If you are injured at work and have notified your employer and they are either ignoring it or have denied your claim, you should immediately seek the assistance of an experienced workers’ comp attorney, like those at Aversa and Linn.
Click here for a detailed flowchart for a workers’ compensation claim from the Pennsylvania Department of Labor & Industry.
If your employer or their insurer denies your claim, they must issue a Notice of Workers’ Compensation Denial and file that with the Bureau of Workers’ Compensation. At this point, the claim is closed, and the only way to proceed is through litigation.
If your request for workers’ comp is denied, contact Aversa and Linn to assist you with your next steps. Although you are permitted to file a petition with the Office of Adjudication yourself, workers’ compensation litigation is complex, and your employer or your employer’s insurance carrier will be represented by an experienced attorney. Failure to file a petition in a timely manner may result in forfeiting your right to benefits.
Just because an employer is denying a claim does not mean the denial is valid. You may have a valid claim even if they are saying you do not.
Common reasons claims are denied:
If you are hurt at work, you should tell your supervisor or boss as soon as possible, even if you think it is a minor injury or will go away without requiring medical care. For an injury, you must give your employer notice no later than 120 days after the injury for compensation to be allowed. [1]
Your employer or their insurer may claim that you missed the deadline, and deny your claim as a result.
2. Not work-related
Pennsylvania courts have found that the Workers’ Compensation Act was not intended to make employers liable for all injuries that take place on their premises. In other words, just because the injury took place on an employer’s premises doesn’t always mean they are responsible, and doesn’t mean the injured person is eligible for workers’ comp.
You don’t have to be physically on the premises of the employer, so long as you are engaged in the “furtherance of the business or affairs of the employer” when the injury occurs.
An occupational disease must have been proximately caused by, or aggravated by, the conditions of your work.
Your employer or their insurer may claim that your injury is not work-related, and deny your claim as a result.
Usually, workers are eligible for workers’ comp benefits even if they caused their injury through their own negligence or carelessness. After all, the main motivation behind the workers’ compensation system is to protect the safety of workers and to protect employers from lawsuits. Not assigning fault for the accident is one of the pillars of the system.
However, an employer will sometimes deny a claim by claiming the employee’s injury was:
- Intentionally self-inflicted
- The result of willful misconduct
- The result of horseplay
- Caused by a violation of the law, including, but not limited to illegal use of drugs
- Caused by intoxication
- As with any denials of claims, these cases are complex and best handled with the advice of an attorney.
Would Michael Scott’s claim be denied?
The “Safety Training” episode of The Office gives an example of someone who could have caused their own injury. Michael Scott, the boss, turns a safety training into a competition about who has the more dangerous job, the warehouse workers or the office workers, and becomes upset that the warehouse workers think that he has a cushy, safe job compared to theirs.
He decides to demonstrate how dangerous office work is, by having Dwight gather all of the workers outside, so he can go up on the roof, pretend to be depressed, and then jump, pretending to kill himself but actually landing on a trampoline.
When the workers come outside, they find Michael on the roof.
Michael: [on the roof] My life! Oh, my life…
Dwight: [on megaphone] Michael, what’s wrong?!
Michael: Everything’s wrong. The stress of my modern office has caused me to go into a depression.
Once the workers figure out what he’s about to do, they convince him to come down without jumping.
But what if he had jumped, and injured himself? Could Dunder Mifflin deny his workers’ comp claim?
Is Michael violating a known and enforced rule? If so, this could be considered horseplay or willful misconduct. It could also be considered intentional self-infliction of harm. Even though Michael doesn’t think he will be injured or killed, a reasonable person would know that jumping off a roof onto a trampoline or bouncy house is very dangerous. These are all factors that would be considered in determining if there was a viable worker’s comp claim.
Michael does not seem to think he did anything wrong. At the end of the episode, he says “An office is as safe as the people in it. And sometimes those people can drive you to crazy things to show the dangers of the office. That’s the danger I found myself in today. I saved a life. My own. Am I a hero? [pause] I really can’t say, but yes.”
If your request for workers’ comp has been denied, contact the experienced workers’ compensation lawyers at Aversa and Linn to assist you with your next steps.
1. In occupational disease cases, injury/disability must occur within 300 weeks from the date of last employment in an occupation in which you had exposure to a hazard, and a petition must be filed no later than three years from the date of injury/disability.
