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What Happens if My Workers’ Compensation Claim is Denied?

Nearly all workers in the Commonwealth of Pennsylvania are entitled to workers’ compensation benefits if they are injured on the job or suffer an illness due to work conditions. During 2015, 166,102 work injury and illness cases were reported to the Bureau of Workers’ Compensation in Pennsylvania. Most of us assume of we are injured on the job or become ill because we were exposed to hazards in the workplace that we will automatically be approved for workers’ compensation benefits. Unfortunately, this is not always the case.

Reporting Obligations Impact

Employees are required to report a work-related injury or illness as soon as possible but not more than 120 days from the time the employee knew about it. Employers are obligated to report this information, once the employee has missed one shift of work, to the insurance company. Should an employee not make a timely report, they may not be able to collect benefits they might otherwise be entitled to.

It is important to know that in the case of a work-related illness which manifests within 300 weeks of an employee leaving a company, they have three years to file a claim with the employer. One hopes the insurance company will accept your claim and pay you the benefits you are entitled to. However, this does not occur in every case, in some instances, benefits are denied.

Prompt Action After a Denial

Insurance companies have 21 days from the date your claim is filed to accept or deny your claim. Even in cases where it is clear the injury or illness was job-related, insurance companies still may deny your claim. You do have the right to file an appeal with the Office of Adjudication. It is important to keep in mind, you have the right to represent yourself, you may be represented by an attorney but you may not be represented by a non-attorney.

Reasons for Denial of Claims

There are numerous reasons why your workers’ compensation claim may be denied including:

  • Information in your accident report is inaccurate
  • Missed deadlines
  • Employer disputing severity or validity of injury
  • Claims the injury occurred off the job
  • Claims you were under the influence at the time you sustained the injury

If the insurance company states any of these reasons are why your claim was denied, you should contact a workers’ compensation attorney immediately for assistance. Keep in mind, typically, you would be eligible to have all medical bills arising from the injury or illness paid for and you would receive a portion of your wages — generally these benefits start once you have missed work for seven days. However, if your claim is denied, the process can be lengthy and complex.

There are a lot of things to worry about after a workplace injury, and worrying about your benefits should not be one of those concerns. If you have been injured at work in Lancaster County and your legitimate workers’ compensation claim has been denied, contact Georgelis Injury Law Firm immediately for a free consultation. We do not collect a fee unless we are successful in resolving your claim successfully.

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