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PENNSYLVANIA FEDERATION OF INJURED WORKERS Call us toll free 1-888-376-7942
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November 14, 2002
No Penalty for an Employer Who Denies a Work Related Injury Claim Without Reason! Expressed opinion by Michael A. Kerstetter, PFIW Dauphin County Because there is no protection against the practice of denying a work related injury claim without any reason many injured workers suffer financially. Section 406.1 (c) of the Pennsylvania Worker's Compensation Act allows an employer to controvert an injury claim. Many injured workers lose their homes to foreclosure and a lot of families fall apart because of the financial disarray caused when an employer/worker's compensation insurance company decide they will just out right deny that an injury occurred on the job. In order to stay financially solvent many injured workers use their savings and retirement funds while a petition is filed to get an employer to except responsibility for a work related injury. If an injured worker does not have those resources available to fall back on then bankruptcy is the only option. It takes at least 9 months, maybe longer, to get a petition through the litigation process for a determination of a claim. Employers/worker's compensation insurance companies hope that an injured worker will give up during that period and disappear. Denying that an injury occurred on the job is a malicious act meant only to cause suffering for the injured worker. I say this because section 406.1 (d) of the Pennsylvania Workers Compensation Act allows an employer to pay out worker's compensation benefits without accepting responsibility for the injury. This allows the employer time to investigate and make sure the injury is legitimate. If through litigation in the worker's compensation system the employer is found to not be responsible for the injury, section 443 (a) of the Pennsylvania Worker's Compensation Act allows the employer to be reimbursed for the amount of benefits paid out. So if the employer is protected against any loss due to paying out worker's compensation benefits they are not responsible for, why do they deny claims? Because the employers know they are responsible for the injury and by denying it the employer keeps their worker's compensation insurance rate from increasing until a Worker's Compensation Referee orders the employer to accept responsibility. Also the employer may be self-insured and just wish to escape from the financial expense of paying compensation benefits for a work related injury. Some employers go as far as to exploit injured workers, who do not speak very good English or don't know their rights under the Pennsylvania Worker's Compensation Act, by convincing them to not file an injury report. Then the injured worker is instructed to seek medical treatment through the employers HMO. This is one of the most common practices of unethical employers. They will even go as far as to allow the injured worker to collect Unemployment Compensation while recovering from the injury by not contesting the claim for unemployment. This is insurance fraud in it's most ugly form perpetrated by the very employers who claim the injured worker is committing fraud by using worker's compensation. Then when the injured worker wants to return to his/her job it is no longer available for them. They are left out in the cold with no where to turn to for help. This practice is being perpetrated on mostly Hispanic and other immigrant workers in parts of the state where the law seems to be scarce and the jobs available are hazardous to a workers health. This issue was brought up at the Pennsylvania Worker's Compensation Advisory Council meeting by the Pennsylvania Federation of Injured Workers but so far no action has been taken on the issue to date. Once again, there is no penalty for an employer denying a work related injury claim. If an employer denies a legitimate claim for worker's compensation there should be a substantial penalty for the denial since this practice is so devastating to an injured worker and his/her family. This would make sense and it would stop unethical employers from denying a legitimate workplace injury claim. Where is the protection for the injured worker?
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