Can I Appeal a Denied Workers’ Compensation Claim?

When an accident occurs at work, you likely assume that Workers’ Compensation will provide the money you need to recuperate properly from an injury without missing out on wages. However, when things don’t go according to plan, it’s time to take a look at your rights, the laws, and the best course of action to determine whether you should appeal a denied claim.

In Pennsylvania, under the Workers’ Compensation Act, injured individuals are eligible for wage-loss benefits equal to two-thirds of their weekly wages. For injuries occurring on and after Jan. 1, 2024, the statewide maximum weekly wage is $1,325 per week.

With more than $3 billion in medical and wage benefits paid to injured workers in 2022, it’s not surprising that the details are scrutinized in the more than 167,000 cases reported. However, it is also an unfortunate reality that some insurance companies go out of their way to prove an individual is undeserving of Workers’ Compensation – even when they have a legitimate claim.

Why Are Claims Denied?

Here are some of the most common reasons for denying a claim:

• An injury was not reported on time. In Pennsylvania, an individual has 21 days to report a workplace injury, so immediately reporting an incident to a supervisor is paramount to starting a timeline. Additionally, employees must file a Workers’ Compensation claim within three years of an accident to pursue lost wages or recoup medical expenses.

• An employee is under the influence. There is no law in Pennsylvania that prohibits employers from drug testing an individual after a serious accident at work. Federal regulations may come into play for those with a commercial driver’s license. In either case, an employer may try to prove that drugs or alcohol were a factor in an accident and, therefore, an individual should not be entitled to Workers’ Compensation benefits.

• An individual is still capable of work. A physician may determine there is an injury, and it warrants rest, but it does not require completely missing work. Often referred to as light duty and medically restricted, returning to work in this condition may affect your ability to collect full Workers’ Compensation benefits.

If a judge denies a Workers’ Compensation claim, an individual has 20 days to file an appeal with the Workers’ Compensation Appeal Board (WCAB). This body’s commissioners have statewide jurisdiction to oversee hearings requested both virtually and in person. In 2023, the average time to decision, or the time the appeal was ready for commissioner deliberation to the time the opinion was published, was 3.21 months.

Therefore, when it comes to proving that an injury is significant, time is of the essence. Don’t delay in filing a Workers’ Compensation claim or you could be waiting several months to collect a check while insurance companies and employers sort out the details.

Additionally, if a claim is denied, there are still avenues to pursue in seeking help. If a judge and the WCAB rule against a claim, there is always an opportunity to be heard by the Commonwealth Court and the Pennsylvania Supreme Court.

Find Answers to All of Your Questions with Help from the Philadelphia Workers’ Compensation Lawyers at Freedman & Lorry, P.C.

If you believe you have been denied Workers’ Compensation even after filing an appeal, learn more about the process from the Philadelphia Workers’ Compensation lawyers at Freedman & Lorry, P.C. Call 888-999-1962 or submit an online form for a free consultation. Our office locations in Philadelphia and Cherry Hill, New Jersey are waiting to assist clients in Pennsylvania and New Jersey.