Understanding Your Rights When Your Workers’ Compensation Claim is Denied
If you are injured at work or suffer a work-related injury, such as a car accident while on the job, you are entitled to workers’ compensation benefits under the Pennsylvania Workers’ Compensation Act.
However, if you received a Notice of Compensation Denial from your employer, they are denying you the compensation you are entitled to. Despite this denial, as a worker in Pennsylvania, you can still pursue benefits if the insurance company has denied your claim.
They may deny your benefits for any reason, even if they don’t have a legal basis. This is why you need an attorney in your corner!
Common Reasons for Workers’ Compensation Claim Denial:
- Employer does not believe you suffered a work-related injury: This may include pre-existing injuries.
- The injury occurred outside the scope of your employment.
- You were not employed by your employer at the time of the injury.
- You failed to give notice of your injury to your employer within the timeframe specified in the Pennsylvania Workers’ Compensation Act: The Act requires you to notify your employer, such as your boss, supervisor, or HR department. To collect workers’ compensation benefits from the date of injury, notify your employer within 21 days of the injury. If you notify your employer within 120 days, you may still receive benefits, but only from the date of notice, not the date of injury.
- Other reasons as explained on the form: These may include intoxication on the job, disagreement on the severity of the injury, or delay in seeking medical treatment.
What Are Your Rights When Your Claim is Denied?
You have the right to contest the denial of benefits. A workers’ compensation judge will be assigned to hear your case and determine whether the denial was appropriate. To initiate this process, you must file a Claim Petition.
- File a Claim Petition: Ensure the injury occurred within three (3) years of the date you file.
- Present Medical Evidence and Testimony: Both you and your employer will present medical evidence and testimony. Your treating physician may testify regarding the nature and diagnosis of your injury. The insurance company may require an independent medical examination (IME) to assess the injury.
Continue to seek medical treatment for your work injury to strengthen your case and satisfy the burden of proof required when filing a Claim Petition. The burden of proof lies with the injured worker, and ongoing treatment provides additional medical evidence to support your claim for wage loss and medical expenses incurred from the work-related injury.
Contact an Experienced Workers’ Compensation Attorney
If you or a loved one has been injured in a work-related accident, contact us today. The initial workers’ compensation consultation is always free of charge.