By Dennis L. Plank, Attorney
When an employee is injured on the job, they are usually entitled to workers’ compensation under The Pennsylvania Workers’ Compensation Act. In addition, Pennsylvania laws require most employers to carry insurance that provides medical and wage benefits to employees who are injured or become ill while at work or doing work on behalf of an employer.
While most workers’ compensation claims are awarded without incidence, insurance companies sometimes deny claims based on technicalities. Other insurance companies try to deny claims in an attempt to save money.
When this happens, our law offices can contest a denied claim to get our clients the payments they deserve. All workers’ compensation work at Going and Plank is done on a contingency basis. In other words, we don’t charge for our services unless we secure the benefits on behalf of our client.
Over the years, we’ve worked with hundreds of clients to overturn denied workers’ compensation claims. While every case is different, our deep experience in the field has helped us identify five steps every injured worker should take to ensure they get the benefits they deserve.
Step One: Report
When employees are hurt on the job, they often ignore it. That’s a mistake because conditions such as a sore back, a bump on the head, or a seemingly harmless fall can become more severe over time. Resulting physical limitations could impact the ability to work. Reporting minor issues as they occur protects the worker in case of future complications.
Immediate reporting also decreases the likelihood of a contested claim. In Pennsylvania, employees must report injuries within 120 days of the incidence date to qualify for. However, the longer the worker waits to document the event, the more difficult compensation claims become. That’s why our law offices strongly encourage clients to report any accident or developing condition within 21 days.
Exceptions exist for work-related conditions that develop over time, such as chronic back pain, carpal tunnel syndrome, or lung conditions. In these cases, employees must report the condition within 120 days of the doctor’s diagnosis.
While filing within deadlines will reduce complications, it’s sometimes possible to collect workers’ compensation even if time limits are exceeded. For example, exceptions may exist if there was a witness to the injury, if the employer was aware of the event, if the employer didn’t post notices about workers’ comp requirements, or if the injured party was incapacitated and unable to file a report.
Step Two: Double Check the Paperwork
Filing can be complicated. Claim forms usually require medical documentation, employee signatures, and a lot of detailed information. While paperwork errors are often easy to remedy, insurance companies rarely assist in the process. That’s why some workers’ compensation claims are initially denied based on errors in the documentation.
We advise our clients to take the time to fill out the paperwork carefully. While some employees are tempted to complete forms quickly at work, it makes sense to take the documents home and thoroughly review the requirements.
We encourage our clients to try to file a complaint within 21 days, and the law allows up to 120 days, so don’t rush it. Check all the requirements carefully. Work with your doctor’s office to ensure all injuries are correctly recorded. If your claim has already been denied due to a paperwork error, contact the Law Offices of Going and Plank. We can guide you through filing a claim petition and collecting the necessary documentation, medical records, testimony, and evidence to prepare for a hearing before a workers’ compensation judge.
Step Three: Make Sure Complete Medical Information is Included
Pennsylvania requires medical information and an accident report for workers’ comp claims. A thorough medical evaluation is needed to verify the injury and its cause, so seek medical attention promptly, even if the injury seems minor.
Most healthcare offices will ask if the injury occurred at work. They know that workers’ compensation claims have detailed requirements. So, make sure your medical professional knows your injury is work-related. Ask your doctor to include any physical limitations and work restrictions in their report. Get a copy of the doctor’s assessment for the workers’ comp claim, and ask that the report becomes a permanent part of your medical records.
Step Four: Comply With Requests for Independent or Follow-Up Medical Exams
Some insurance companies may ask that the injured employee is evaluated by an independent medical professional. This physician provides a second opinion and often performs a physical exam or orders additional tests. If you are an injured employee, you should cooperate with these requests.
You may need to attend additional independent medical examinations at specific intervals to assess their progress or ability to return to work continually. Employees should agree to these appointments since failure to participate could result in a denial or end to ongoing benefits.
Step Five: Get an Experienced Workers’ Compensation Attorney
Getting a fair workers’ compensation settlement isn’t always automatic or easy. If you feel that your employer or their insurance company has submitted false information or that your claim is being unfairly denied, contact the Law Offices of Going and Plank in downtown Lancaster for a free consultation. We don’t charge you unless we secure workers’ comp benefits or a lump sum on your behalf.
Want to learn more about denied workers’ comp claims in Lancaster? Check out these articles.
We Answer Questions About Denied Workers’ Comp Claims in Pennsylvania
Can Lancaster County Employers Legally Deny Workers’ Comp Claims?
Worried About Filing for Workers’ Compensation? Knowing These Terms Can Help.
Why do Lancaster County Employers Deny Workers’ Compensation?
Workers’ Compensation: Terms You Need to Know
Workers’ Comp: Can You Appeal a Denied Claim?
Why are Workers’ Comp Claims Denied in PA?
5 Common Reasons Workers’ Comp Claims are Denied