What to Do If Your Claim is Denied

May 2, 2018

Most workers in Pennsylvania are entitled to workers’ compensation for their work-related injuries. However, your claim may initially be denied by your employer or their insurance company. If your Workers’ Compensation claim was denied, do not give up. You may appeal the denial and ultimately receive benefits.

At Larry Pitt & Associates, our experienced Workers’ Compensation lawyers are experienced in handling work injury claims from initiation through denial and we are here to help you through the entire appeals process.

Common Reasons for Denial

Injured workers must report on-the-job injuries in writing to their employer immediately. They should include the date and time of the injury along with a description of the injury. In Pennsylvania, any missed shifts or days of work should also be reported to the Bureau of Workers’ Compensation. After filing the claim, the worker’s employer, under advisement of their insurance company, will initially rule on the application. Common reasons for initial denial include:

  • Incorrect or inadequate information regarding the injury
  • Injury was not reported on time
  • Failure to show that the injury was work-related
  • Failure to file a claim within the 120-day statute of limitations
  • Employer believes that the claim is fraudulent
  • Employer questions the severity of the injury
  • Employer believes that the injury was a pre-existing condition
  • Employer claims worker was injured because they engaged in illegal activity, such as using drugs

Appealing a Denied Workers’ Compensation Claim

If your application for Workers’ Compensation benefits is denied, you can appeal the decision. In Pennsylvania, you must follow a specific procedure to object to the denial. You have three years from the date of the injury to file a Claim Petition with the state Bureau of Workers’ Compensation. A Workers’ Compensation judge will then decide whether to approve or deny your appeal.

If the judge denies your appeal, you can appeal to the Pennsylvania Workers’ Compensation Appeal Board within 20 calendar days from the Circulation Date listed on the front page of the judge’s decision. It is important to ensure that all directions are followed, including attaching a copy of the judge’s decision to the original appeal, completing the proof of service page, checking all information for completeness, and mailing the original along with two additional copies.

If your appeal is denied by the Appeal Board, you may then appeal to the Pennsylvania Commonwealth Court within 30 days from the Appeal Board decision. The Commonwealth Court will decide whether there was an error and if the Appeal Board decision was supported by substantial evidence. Most claims end after the Commonwealth Court issues its decision, however you may appeal one final time by filing a Petition for Allowance of Appeal to the Pennsylvania Supreme Court within 30 days of the Commonwealth Court decision.

Philadelphia Workers’ Compensation Lawyers at Larry Pitt & Associates Help Injured Workers with Denied Claims

If your Workers’ Compensation claim was denied, contact the skilled Philadelphia workers’ compensation lawyers at Larry Pitt & Associates. We can help you navigate the complex appeals process, so you can obtain the benefits you deserve. With offices across Philadelphia, we serve clients throughout Pennsylvania, including those from Berks County, Bucks County, Chester County, Delaware County, and Montgomery County. For an initial consultation, call us today at 1-888-PITT-LAW (748-8529) or submit an online contact form.