Denied Workers’ Compensation Claims
If you recently got hurt at work or contracted an illness or disease as a result of your employment, you probably began the process of filing a workers’ compensation claim. The Pennsylvania Workers’ Compensation Act allows injured employees in Wilkes Barre and throughout the state of Pennsylvania to seek compensation for injuries and illnesses that have arisen out of the course of someone’s employment. While many injured workers are able to obtain the financial compensation they need after filing a claim, other workers are devastated to learn that their claims have been denied. Workers’ compensation claims can be denied for a variety of reasons, and it is essential to know your options for appealing.
Why Are Workers’ Comp Claims Denied?
Reasons for denying a claim include the following:
- The employee did not suffer a work-related injury includes disease, pre-existing condition or aggravation);
- Injury not in course and scope of employment;
- The employee was not employed by defendant;
- Failed to give notice within 120 as require under the Workers’ Compensation Act; or
- Other good cause.
Sometimes claims are denied because an application was incomplete or had incorrect information due to an error. You can avoid this type of mistake by working with an experienced Pennsylvania workers’ compensation lawyer from the start of your case. Applications for workers’ comp can be extremely complicated, and it can be easy to make a mistake if you do not have experience filling out the required forms and providing the detailed information necessary for a claim to be approved.
In other situations, an injured worker may have missed a deadline, or the employer could have missed a deadline. Injured workers must report the injury or illness to the worker as soon as possible. Once the employer is provided Notice they have 21 days to respond accept or deny the claim. The injured worker may not have properly reported the injury to the employer, or the employer may have missed a deadline. Sometimes an injured worker waits too long to provide Notice as required under the Workers’ Compensation Act, which requires workers to give Notice of the injury to the Employer within 120 days of the injury or diagnosed illness. If that time window closes, the worker may be unable to seek compensation through the workers’ compensation system. If the claim is Denied the employee has three years to file an appeal.
Appealing a Denial of Benefits
In most cases, an injured worker in Pennsylvania who receives notice that their workers’ compensation claim has been denied can file an appeal. Appeals are complex, and you should have an experienced Wilkes Barre workers’ comp lawyer on your side during this process. In general, the following is the requirement for objecting to the denial of the claim:
- You must file the appropriate petition for benefits within three years of the work-related injury or diagnosed illness;
- After you claim is denied you get to choose your own treating doctor;
- It is imperative that you are being treated even if you claim is denied to establish the evidence necessary to show that you are disabled and the injury was caused while at work;
- It is important to have a doctor that will record detailed histories and findings and cooperate with requests for providing work notes, preparing disability forms and/or providing testimony for your claim.
Contact a Wilkes Barre Workers’ Compensation Lawyer
The appeals process can be extremely complicated, especially if you need to go to court. These claims can take time, so the sooner you act the better. The dedicated Wilkes Barre workers’ compensation lawyer Keith Figured is available directly to assist you at 570.954.9299. Contact the Figured Law Firm to learn more about the services we provided to injured workers and their families in Pennsylvania.
