Learn more about why workers’ compensation claims are denied and what you can do about it
Workers compensation is an insurance program with the purpose of providing compensation to employees who have suffered job-related injuries and illnesses. The Pennsylvania Workers’ Compensation Act ensures that your medical expenses will be paid and, if you are unable to work, you will receive compensation for lost wages until you are able to return to work. Private insurance companies pay these benefits or, for self-insured employers, the State Workers’ Insurance Fund.
Workers’ compensation covers work caused injury, illness, or disease. As long as your injury or illness was not intentionally self-inflicted or caused by breaking the law, you should be covered by workers’ compensation. Despite this sounding like broad protection for employees injured on the job, workers’ compensation claims are frequently denied.
The workers’ compensation system can be very difficult to navigate. The denial of a workers’ compensation claim, however, does not mean you are out of options. If you find yourself in this position, it is important to know what you can still do to possibly recover compensation for your workplace injury or illness.
What happens if my workers’ compensation claim is denied?
Some of the most common reasons for workers’ compensation claim denials include:
- Untimely claim filing
- Untimely reporting of a workplace injury
- No witnesses to your injury
- Failure to cooperate with insurance company requests
- Medical report states presence of illegal drugs in your system
- Employer disputes the accident occurred at work
- Employer disputes the illness/injury resulted from workplace accident
If you receive a notice that your workers’ compensation claim is being denied, then you should know that you still have options to pursue your claim. The notice of denial should state the reason(s) your workers’ compensation claim was denied. This letter may also explain how you can appeal the denial of your claim. Be cognizant of any details included in the letter such as deadlines to file an appeal.
You have 20 days after receiving notice of your claim’s denial to file an appeal with the Pennsylvania Workers’ Compensation Appeal Board. The Appeal Board reviews your case and will issue a written decision. Usually, this happens without the need for a hearing.
If the Appeal Board still denies your workers’ compensation claim, you have 30 days to appeal your case in Pennsylvania Commonwealth Court. The Pennsylvania Commonwealth Court will review your case and issue a written decision.
Most likely, this will be the last stop in your appeal process. If your claim has been denied once again, you have the option of filing an appeal with the Pennsylvania Supreme Court. This must be done within 30 days after you have been notified of the Pennsylvania Commonwealth Court’s decision. The Pennsylvania Supreme Court will review your case and decide if you will be allowed a hearing. If not, this is the final decision on your workers’ compensation claim.
This process may seem daunting, but could be worth it if you have sustained a job-related injury or illness. Workers’ Compensation benefits include:
- Lost wages
- Death benefits
- Specific loss benefits (if you have lost permanent use of a body part or have been disfigured)
- Medical care
Philadelphia Workers’ Compensation Lawyers at McCann Dillon Jaffe & Lamb, LLC: Dedicated to Helping Injured Workers in Pennsylvania
In order to protect your right to this kind of compensation, contact an experienced Pennsylvania Workers’ Compensation attorney as soon as possible. The Pennsylvania Department of Labor & Industry states, “You may represent yourself in WC (workers’ compensation) proceedings, but a non-attorney cannot represent you. However, 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.” The dedicated Philadelphia Workers’ Compensation lawyers at McCann Dillon Jaffe & Lamb, LLC give you the benefit of their more than 40 years of combined experience and an unstoppable attitude for winning. Contact McCann Dillon Jaffe & Lamb, LLC online or call 215-569-8488 today for a free consultation.