Workers' Compensation Denials & Appeals in PA

denied work injury claim

Pennsylvania Workers’ Comp Appeal Attorneys

You’ve worked hard for a company. You believed if were ever injured on the job, you would get workers’ compensation benefits. After all, you were legally entitled to those benefits.

Now you’ve been hurt. All of a sudden, your workers’ comp claim has been denied.

Now what? How will you pay the medical bills for your injuries? How will you even pay rent? As you recover from your workplace accident, workers’ comp won’t pay you for the paycheck you’re losing.

Here’s the good news. At Calhoon and Kaminsky P.C., we understand how frustrating and frightening it is when a workers’ comp claim is denied. We are here to help you fight for the benefits you deserve.

Insurance companies know that most people won’t appeal their denied claims. But that doesn’t have to be the end of the road for you. Our skilled workers’ comp appeal lawyers have decades of experience. We have spent years fighting for hardworking professionals like yourself.

In fact, we’ve helped injured workers like you recover more than $221 million. We want to help you get the benefits you are owed.

Ready? Contact Calhoon and Kaminsky P.C., today. Let our workers’ comp appeal attorneys work for you. Here’s our promise: We won’t charge you a dime unless we help you recover compensation. Call us today or contact us online to set up your free initial consultation.

Workers’ Comp Denial Reasons

When employees claim they were injured at work, it often costs employers a lot of money. That’s why employers and their insurance companies do everything they can to avoid paying workers’ comp claims. They regularly use every scheme you can think of to deny even valid claims.

We’ve seen the excuses employers use to deny workers’ compensation claims:

  1. You didn’t report your injury on time. Under Pennsylvania law, employees have only 21 days to tell their employer about a workplace injury. Employees only get three years to file a workers’ comp claim. Bottom line: if you wait until the last minute to take action on your claim, an insurance company might argue your injury isn’t as bad as you say it is.
  2. Your injury isn’t that bad. Your employer and the insurance company may agree that you were hurt on the job. They may admit you are suffering from an occupational illness but argue it is not as bad as you claim. They will argue there wasn’t any reason for you to see a doctor or to miss a shift.
  3. You were drunk or high on the job. Insurance companies often use this excuse as a way to deny workers’ comp benefits. Even if you had one beer with lunch and were injured later that day, the insurance company may point to that fact as proof you were intoxicated.
  4. Your injury or illness isn’t work-related. This is a common reason to deny benefits for injuries or illnesses that are stress-related. That can include a repetitive stress injury such as carpal tunnel syndrome.
  5. You didn’t see a doctor when you were hurt. If you were injured on the job but decided not to see a doctor right away, your employer and the insurance company often use this as a reason to deny benefits.

How to Appeal a Workers’ Comp Denial

Was your initial claim denied? You might still get workers’ comp benefits if you follow these steps:

  • Contact an attorney. Under Pennsylvania law, if your workers’ comp claim is denied you have up to three years to file an appeal. An experienced workers’ comp lawyer can quickly evaluate your initial claim and denial letter.
  • File an appeal. Once a workers’ comp claim is denied, the employer usually doesn’t have to do anything further on the matter. It’s completely up to the employee to take additional steps to pursue their rights. An attorney can file your appeal and put together a solid case before it’s too late.
  • Request a hearing. With an attorney’s help, an employee can file an appeal with the Workers’ Compensation Bureau to request a hearing. The case will then be assigned to a workers’ compensation judge. The Workers’ Compensation Bureau will try to choose a judge who lives nearby so you don’t have to travel too far. The judge will assign a date for the hearing and notify you of the date, as well as your lawyer, your employer and the employer’s insurance company.
  • Prepare for the hearing. To prepare for the hearing, your lawyer will collect all important accident information and medical records, including your medical bills and your doctors’ reports. Your attorney will interview witnesses, including any coworkers who may have been present when you are injured. In anticipation of the hearing, your attorney may ask you to keep a journal and record the date of each doctor visit. Your attorney will also collect information from friends, family members and witnesses about the medical and psychological effects of your injury or illness.

What Happens If the Judge Denies My Claim?

At the hearing, the judge may attempt to settle the issue through mediation. If that fails, the judge will issue a ruling after the evidence has been presented. If the ruling is not in your favor, you can appeal this decision.

You have 20 days to file an appeal with the Workers’ Compensation Appeal Board. You will use this form: Appeal from the Judge’s Finding of Fact and Conclusions of Law (form LICB – 25/26). This 20-day time limit starts on the day the judge’s decision letter is postmarked.  Suppose the letter is postmarked February 5 but not received until February 7. You have until February 25 – the 20-day limit – to appeal the decision.

Your lawyer will ensure these processes are taken care of during your appeal:

  • The letter that you receive with the judge’s decision is known as a circulation sheet. A copy of the circulation sheet will be attached to your appeal.
  • Form LICB – 25/26 includes a Proof of Service page. It will include each name and address that appears on the judge’s circulation sheet. It will also have the judge’s address. Your attorney will ensure a copy of your appeal is mailed to everyone on this list.
  • Before anything is mailed, your lawyer will double-check the information. Your lawyer will also explain why it is believed the judge made an incorrect decision.
  • A workers’ compensation judge’s decision is not often overturned, but it does happen. Your lawyer may argue the judge did not consider a critical piece of evidence or overlooked critical facts of the case. The Appeals Board can send back the decision and order the judge to rehear your claim.

What Do I Do If the Appeals Board Denies My Claim?

If the Appeal Board rules against you, you have 30 days to file an appeal with the Commonwealth Court. This court will examine the facts and arguments in your case before issuing a written decision.

For many workers, the appeals process won’t go past the Commonwealth Court. If that court denies your case and you still feel that your claim has merit, you have 30 days to appeal to the Pennsylvania Supreme Court. That court is the final avenue of appeal.

If the Supreme Court decides to hear your case, your lawyer and your employer’s lawyer submit briefs. In some cases, the parties will be required to make arguments in front of the court. The court will review the parties’ briefs and all the evidence before issuing a final decision.

Chances of Winning a Workers’ Comp Appeal

It’s hard to say how long it takes a workers’ compensation claim to go through the appeals process. An appeal can sometimes last up to two years, especially in complex cases.

Yet as odd as it may sound, your chances of success improve with each level of the appeals process. For instance, your employer and their insurance company may decide the appeals process is too costly or time-consuming. In cases like that, the employer may be more inclined to negotiate a settlement.

Talk to Our Pennsylvania Workers’ Comp Appeal Lawyers Now

If you believe your workers’ compensation claim was wrongfully denied, contact Calhoon and Kaminsky P.C., today. We’ve helped many clients successfully appeal workers’ comp denials. We can help you do the same. Contact us by phone or online for a free consultation.