You’ve been injured at work, but thankfully, you have workers’ compensation to fall back on. Then you get the bad news: your claim has been denied. What can you do if your employer or the workers’ compensation insurance company has refused to pay benefits? Do you have any legal options? You may have the right to appeal your denied claim. The appeals process is complicated, and you only have a limited time to act. But you can count on the dedicated workers’ compensation attorneys of Nikolaus & Hohenadel, LLP to help you appeal your denial.
Understanding The Workers’ Compensation Process
An injured worker should understand the basics of how workers’ compensation claims are submitted and processed. Claim rejections often happen because of an alleged missed deadline or failure to follow the proper procedure.
You should notify your employer right away if you’ve been hurt on the job, and within 21 days to receive benefits retroactive to the date of injury. If you fail to file within 120 days of the injury, you won’t receive any benefits at all.
During the first 90 days of your treatment, you may be required to see a doctor selected by your employer. After that period, you can see the doctor of your choice. But you should document as much as possible about your injury, including your medical records and communications with your employer.
The workers’ compensation insurer, or the employer if it is self-insured, has 21 days after being notified to approve or deny your claim. If the claim is approved, the insurer or employer starts paying benefits. If it is rejected, a notice of denial is issued to the employee. The employer or insurer can also pay temporary benefits without admitting liability for the claim. This temporary payment can be revoked within 90 days.
Why Are Workers’ Compensation Claims Denied?
There are a number of reasons a workers’ compensation claim may be denied in Pennsylvania. It’s important not to get discouraged, however, because the insurer or your employer does not necessarily have the final word. Some of the most common reasons for claim denials are:
- The worker filed more than 120 days after being injured
- The employer disputes the severity of the injury
- The employer claims the injury was not work-related
- Allegations of illegal activity, such as illegal drug use, causing the injury
- Allegations that the worker did not use available safety equipment
- Insufficient medical documentation of the injury
- Inaccurate information in the accident claim or workers’ compensation report
- Failure to follow the proper procedures to submit the claim
- Failure to get medical attention for the injury
What Can I Do If My Claim Was Denied?
There are a number of steps you can take to appeal your denied workers’ compensation claim. First, you can file a claim petition with the Pennsylvania Bureau of Workers’ Compensation. You have three years from the date of injury, or the date on which you reasonably should have known you had a work-related injury, to file a claim petition. Your case will then be assigned to a workers’ compensation judge with the Bureau.
The judge will hold a hearing to review evidence submitted by you and your employer. That evidence should include medical records and other documentation related to the injury. After the hearing, the judge will decide whether to approve your claim or deny it.
If your claim is denied at this point, you still have legal options available. Within 20 days of the denial, you can appeal your claim to the Pennsylvania Workers’ Compensation Appeal Board. The Appeal Board may or may not conduct a hearing, but in any event will review the evidence submitted and render its decision.
If you don’t agree with the decision made by the Appeal Board, you have 30 days to appeal to the Pennsylvania Commonwealth Court. Just like the Appeal Board, the court will review the evidence and information to make a decision. You then have the option to make one final appeal to the Pennsylvania Supreme Court, which must be done within 30 days of the Commonwealth Court’s decision.
How Long Does It Take To Appeal A Rejected Claim?
The time it takes to appeal your workers’ compensation claim will depend on a number of factors. Perhaps most important is how far you wish to take your appeal. The further along in the process, the fewer employees will contest an adverse decision. This isn’t necessarily because of the strength of the claim. Many employees simply give up.
Another factor is how hard your employer or the workers’ compensation insurer fights you. It is possible to settle your claim, and many employers find that doing so is preferable to the time and expense of litigation. But other employers will fight you all the way to the state Supreme Court.
Finally, your appeal timeline will depend on the workload of the judge or judges who hear your claim and appeals. This is another reason that settlement is often an attractive alternative for both employees and employers.
How Can A Workers’ Compensation Attorney Help Me with a Denial?
The more appeals you make, the more necessary it becomes to have a knowledgeable workers’ compensation attorney. The Appeals Board does not often overturn decisions made by judges, and the same is true for judges in the state court system. Missing a deadline, failing to include necessary evidence, or skipping over a required form could risk your case. That’s why you need a law firm experienced with the Pennsylvania workers’ compensation system.
Contact Our Lancaster Workers’ Compensation Attorney
Nikolaus & Hohenadel, LLP, is committed to helping injured workers get the financial assistance they deserve for their injuries. If your workers’ compensation claim has been denied, you owe it to yourself to explore your legal options. Reach out to us today to schedule your confidential consultation.