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Common Ways Employers Dispute Injury Claims
When you get hurt at work, you expect your employer’s insurance to step up and cover your medical bills and lost wages. But the reality is, many workers in Philadelphia run into problems when their claims get disputed. If you’re wondering why employers push back against honest claims, you’re not alone. Let’s break down some of the most common tactics employers use to fight work injury claims and what you can do if you run into these roadblocks. If your claim is under attack, talking to a Philadelphia workers’ compensation attorney can make all the difference.
Table of Contents
Denying the Injury Happened at Work
One of the first arguments employers use is saying your injury didn’t actually happen while you were working. They may claim you got hurt off the clock or outside the workplace. For example, if you slipped in the parking lot at the end of your shift, your boss might argue that you were “off the job” and not covered.
Sometimes, employers insist the injury happened due to activities outside work, such as during your commute or a weekend sports game. This approach is especially common when the injury isn’t witnessed or there’s no camera footage. If your accident happened in a less obvious way, like developing carpal tunnel from repetitive tasks, they may claim it’s unrelated to your job.
Don’t let this stop you from getting what you deserve. Pennsylvania law covers most injuries that occur in the “course and scope” of employment—even if you’re not at your workstation. If your boss uses this excuse, keep detailed notes about when, where, and how you were injured. Talk to coworkers who witnessed the accident. If you’re unsure what counts as a work injury, a workers’ compensation lawyer can review your situation and help you gather proof.
Claiming the Injury Was Pre-Existing
Another popular tactic is arguing that your pain or condition existed before you ever started the job. Employers or their insurance companies may dig into your medical history to find anything they can use. For example, if you hurt your back lifting boxes at work, your employer might point out you had back pain years ago, hoping to shift the blame off themselves.
They may also suggest your current pain is a “flare up” of an old injury, not something new. Workers dealing with repetitive stress injuries or chronic pain are especially vulnerable to this excuse.
You have the right to claim benefits for new injuries—even if you had a similar problem in the past. The key is showing that your job caused your current condition or made it worse. Medical records, doctor’s notes, and statements from healthcare providers can help draw a clear line between your work duties and the injury. If you’re facing this kind of pushback, speaking with a work injury lawyer can help you build a strong case.
Delaying or Disputing Medical Treatment
Employers and their insurers often try to control or delay your medical care. They may refuse to approve certain doctors or treatments, hoping you’ll get frustrated and drop the claim. Sometimes, they say your treatment isn’t “reasonable” or “necessary,” even if your doctor says it is.
You might also run into problems if you don’t follow your employer’s rules about reporting injuries or using their list of preferred providers. In Pennsylvania, you usually have to see a company-approved doctor for the first 90 days after your accident, but after that, you can choose your own.
Insurance companies use delays and denials to pressure you into accepting less money or giving up. Don’t give in. Keep all records of your medical visits and prescriptions. Follow your doctor’s advice and meet all deadlines for reporting and appointments. If you’re being sent for repeated medical exams or your care is being stalled, a workers’ compensation attorney can fight to get your treatment approved.
Blaming the Employee for Misconduct or Policy Violation
Some employers try to avoid responsibility by accusing the injured worker of breaking rules, being careless, or even being under the influence. Pennsylvania law generally provides “no-fault” coverage, but there are exceptions. If your employer can prove your injury happened because you were intoxicated, violating safety rules, or acting recklessly, they may deny your claim.
For instance, if you got hurt by not wearing required safety gear or because you were fooling around, your employer might argue you’re not eligible for benefits. Even so, these cases aren’t always clear-cut. The law puts the burden on the employer to prove you were at fault in a disqualifying way.
If you’re facing accusations of misconduct, get statements from witnesses and gather any evidence that supports your side of the story. Remember, a workers’ compensation lawyer can help defend you against unfair or exaggerated claims from your employer.
Arguing the Injury Isn’t Severe or Doesn’t Require Missed Work
After a work injury, some employers argue that you aren’t really hurt “that bad” or that you can work in a “light duty” job and shouldn’t be off work at all. They may downplay your pain or insist you should be able to return quickly, even if your doctor feels otherwise.
Employers sometimes offer alternative jobs that don’t match your abilities or ignore restrictions set by your doctor. If you refuse the position, they might accuse you of not cooperating and try to cut off your benefits.
You have the right to follow your doctor’s advice, not just your employer’s wishes. If you’re pressured to go back before you’re ready, document all communications and keep copies of your doctor’s notes. An experienced workers’ compensation attorney can protect your rights and make sure you aren’t forced back to work before you’re medically cleared.
FAQs About Common Ways Employers Dispute Injury Claims
What should I do if my employer denies my work injury claim?
If your claim is denied, don’t panic. Report the denial to your doctor and keep all paperwork. Then, contact a Philly work injury lawyer who can review your case, gather evidence, and file a petition with the Pennsylvania Workers’ Compensation Bureau on your behalf.
Can I still get workers’ comp if the accident was my fault?
In most cases, yes. Pennsylvania workers’ comp is “no-fault,” so you can receive benefits even if you made a mistake. However, claims may be denied for injuries caused by intoxication, fighting, or clear violations of safety rules.
How long do I have to report my work-related injury in Philadelphia?
You should report your injury to your employer as soon as possible, ideally within 21 days. If you wait more than 120 days, you could lose your right to benefits. Always report accidents in writing and keep a copy for your records.
Can I sue my employer for a workplace injury in Philadelphia?
Workers’ compensation is usually your only remedy. However, you can sue your employer in rare cases of intentional harm or gross negligence. You may also have a claim against equipment manufacturers or other third parties. If you think your situation qualifies, talk to a Philadelphia personal injury lawyer for guidance.
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