Workers’ Comp: Can You Appeal a Denied Claim?

plank-dennis-Lancaster-County-PennsylvaniaBy Dennis Plank, Attorney

Work-related injuries often cause more trauma than the mere injuries themselves. Fear of lost work time and wages, mounting medical bills, and the worry of supporting a family can add stress to an already difficult situation. Fortunately, Lancaster County workers who suffer injuries on the job typically qualify for compensation under The Pennsylvania Workers’ Compensation Act. The state law requires most employers to carry insurance that will pay benefits to cover medical bills, lost wages and possibly a lump-sum settlement to employees who are injured or disabled in connection with their job.

Injured employees often find the workers’ compensation claim process complicated and time-consuming. The result is many denied claims, frequently due to simple mistakes. An experienced workers’ compensation attorney can often appeal a denied claim and get it approved. Here’s a look at some common reasons for denied claims and how a workers’ comp lawyer can help.

Missed Deadline for Filing a Workers’ Comp Claim

An employee must report a work-related injury to an employer within 120 days of the date of injury to receive workers’ compensation benefits. If they have a work-related condition or illness that occurred over time, they must report it within 120 days of diagnosis. Reporting an injury as early as possible offers the best chance for maximum compensation for medical bills and lost wages. Whenever possible, put the report in writing and keep a copy. Include a description of the injury and when and where it occurred.

Under some circumstances, injured workers have recourse for claims denied due to missed deadlines. A workers’ comp lawyer can determine if the employee qualifies for an exception in Pennsylvania. That may be the case if the employer was aware of the injury, if the employee was incapacitated and unable to notify the employer on time, or if the employer did not clearly post workers’ comp rules.

Lack of Witnesses to Support Workers’ Compensation Claim

Insurance companies often deny workers’ comp claims that lack eyewitness proof. Without eyewitnesses, the insurance company may suggest that the accident never happened or that it happened outside the workplace.

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In some cases, a workers’ compensation attorney can build a case for a successful appeal if the employee told a co-worker or supervisor about the injury, if there are witnesses who saw the employee before or after the accident, or if the injured employee left work to seek medical attention.

Workers’ Compensation Denied Due to Illegal Drug Use

Some employers require a drug test following a work-related injury. Failing that test increases the likelihood of denied workers’ compensation benefits if the insurance company claims that substance abuse contributed to the accident.

Even if a medical exam shows illegal drug use, there are some cases where an experienced workers’ comp lawyer can show that those test results should not affect benefits – in particular, if the substance abuse was not a contributing factor in the accident. An attorney might also question the integrity of the drug test, the timeliness of the test for accurately proving intoxication at the time of the accident, or whether the employer had a reasonable basis for ordering the test. The Occupational Safety and Health Administration (OSHA) prohibits employers from using drug testing as retaliation against an employee who reports a workplace injury. In such cases, a workers’ comp lawyer may successfully appeal a denied claim if the employer failed to request a drug test from other employees who did not report injuries but who may have contributed to the accident.

Workers’ Comp Claim Filed After Termination

Insurance companies are likely to deny workers’ compensation claims filed after an employee quits, gets fired or laid off, viewing the claim as nothing more than an act of revenge. An experienced workers’ comp attorney can help compile the necessary witness accounts and medical evidence to prove that the claimant suffered a legitimate injury while still on the job. A lawyer may also successfully appeal a denied claim if the employee reported the injury while still employed or if the injury occurred after the employee gave or received notice but before their last day of work. Even with a successful appeal, however, employees who quit may not qualify for benefits covering lost wages since they gave up their wages voluntarily.

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Remember: Although Pennsylvania is an at-will state, meaning an employer can fire an employee at any time and for any reason, it is illegal to terminate an employee for reporting a workplace injury. Any employee who believes they have lost their job because of an injury should contact a workers’ compensation lawyer immediately.

A Doctor Says Your Injuries are not Work-Related

In Pennsylvania, injured employees must seek treatment from a list of employer-approved physicians for the first 90 days. An insurance company may deny a workers’ compensation claim if a doctor determines that the injury occurred outside the work environment or because of a pre-existing condition.

Some injuries outside the workplace do qualify for benefits. A workers’ comp attorney can gather evidence for a successful appeal if the employee sustained the injury while traveling to a remote worksite, working from home, traveling for business, or making deliveries for an employer. In the case of pre-existing conditions, if work-related activities result in a new injury, a lawyer can help prove that the injury qualifies for workers’ comp coverage.

Paperwork Errors in Workers’ Compensation Claim

Filing a workers’ compensation claim requires significant documentation and detailed information. Insurance companies look for reasons to avoid paying benefits and frequently deny claims due to paperwork errors. When this happens, an experienced workers’ comp attorney can help file a claim petition and collect the documentation, medical records, testimony, and evidence necessary to prepare for a hearing before a workers’ compensation judge.

Lancaster County workers who suffer a workplace injury should consult with an experienced workers’ compensation attorney. The Law Offices of Going and Plank in downtown Lancaster can help with meeting state deadlines, securing evidence to file a claim, and navigating the workers’ comp process to ensure maximum benefits. Remember, an initial denial is not final. Contact us today for a free consultation to review all options for an appeal.

Want to find out more about Dennis Plank? Read these articles and blogs:

Why are Workers’ Comp Claims Denied in PA?

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Why are Workers’ Comp Claims Denied in Pennsylvania?

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Maggie Vergenes

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