What To Do If Your Workers’ Compensation Claim Is Denied

Worker’s compensation is an important form of insurance that provides benefits to employees who suffer job-related injuries or health issues.  When an employee is injured on the job, workers’ compensation can cover medical expenses, lost wages, and other related costs.

Unfortunately, not all workers’ compensation claims are approved.  If your claim is denied, you may feel frustrated and unsure of what to do next.  In this article, we’ll discuss the reason why workers’ compensation claims may be denied, what steps to take if your claim is denied, and how to appeal a denied claim. 

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Reasons Why Workers’ Compensation Claims Get Denied

There are several reasons why workers’ compensation claims may be denied.  Here are some of the most common reasons: 

1. Failure to report the injury in a timely manner
2. Lack of evidence to support the claim
3. The injury was not work-related
4. The injury caused by the employee’s misconduct
5. The claim was not filed correctly or on time

To avoid having your claim denied for any of these reasons, it’s important to follow proper reporting procedures, gather evidence to support your claim, and file your claim correctly and on time.  Additionally, it’s crucial to ensure that your injury is work-related and that you weren’t at fault for the injury. 

If your workers’ compensation claim is denied, you will need to retain an attorney to file a Claim Petition for Workers’ Compensation.  Contact O’Connor Law for a free consultation on this process.  The steps are as follows:

1. The attorney will file a Claim Petition which will be assigned to a workers’ compensation Judge.  That judge will hold an initial hearing and additional hearings thereafter.
2. Your attorney will produce your testimony and the testimony of your physician to prove your case. 
3.  The attorney for the insurance company will also produce witnesses and have you examined by an independent medical examiner who will issue a report and potentially testify on behalf of the insurance company.
4. During the process of litigation, it is possible that your case could settle or resolve in some fashion.
5. If your case does not settle during the litigation, your judge will make a decision after reviewing all the evidence; both testimony from fact witnesses and medical witnesses.

What if the Workers’ Compensation Judge Denies my Claim?

In Pennsylvania, if the workers’ compensation judge denies your claim, you may appeal this denial to the Workers’ Compensation Appeal Board (WCAB).  Your attorney will do so within 20 days of the date of the decision of the Judge.  The Workers’ Compensation Appeal Board will hold a hearing and the attorneys for both sides will have an opportunity to file legal briefs. 

The WCAB will then usually make a decision within 3-6 months.  If either party is dissatisfied with the WCAB’s decision, they may file an appeal with the Commonwealth Court of Pennsylvania within 30 days.  Again, the parties have an opportunity to argue the case before the Commonwealth Court and file briefs. 

Once the Commonwealth Court makes a decision,  the final appeal is to the Supreme Court of Pennsylvania and that must be filed within 30 days.

It’s important to note that the appeals process can be lengthy and complicated, and it’s advisable to seek the assistance of an experienced workers’ compensation attorney.  They can help you understand the ins and outs of your case as well as navigate the appeal process with confidence.  They will also ensure that you have the best possible chance of winning your case by working to get the evidence you need to back your case. 

O’Connor Law For Your Workers’ Compensation Case

If you or a loved one has been injured on the job and your workers’ compensation claim has been denied, don’t despair.  At O’Connor Law, we understand the frustration and uncertainty that comes with a denied claim.  That’s why our team of experienced workers’ compensation attorneys is here to help you navigate the appeals process and fight for the benefits you deserve.  We can assist you with gathering evidence, filing an appeal, preparing for your hearing, and representing you in front of the judge.  Our goal is to ensure that you have the best possible chance of winning your case and receiving the benefits you’re entitled to.  Contact us today to schedule a free consultation and let us help you back on the road to recovery.

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