Appealing A Denied Workers’ Comp Claim In Pennsylvania

Each day, millions of Americans work hard at their jobs to provide for their families and to contribute to their communities. Most of us probably don't expect a work-related injury, illness, or occupational disease to suddenly deprive us of a steady paycheck. In some cases, a debilitating injury creeps up on a worker slowly over time. In any instance of job-related impairment, injured employers are entitled to file claims for Workers' Compensation.

Unfortunately, far too many workers struggle to receive the benefits they're entitled to. Employers and insurance companies can both be hesitant to accept claims in order to save money. While there are cases of frivolous claims by workers who don't truly require time off, there are many cases where injured workers who are genuinely unable to work are denied the compensation they deserve.

If you've recently received a letter for a denied claim, you may still have a right to compensation. Appeals offer recourse for workers who have wrongfully been denied the compensation they're entitled to.

Many injured workers get denied because they're unfamiliar with the system. In other situations, their employer or the insurance carrier may have unfairly disputed the claim. When this happens, an experienced work injury lawyer can help gather the necessary evidence and documents to get through the complex appeals process so that you can receive the compensation you need while recovering from a work injury.

Common Reasons For Denied Claims

Receiving Workers' Compensation is not always easy. Your claim could be denied for a number of reasons, including relatively minor mistakes.

Common reasons for claim denials include:

• You filed your report too late
• You visited a doctor but didn't report the injury to your employer
• Differences between your report and your medical records
• Your employer is contesting the claim (e.g. they believe the injury happened outside of work, they believe you were intoxicated, etc.)

If your claim has been denied, you should contact your employer and their insurance company to see if a simple misunderstanding might be to blame, such as missing paperwork.

Retaining an experienced work injury lawyer is often the best way to move through these roadblocks as soon as possible. Attorneys who specialize in these cases know what evidence they need and how to collect and present it so that your appeal is accepted.

How Does The Appeals Process Work?

When you file a claim for Workers' Comp in Pennsylvania, the insurance company must respond within 21 days and either accept or deny your claim. If your claim is denied, you have 20 days to file a claim petition with the PA Bureau of Workers' Compensation. A Workers' Comp judge will hear your case and either accept or deny your appeal.

If your petition is denied at this stage, you can take further action by filing an additional appeal with the Workers' Compensation Appeals Board. The Board will review the details of your case and provide you with a written decision. If your appeal gets denied at this stage, you have 30 days to file another appeal with the Pennsylvania Commonwealth Court.

Do I Need A Lawyer For An Appeal?

While you're free to go through the appeals process on your own, having a knowledgeable work injury lawyer by your side dramatically improves your chances of success. According to Pennsylvania's Department of Labor and Industry, "you should be aware that WC litigation is complex, and your employer or your employer's insurance carrier will be represented by an experienced attorney." In order to ensure a fair fight, it's almost necessary to have your own experienced legal representation.

If you're worried about how you can afford lawyer's fees on top of medical expenses while you're out of work, don't be. We understand the financial struggles injured workers go through while battling through a difficult appeal. That's why we'll evaluate your claim for free and only ask for payment as a small percentage of your benefits if we win for you.

More About Workers' Comp

• Guide to Pennsylvania's Workers Compensation system
• Industries with high frequencies of injuries and illnesses
• Workplace injuries which require missed days and benefits