Philly, or anywhere else in Pennsylvania, learn how we can help protect your rights to compensation by scheduling a FREE consultation with our experienced workers’ compensation attorneys at HGSK. We are here to help you and your family after a workplace injury or accident caused your injuries. Call (267) 350 6600 or use our “contact us” box to send us a message to get started today.