What To Do if Your Workers’ Compensation Claim Is Denied in Pennsylvania
Work injuries often bring more than just physical pain—they can disrupt your income and peace of mind. And if your workers’ comp claim gets denied, it just adds more stress to an already tough time. But a denial doesn’t mean it’s over. In Pennsylvania, you can appeal the decision, and there are steps you can take to push back.
Determine Why Your Claim Was Denied
The first step is to review the Notice of Compensation Denial. This letter explains why your claim wasn’t approved.
Common reasons for denial include missed deadlines, insufficient medical evidence, disputes over whether the injury occurred at work, or the employer claiming the injury was pre-existing.
Knowing the reason helps you decide how to move forward. If the denial is based on missing paperwork or unclear medical records, correcting those issues can help.
Keep Deadlines in Mind
Workers’ compensation cases have strict deadlines. First, you must inform your boss about your injury within 120 days. Then, if you’re filing a Claim Petition, you have to do it within three years from the date you got hurt. If you miss either deadline, you might lose your chance to get benefits, even if you should qualify.
Gather Compelling Evidence
Solid evidence is key in an appeal. This can include:
- Medical reports from your treating doctors
- Testimony from medical experts
- Witness statements from coworkers
- Documentation showing how the injury has affected your ability to work
Your medical records need to show that your injury is work-related. Sticking with your treatment and attending follow-up appointments can make a significant difference for your claim.
File a Claim Petition
If you think your workers’ compensation claim was wrongly denied, you can file a Claim Petition with the Pennsylvania Bureau of Workers’ Compensation. This is how you officially initiate the appeal process and request that your case be reviewed.
After you file the petition, a workers’ compensation judge will be assigned to your case. The judge will hold hearings to look at evidence from both you and your employer. You might need to testify and share medical records to support your claim. Your employer and their insurance company will also get a chance to explain their side.
What Benefits Could Be Recovered on Appeal?
If your appeal is successful, you could receive:
- Partial wage replacement
- Medical expenses related to your injury
- Ongoing treatment or therapy
- Specific loss benefits for the loss of use of a body part
The amount of money you receive depends on the severity of your injury and whether you can still perform your job.
Consider Legal Help
The appeals process can be complicated. It involves hearings, rules of evidence, and legal arguments. A workers’ compensation lawyer can represent you at every stage and help gather the proper proof. If your employer or their insurance company has a lawyer, having your own legal support can level the playing field.
Lawyers who handle these cases typically work on a contingency fee basis. That means they only get paid if you win your case or receive a settlement.
Remember: The Denial Isn’t the End of the Road
Getting denied can be incredibly frustrating, but it’s not the end of the road. If your Pennsylvania workers’ comp claim was turned down, don’t wait—take action. Review the denial letter, gather your paperwork, and call a lawyer to familiarize yourself with your rights.
At Stine & Associates, P.C., we help injured workers protect their rights and recover from their losses. Our team is ready to guide you through the next steps after a denial so that you can focus on your health and your future. Reach out today.