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Why Some Workers’ Compensation Claims Get Denied in Allentown—and How to Appeal
Filing a workers’ compensation claim after a workplace injury is supposed to offer fast financial support and medical coverage, but many Allentown workers are shocked to learn their claim has been denied. A denial doesn’t mean your case is over. In fact, it’s the beginning of a critical legal process.
At Munley Law Personal Injury Lawyers, we help injured workers in Allentown overturn denied claims and fight for the benefits they’re entitled to under Pennsylvania law. This blog explains the most common reasons for denial and what you should do next if your workers’ compensation claim is rejected.
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One of the most common reasons for denial is failure to report the injury on time. In Pennsylvania, you must report your work injury to your employer within 120 days. Ideally, this should be done immediately or within the first 21 days, or you may lose the right to retroactive wage benefits.
A delayed report can raise red flags for insurance companies, who may argue that the injury didn’t actually happen at work or didn’t happen at all.
For your injury to qualify for workers’ compensation, it must be work-related. Some claims are denied because the employer or insurer argues that the injury occurred outside of work, during off-duty hours, or as a result of horseplay, intoxication, or pre-existing conditions.
For example:
An employer might argue your back injury happened at home, not while lifting boxes
An insurer may say your repetitive stress injury developed from non-work activities
A claim may be denied if you were not performing your job duties when injured
Medical documentation is the backbone of any workers’ comp claim. If your records are incomplete, inconsistent, or missing entirely, your claim may be denied. Other medical-related reasons include:
Not seeking treatment from an approved provider (within the first 90 days)
Failing to follow prescribed treatment plans
Contradictory reports between physicians and specialists
Medical opinions stating you are fit to work despite symptoms
Insurance companies may request an Independent Medical Examination (IME) and base their decision on that doctor’s findings—which are often more favorable to the employer.
Workers’ comp claims can be denied due to paperwork issues. This includes:
Incorrect or missing forms
Conflicting statements in your report or testimony
Lack of supporting documents
Missed deadlines
Insurers also look for inconsistencies between your incident report, medical records, and employer’s version of events. A small mistake or poorly worded description can be used to deny the claim or delay benefits.
In some cases, employers may dispute the claim directly. They may allege that:
The injury was self-inflicted
You were under the influence of drugs or alcohol
You violated company policy
You were not acting within the scope of your employment
This puts your word and evidence up against theirs, which is why having legal representation becomes crucial early in the process.
If your claim has been denied, you still have options. In Pennsylvania, you have the right to file a Claim Petition with the Bureau of Workers’ Compensation. This initiates the appeal process and puts your case in front of a Workers’ Compensation Judge (WCJ).
Here’s how the process works:
File a Claim Petition within three years of the injury
Attend a hearing where both sides present evidence
Provide medical records, testimony, and expert opinions
Wait for the judge’s decision, which can take weeks or months
The appeal process is legal in nature and often adversarial. Insurance companies will have attorneys representing them. You should, too.
Munley Law has successfully appealed denied workers’ compensation claims in Allentown for decades. We’ll help you:
Gather strong medical evidence
Prepare and file all legal paperwork
Coordinate expert witness testimony
Challenge the insurance company’s IME findings
Represent you at all hearings and negotiations
Our goal is to get your claim approved as quickly and effectively as possible, so you receive the medical care and wage support you need.
Here are some tips to improve your chances of a successful appeal:
Keep copies of all documents, including accident reports, medical records, and communications
Don’t exaggerate or minimize your injuries—be consistent and honest
Avoid posting about your injury or case on social media
Follow your doctor’s instructions exactly
Consult a lawyer before attending an IME or responding to insurance inquiries
Having an attorney by your side can prevent small errors from becoming costly mistakes.
Workers’ compensation denials are frustrating, especially when you’re dealing with pain, stress, and financial uncertainty. But you don’t have to give up hope. Many denied claims are approved on appeal—with the right legal strategy and support.
At Munley Law Personal Injury Lawyers, we know how to challenge insurance company tactics and fight for workers in Allentown who have been unfairly denied benefits. We offer free consultations and work on a contingency fee basis—you pay nothing unless we win.
If your workers’ compensation claim has been denied in Allentown, contact Munley Law today. We’ll review your case, explain your options, and help you move forward with confidence.