Once an insurance carrier is notified of a work injury, it is required by law to promptly investigate the injury and determine whether the claim is compensable within 21 days under Section 406.1 of the Pennsylvania Workers’ Compensation Act. Before any decision is made on each claim, one can only assume that at the very least these investigations involve speaking with the injured worker, obtaining witness statements and incident reports from the employer, and reviewing medical records. However, there is a growing concern that claims adjusters too commonly deny claims without performing a reasonable investigation of the injury and ignore pertinent information they do have in their possession at the time a denial is issued.
Imagine being transported by ambulance to the emergency room following a witnessed work accident. The injury was timely reported to the employer on the date it occurred and medical records documenting the work injury were turned over once they became available. Due to the severity of the injury, it is undetermined when a return to work is possible, if at all, and the only available form of income while being out and recovering is weekly workers’ compensation benefits. Then, out of nowhere, a notice of workers’ compensation denial is received in the mail indicating that no work injury was sustained on the date in question.
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