What happens if your workers’ compensation claim is denied?

On Behalf of | Apr 3, 2024 | Workers' Compensation

Many workers suffer injuries while on the job. They should be able to count on workers’ compensation benefits to help cover the expenses of their injuries, as they may need to obtain partial wage replacement benefits and other specific kinds of compensation unique to their circumstances.

Despite the fact that workers’ compensation is meant to help protect workers, an injured person may face a denial of the claim. This is often a shock, but they can’t wallow in the frustration that is typically inspired by a denial, as acting quickly can make a difference in the process to follow.

The reasons for denial and immediate actions

Employers or insurers may deny workers’ compensation claims for various reasons, including disputes over whether the injury is work-related, whether the claim was filed on time, or the injury’s severity. Upon receiving a denial, the first step for an employee is to review the denial letter carefully. This document should outline the reasons for the denial, providing crucial information on what aspects of the claim need to be addressed or contested.

Filing an appeal with the Bureau of Workers’ Compensation

In Pennsylvania, workers who have had their compensation claim denied have the right to file an appeal. This process begins with filing a Claim Petition with the Pennsylvania Bureau of Workers’ Compensation. The petition must be filed within three years from the date of the injury. The case will then be sent to a judge who hears workers’ compensation cases.

The role of workers’ compensation judges

The appeal process involves presenting the case before a workers’ compensation judge. The employee and the employer or their insurance company will have the opportunity to present evidence, including medical records, expert testimony and other relevant information. The judge then makes a decision based on the evidence presented. This can take several months and may involve multiple hearings.

The potential for further appeals

If the workers’ compensation judge’s decision is unfavorable, the employee has the right to appeal to the Pennsylvania Workers’ Compensation Appeal Board. Further appeals can be made to the Commonwealth Court and the Pennsylvania Supreme Court.

Each level of appeal focuses more narrowly on legal errors than the ones before, which is just one of the many reasons why having legal representation is critical for anyone in this position.

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