What to Do When Your Workers’ Compensation Claim is Denied

When a worker in Pennsylvania sustains a work-related injury, that worker may be entitled to workers’ compensation benefits. Although a worker may be entitled to benefits, the employer or the insurance company may deny the claim. If a worker’s claim is denied, the worker can file a petition for a hearing.

Claim Denials

The first step in obtaining benefits is reporting the injury to the employer immediately. The worker should include information about the date and time when the injury occurred. If the employee misses a day or shift of work, Pennsylvania law requires the employer to report the injury to the Bureau of Workers’ Compensation. After filing a claim, the employer or the insurer can choose to deny or accept the claim.

There are several reasons a workers’ compensation claim may result in a denial, including the following:

  • Inadequate proof of the accident
  • Failure to demonstrate that the injury was work-related
  • Belief that the claim is fraudulent
  • Failure to notify the employer within the specified time
  • Failure to file a claim within the statute of limitations
  • Belief that the injury was a result of a pre-existing condition

Appealing a Claim Denial

A worker has three years from the date of the injury to object to a denial of a claim. The worker must file a Claim Petition with the Bureau. A workers’ compensation judge will preside over the hearing and will issue a decision. A worker can appeal the judge’s decision to the Workers’ Compensation Appeal Board and then to the Commonwealth Court.

When Should You Hire a Lawyer?

Although the Bureau allows self-representation, it is wise to seek legal counsel, especially if the insurer or the employer has denied your claim. A Pennsylvania workers’ compensation lawyer can help you navigate the appeals process. It may take time, and it may involve complex litigation that only an experienced attorney can understand. Contact us at 717-695-4722 or 877-291-WORK (9675).