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What Happens If Your Workers’ Compensation Claim is Denied?

In Pennsylvania, businesses are required to obtain Workers’ Compensation insurance for their employees. The coverage pays for all work-related injuries that occur during business hours. You may, however, be denied at any point during the process. If you were expecting your employer to cover your costly medical expenses, and you are now stuck with that burden, what happens next?

Why Were You Denied?

The first step in your appeal is learning why you were denied. You may feel like your injuries are covered, but you will learn the perspective of your employer or the insurance company when reviewing your case. A denial of your claim may happen if:

  • The injury was not reported in time: In Pennsylvania, you must report workplace injuries that result in death to a supervisor in 48 hours, seven to 10 days after a non-disabling injury, and up to 21 days after an accident for retroactive benefits.
  • Your insurance claim was not filed in time: If it is not filed in a timely manner, your claim will most likely be denied.
  • Your employer has successfully disputed your claim: Employers have been known to claim that injured employees were hurt during horseplay or that they were performing non-work-related tasks.
  • The injury is not compensable: For example, stress-related injuries are difficult to prove in court.
  • You did not obtain medical treatment: If you have not seen a doctor, your employer can claim you were not truly injured.
  • You did not show that the injury is work-related: Your claim may be denied if you cannot prove it occurred at work.

Can You Appeal the Decision?

You will likely receive a denial letter from the insurance company or your employer. The letter will clearly state a deadline for all appeals, and the letter should be provided to a knowledgeable lawyer as soon as possible. You may be able to resolve the case with your employer or the insurance carrier. If you cannot reach an agreement, you must appeal your claim immediately.

A lawyer will collect evidence about the case that resolves any issues noted in the denial. For example, you can show that the claim was filed properly, you have a work-related injury, or you received the appropriate medical care. The injury might be evaluated by an independent medical practitioner, and a lawyer will interview anyone involved in the case. The appeal will then be drafted and presented to the court after a thorough investigation.

What Happens Next?

You should not contact your employer or the insurance carrier once your lawyer has taken over the case. Anything you say could be used to deny your claim, and you do not want to cause any problems while you are recovering. Your lawyer will argue your case vigorously, and your case may go to the appropriate circuit court if the appeal is denied.

Philadelphia Workers’ Compensation Lawyers at Gross & Kenny, LLP Represent Injured Workers Throughout Pennsylvania

Work accidents and injuries occur frequently throughout the United States. Unfortunately, claims for compensation can be denied. Our Philadelphia Workers’ Compensation lawyers at Gross & Kenny, LLP will handle your appeal and fight vigorously so that you receive appropriate compensation. Contact us online or call us at 215-512-1500 for a free consultation. Located in Philadelphia, we serve clients throughout Pennsylvania.

A Message to Our Clients About Coronavirus COVID-19:

A Message to Our Clients About Coronavirus COVID-19:

At Gross & Kenny, LLP we view the safety and well-being of our clients, staff and business partners as our highest priority.

The situation regarding the COVID-19 virus is continually changing, and we are following all recommended guidelines to stay healthy.

Currently, our law firm is remaining open to serve your legal needs. If you were working light duty or modified duty as a result of a work injury in Pennsylvania and were recently laid off or terminated from your job due to the Coronavirus you may be entitled to weekly workers' compensation checks for lost wages moving forward. Contact us to find out . We are open and ready to assist.

We are happy to arrange for phone or video consultations should you have any concerns about keeping your scheduled appointments with us. We are also able to exchange documents via secure drives or email.

Should you have any concerns regarding an upcoming meeting with us, please contact us online or call (215) 512-1500.

We are continuing to fight on behalf of our clients and that we are all able to handle things even if mandated by the government that we work remotely.

Thank you and take care.