What to Do if Your Workers’ Comp Claim Is Denied

As with any legal claim, the right to assert a workers’ compensation claim is limited. This is especially true of workers’ compensation claims where If you have been injured at work and denied either medical benefits or wage loss benefits, you must file a claim within three years of the date of injury.

Workers’ compensation claims may be denied for many different reasons that include the following:

• The workplace injury is not reported in a timely fashion to a work supervisor.
• The workers’ compensation claim is not filed in a timely fashion within the requirements of state law.
• The doctor chosen by the employer or the employer’s insurance carrier claims the absence of any serious injury.
• The employer claims the workplace injury occurred outside of work.
• The employer claims the workplace injury is the result of a pre-existing medical condition.
• The claimant failed to provide sufficient evidence proving that the injury is work-related.

Once an injury is reported, an employer has 21 days to deny the claim. Within 21 days from the date an employee provides notification of an injury, if an employer or insurance carrier denies liability and issues a Notice of Workers’ Compensation Denial to the employee, the claim is now closed, though the injured worker may seek legal advice to pursue a claim through the litigation system.

Once a workers’ compensation claim has been denied, it is crucial to take the following actions as soon as possible:

• Gather documentation in support of the claim– Review the evidence in your case and ensure that you have all medical bills and records, as well as any testimonials from your doctor, co-workers, or anyone else relevant to the work-related injury or illness. An experienced workers’ compensation attorney may help gather, review, and analyze any relevant evidence to help reverse the denial of a claim and move it forward.
• Keep a diary of the work-related injury– Monitor any symptoms or pain and record this information in a journal noting specific dates and times. Workers’ compensation claims are often detail-laden and may turn on the presence or absence of certain facts.
• Timely appeal the denial of the claim– Injured workers have the right to appeal a denied workers’ comp claim with the Pennsylvania Workers’ Compensation Appeal Board. Pennsylvania requires that an injured worker files an appeal 20 days from the day the claim was denied.
• Hire an experienced workers’ compensation attorney– The denial of a workers’ compensation claim may have serious consequences for an injured worker who, like most of us, relies on his or her wages to make a living. Often, the successful appeal of a denied workers’ compensation claim may seem insurmountable. Especially, since the employer’s insurance company will zealously fight against any decision that reverses the denial of the claim. Appealing the denial of a workers’ compensation claim is an example of a situation where an individual must assert and protect his or her rights. It, therefore, requires someone with a thorough knowledge and understanding of the applicable law who may assert and protect these rights.

Reversing the denial of a workers’ compensation claim in Pennsylvania may be complicated and challenging, but it is not insurmountable. Powell Law has represented injured workers for 115 years and has a distinguished reputation throughout northeastern Pennsylvania for adhering to the highest standards in serving those injured on the job. Contact Powell Law at (570) 961-0777. The consultation is FREE, and you don’t pay unless we win!