Your Workers’ Comp Claim has Been Denied. What do You do Next?

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

Many of us work hard at our jobs. We show up day after day, giving our employers our best efforts. But even dedicated, experienced employees may get hurt on the job. In 1915, Pennsylvania enacted the Pennsylvania Workers’ Compensation Act to provide medical benefits and to compensate workers for lost wages when they were hurt on the job. Over 100 years later, The Pennsylvania Workers Compensation Act is still in effect and has grown to cover most types of full-time and part-time employees.

How Does the Act Work?

The Pennsylvania Workers’ Compensation Act requires most Pennsylvania employers to carry workers’ compensation insurance. This insurance is in place to pay out claims that cover the costs of medical treatment and compensation to PA employees for lost wages arising from their work-related injuries and medical conditions.

The Act specifically states that the insurance is in effect regardless of fault. That means that if, for example, you fall on the job, even in a workplace that is safe, and the fall was not caused by the employer’s negligence, you are eligible for workers’ compensation. The Act provides protection to employees under many circumstances where the employee suffers an injury while in the course of performing his work duties.

However, workers’ compensation does not cover deliberate or reckless behavior. So, if you are hurt on the job because of horseplay, drug use, or you intentionally hurt yourself, the Act will not cover your injuries.

Workers’ Compensation may provide an opportunity to negotiate a lump sum settlement of your claim to cover future wage loss or future medical expenses. In addition to total or partial wage loss and payment of medical expenses, the Act provides for compensation for specific loss of body parts, scarring and disfigurement, and death of an employee arising from the performance of work duties.

Petitioning a Denied Worker’s Comp Claim is a Complicated Process

Getting your workers’ compensation claim approved and paid is not always simple or straightforward. Claims often require detailed documentation and obtaining detailed medical records and reports. Insurance companies and their lawyers often dispute claims. As a result, many workers’ compensation claims are unfairly denied. If your workers’ compensation claim has been denied, you still have rights. In Pennsylvania, you can further pursue a workers’ compensation claim by filing a petition with the Bureau of Workers’ Compensation.

In filing this petition, you will be asked to provide evidence and documentation of your injury at a hearing before a workers’ compensation judge and the insurance company’s attorney will also be asked to defend their rationale for denying the claim.  If you need help evaluating your denied claim, contact Going and Plank to schedule a free consultation.

If your claim was denied, you need to know what to do, and how to do it quickly. Here are some tips to help you through the process.

Step One: Know Why Your Workers’ Compensation Claim Was Denied

There are many reasons a workers’ compensation claim is denied. Read your denial letter carefully to determine the issue(s).

In some cases, denials may be due to a technicality such as a paperwork error or that you reported the injury late. In other cases, the insurance carrier may allege that your injury did not meet the legal requirements for compensation. An example might be that your injury did not occur in the course of your employment or was not related to your work activity.  In some cases, the attorney for the workers’ compensation insurance company may dispute the truth or the validity of your claim.

The good news is that initial denial is not final. If your claim was denied, if you think the denial was reached in error, if you want to dispute a technical error, or if you feel that your employer or the insurance company has submitted untrue or unfair information that has hurt your claim, you may take additional steps to further pursue your claim. Schedule a free appointment to discuss your options.

There are many reasons claims are denied. Here are some of the most common:

  1. No Witness

Without a witness, it’s easier for insurance companies to claim your accident never happened, or to claim it happened elsewhere. If you make a claim without the proof of an eyewitness, insurance companies will question your claim, and many such claims get denied. If you’re hurt at work, but no one saw your injury, Going and Plank may be able to build a case, especially if you told co-workers or supervisors about your injury when it happened, if there are witnesses who saw you before or after the accident, or if you left work that day to seek medical attention. Contact us at 717-392-4131 for a free workers’ comp consultation.

  1. Missed Deadline for Reporting Injury

Sometimes employees get hurt at work and consider it a minor injury. You may have put off reporting your injury until you realized it was a more significant issue.

To eliminate these types of issues, an employee should report any minor injury at work, such as a bumped head or a sore joint, even if you feel it’s a minor mishap. However, even if you waited to report your injury, you may still be entitled to workers’ comp. Contact us at Going and Plank for a free consultation.

  1. Inconsistent Accounts

It’s not uncommon to find that the injured person’s account of the incident differs from the accounts given by witnesses, co-workers, supervisors or medical professionals. Such differences may result in your workers’ comp claim being denied. An experienced workers’ compensation attorney can help you evaluate the issues, and help you determine ways to explore the discrepancies and resolve them when possible. If you feel others are misrepresenting your injury, or that you are being treated unfairly, contact us at Going and Plank to schedule a free consultation.

  1. Made Claim After You Were Fired or Let Go

Even small injuries at work can escalate into circumstances resulting in disability. That’s why it’s important to report work injuries immediately. You may have found that when you took a few days off after your injury to obtain medical treatment or to rest, your employer decided to fire you in the interim. In fact, some employers will fire you because you were hurt on the job, to avoid a claim for workers’ compensation benefits.  If this is your situation, contact us at Going and Plank to discuss your choices.

  1. Alcohol or Drug Use

After a work-related accident, some employers require a test for illegal substances. Your workers’ comp claim can be denied if drug use led to an increased chance of an accident. However, certain exceptions may apply. Schedule a free consultation with a workers’ comp attorney to weigh your options.

  1. Refused a Recorded Statement

Employees may be asked to make a recorded statement for the insurance company, but you are not legally required to make this statement. Since recorded statements can be used against you, it’s smart to consult a workers’ comp lawyer at this point. If you were asked to make a recorded statement, and your agreement or denial resulted in a denial of your claim, contact Going and Plank to discuss your options.

Step Two: Find an Experienced Attorney to Represent You in the Workers’ Comp Hearing and Appeal Process

Filing a petition to further pursue your workers’ compensation claim after the insurance carrier has issued a denial can be an intimidating process.  Many claims are initially denied because the claim was not properly or completely documented.  That’s why it is so important to hire an experienced workers’ compensation attorney to represent you through the hearing and appeals process.

You may find that further pursuing your denied claim is a daunting task. The filing of a claim petition requires obtaining significant documentation, medical records, and detailed information regarding your claim in preparation for a hearing which will be scheduled before a workers’ compensation judge, who after taking the testimony of both parties and considering all pertinent documentation including medical records and testimony, will issue a decision as to whether you are entitled to payment for your work injury.

As part of the hearing process, you will be required to provide documentation inclusive of relevant medical records, documentation of your work status and earnings at the time of the injury and any other documentation required by the workers’ compensation judge or requested by the insurance company’s attorneys.  You may also be required to undergo an additional medical examination at the insurance company’s request.

It’s smart to have an experienced workers’ compensation attorney on your side.  Going and Plank has decades of experience handling workers’ compensation issues for injured workers throughout Lancaster, Chester, York, Dauphin, and Lebanon Counties.  We will provide expert and experienced representation to make sure that you receive all of the benefits available to you under the law.  Make sure you schedule a free consultation with Dennis Plank, an attorney with over 35 years of workers’ compensation experience in Lancaster, Pennsylvania.  Schedule your free consultation now.

Step Three: Filing a Workers’ Compensation Claim Petition

Don’t let a denial of your workers’ compensation claim stop you from receiving the benefits you deserve.  You are legally entitled to challenge a denial of your claim by the workers’ compensation insurance company by filing a petition with the Bureau of Workers’ Compensation which will entitle you to a hearing on your claim before a workers’ compensation judge.  An effective presentation to the judge could result in payments of benefits to cover lost wages, medical expenses, or provide the basis for a potential lump sum settlement of your claim.

Pennsylvania law requires an employee to give notice of his work injury to the employer within 120 days of the date of injury.  The law also places a 3-year statute of limitations on the filing of a claim petition to pursue benefits, with this time limit commencing on the date of your injury.  If you believe your workers’ compensation claim was unfairly denied, it is important to meet with an experienced workers’ compensation attorney as soon as possible to ensure that these time limitations are met.

Unfortunately, an injury on the job can have long-lasting financial effects.  Whether you’re full time, part time, or salaried, Going and Plank works with clients to make sure your injury does not hurt your long-term financial security.

These procedures are challenging for most employees. That’s why Dennis Plank and Going and Plank offers a free consultation to help you determine your best course of action. We move fast to help you meet all required deadlines. Our representation of you does not require an initial payment of legal fees, and in most cases, we only receive payment if your claim has been successfully resolved resulting in payment to you.

Schedule Your Free Appointment Now

Dennis L. Plank is a Lancaster County attorney specializing in representing injured workers. He has spent more than 35 years fighting for the fair and legal treatment of every employee. If you’ve been hurt on the job, an attorney from Going and Plank will work to ensure that your settlement covers the resulting long-term financial hardships. A variety of injuries are covered, including:

  • Neck and back pain
  • Nerve damage or spinal cord damage
  • Bone fractures
  • Arm or leg injuries
  • Hand or foot injuries
  • Loss of use of a body part
  • Loss of body parts
  • Brain damage
  • Cranial or skull damage
  • Chronic pain
  • Physical disfigurement and scarring
  • Damage to hearing
  • Damage to eyesight
  •  Dental damage
  • Impaired mobility or loss of dexterity
  • Death

If you feel you’re being treated unfairly or illegally, contact us today to discuss your legal options. Consultations are free, and we only get paid if we win your claim.

Want to Read More About Denied Workers’ Compensation Claims?

 Check out these resources:

9 Important Facts About Workers’ Compensation

Why are Worker’s Comp Claims Denied in Pennsylvania?

Workers’ Comp: Get the Benefits You Deserve

Maggie Vergenes

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