Discovering that your workers’ compensation claim has been denied can be disheartening and stressful. However, it is crucial to remember that a denial does not necessarily mean the end of your pursuit of benefits. In Pennsylvania, as in other states, there are specific steps you can take to appeal a denied workers’ compensation claim.
When your workers’ compensation claim is denied in Pennsylvania, the first step is to understand why. There are many reasons why an insurance company may deny your workers’ compensation claim, including:
- Non-work-related injury: An insurance company can deny a claim if they believe the injury occurred not within the scope of employment. They may believe the injury was pre-existing or occurred outside of work.
- Employer disputes the claim: If the employer denies your injury claim and states that the injury occurred during horseplay or was outside the scope of employment, the insurance company will likely side with the employer and deny your claim.
- Late reporting: It is important to report your injury to your employer immediately. Many insurance companies allow a strict amount of time for an injury to be reported.
- Incomplete paperwork: Claim denials happen all the time due to improper or incomplete documentation, including medical records, and incomplete or inconsistencies in statements.
Reviewing your denial letter to identify why your workers’ compensation claim has been denied is important. Consult an experienced workers’ compensation lawyer if you receive a denial letter. They can provide valuable guidance on your case. A lawyer can review the details of your denial, assess the strengths and weaknesses of your claim, and help you determine the most effective course of action.
File a Petition for Review
In Pennsylvania, the next step after a denial is to file a Petition for Review with the Workers’ Compensation Appeal Board (WCAB). This petition initiates the formal process of appealing the denial. It is crucial to adhere to the deadlines for filing, which typically range from 20 to 30 days from the date of the denial. Failing to file within the specified timeframe may jeopardize your ability to appeal.
Gather Supporting Documentation
Gather all relevant documentation to support your workers’ compensation claim to strengthen your appeal. This may include medical records, witness statements, accident reports, and other evidence substantiating your injury and its connection to your work duties. Thorough documentation is essential to build a compelling case and demonstrate the legitimacy of your claim.
Attend Mediation or a Hearing
After filing the Petition for Review, your case may be scheduled for mediation or a formal hearing before a workers’ compensation judge. Mediation is a voluntary process where both parties attempt to settle with the help of a neutral mediator. If mediation is unsuccessful or not pursued, a hearing will be scheduled to allow both sides to present their arguments and evidence.
Appeal
If the outcome of the hearing is unfavorable, you can appeal to the WCAB. The WCAB is an appellate body that reviews decisions made by workers’ compensation judges. The appeal must be filed within 20 days of the judge’s decision. The WCAB will review the evidence presented during the hearing and may also consider legal arguments related to the application of workers’ compensation law. It is essential to have a well-prepared appeal addressing the issues raised in denying your claim.
If the WCAB upholds the denial, further appeals can be pursued. This may involve appealing to the Commonwealth Court of Pennsylvania and, if necessary, the Pennsylvania Supreme Court. Each level of appeal has specific criteria and deadlines, and the assistance of a skilled attorney is invaluable in navigating these complex legal processes.
West Chester Workers’ Compensation Lawyers at Wusinich, Sweeney & Ryan, LLC Advocate for Workers Whose Claims Were Denied
If you were injured at work and your claim was denied, contact our West Chester workers’ compensation lawyers at Wusinich, Sweeney & Ryan, LLC. Call 610-594-1600 or fill out our online form for a free consultation. Located in Exton, Pennsylvania, we serve clients in Downingtown, West Chester, Coatesville, Phoenixville, Malvern, Lyndell, Wagontown, Uwchlan Township, Parkesburg, Chester Springs, Lancaster County, Reading, and Morgantown.