Hurt while working in Philadelphia? Munley Law Personal Injury Lawyers have been trusted by Pennsylvania workers for decades to win tough workers’ compensation claims.

 Common Reasons Workers’ Comp Claims Get Denied in Philadelphia
 

A workplace injury can disrupt every part of your life—physically, emotionally, and financially. Most injured workers in Philadelphia expect that filing a workers’ compensation claim will help them recover by covering medical bills and wage loss. But what happens when your claim is denied?

Unfortunately, claim denials are all too common in the Pennsylvania workers’ compensation system. At Munley Law Personal Injury Lawyers, we’ve helped countless workers in Philadelphia fight denied claims and get the benefits they are legally entitled to. If your workers’ comp claim has been rejected, understanding its reasons is the first step to building a strong appeal.

You must notify your employer within 120 days of a workplace injury in Pennsylvania. But your claim may be denied if you wait too long or fail to report the injury properly. Employers and insurance companies often use late reporting as an excuse to challenge whether your injury really happened at work.

Find more information on Workers’ Compensation here

To avoid this, consistently report your injury as soon as possible, ideally within 21 days. Provide written notice with details like when, where, and how the injury occurred.

Another common reason for denial is a claim that your injury did not arise “in the course and scope of employment.” For example, the insurance company may argue:

The injury happened on a break or outside work hours
You were not on duty when the injury occurred
The injury was due to a personal activity or a pre-existing condition

Your claim may still be valid even if you were injured off-site or while traveling for work. An experienced attorney can help prove that your injury was job-related.

When your employer or insurer argues that your condition existed before your job began, they may deny your claim entirely. However, you are still entitled to benefits if your work duties aggravated or worsened a pre-existing condition.

At Munley Law, we work with medical professionals who can review your history and provide testimony showing how your injury is related to your current job.

If you fail to seek medical treatment—or don’t follow your doctor’s orders—the insurance company may claim that your injury isn’t serious or that you’ve recovered. They may also accuse you of malingering or refusing treatment.

To protect your claim, always:

Visit a doctor immediately after the injury
Follow all treatment plans
Attend follow-up appointments
Notify your employer and lawyer if your symptoms change or worsen

Pennsylvania law allows employers to require treatment from a panel of approved doctors for the first 90 days after a workplace injury. If you go outside of that panel without approval during this period, your medical bills may not be covered.

After 90 days, you may select your own doctor—but make sure they’re willing to provide workers’ comp documentation and appear at hearings if needed.

Insurance companies may deny your claim because the treatment you’re receiving is “not reasonable or necessary.” This often happens with ongoing physical therapy, surgeries, or expensive prescriptions.

We challenge these denials by working with medical experts to establish the necessity of your care and explain why it directly relates to your workplace injury.

Clerical errors, missing forms, or lack of supporting documentation can lead to delays or outright denials. Common administrative issues include:

Missing accident reports
Inaccurate wage calculations
Incomplete medical records
Failure to file a Claim Petition on time

At Munley Law, we ensure that all paperwork is submitted correctly and on time. We also double-check wage records to ensure you receive the correct amount in lost wage benefits.

If you were intoxicated, acting recklessly, or violating safety rules at the time of your injury, the insurer may attempt to deny your claim. However, the burden is on them to prove misconduct or intoxication was the direct cause of the injury.

Similarly, if you were injured due to faulty equipment, dangerous work conditions, or another party’s negligence, you still have the right to benefits—and possibly a third-party lawsuit.

If your claim is denied, don’t panic—and don’t give up. You can appeal through the Pennsylvania Workers’ Compensation Office of Adjudication. The appeals process involves:

Filing a Claim Petition
Presenting your case before a workers’ comp judge
Providing medical records and witness testimony
Cross-examining your employer’s evidence
Receiving a written decision and further appeal rights

This legal process can be complex; insurance companies will bring experienced lawyers. You should have an experienced advocate in your corner too.

At Munley Law Personal Injury Lawyers, we fight aggressively for injured workers in Philadelphia. Our team will:

Investigate the reasons for your denial
Gather strong medical evidence and expert testimony
Challenge errors in your wage calculation
Represent you at every stage of the appeal
Negotiate for the maximum settlement available under the law

We don’t charge any legal fees unless we win your case.

If your workers’ compensation claim has been denied in Philadelphia, don’t face the appeal process alone. Your decisions now can affect your financial stability and future health.

Contact Munley Law Personal Injury Lawyers today for a free consultation. We’ll help you understand why your claim was denied and take immediate steps to fight for the benefits you’re owed.

 

 

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/