How to Handle a Denied Workers’ Compensation Claim

Getting denied for Workers’ Compensation after an accident or injury at work may be surprising, but it is quite common. Because there are numerous reasons a claim can be denied, it is important to present solid evidence to back up your claim. While you may think that your employer has your back after an unfortunate incident, their insurance company may have other ideas.

In Pennsylvania and New Jersey, Workers’ Compensation is available to employees who are injured or become ill as a result of employment. This includes anything from pulled muscles and broken bones to conditions that develop over time due to repetitive motions required by a particular job. Workers’ Compensation is generally available for medical bills, loss of wages, temporary disability during recovery, permanent disability for loss of limbs, or a payout to relatives for loss of life on the job.

Why Are Claims Denied?

There are many reasons a claim can be denied, but here are some of the most common:

• It is not a work-related injury. Some might argue that an injury was a pre-existing condition or did not occur at work. However, even an action at work that aggravates an existing condition or causes it to worsen may qualify for Workers’ Compensation.
• It is not severe or debilitating enough to warrant compensation. If an individual does not seek medical attention following an incident, some may consider this a lack of severity that does not qualify for compensation. Therefore, seeking medical assistance after an incident within a reasonable amount of time is imperative.
• The individual is not considered an employee. Misclassifying an individual as an independent contractor as opposed to an employee can have a major impact on one’s ability to collect Workers’ Compensation. Therefore, it is important to know the status of your employment and have it confirmed by an employer.
• It was not filed on time, or the statute of limitations lapsed. Every state has strict guidelines on reporting work-related incidents and injuries that could affect whether an individual is paid Workers’ Compensation benefits. For instance, New Jersey law requires an incident to be reported within two years of the date of injury, while Pennsylvania requires an injury to be reported to an employer within 120 days and three years of the date of injury. Knowing the proper timeline can mean the difference between being approved and being denied.
• Negligence contributed to the injury. If an injury is related to horseplay at work or substance abuse, an employer can dispute the claim and argue that the employee is not entitled to compensation because their actions disqualify them.
• Additional information is needed. Whether medical documentation is insufficient or additional narrative is needed to clarify what happened, an insurance company may deny a claim for these reasons. While it may be just a matter of needing more information, it may also be a stall tactic that seeks to delay or withhold payment. Additionally, discrepancies in what happened, such as the sequence of events or other details in official paperwork, may be just enough to deny a claim. For this reason, it is important to have solid facts and witnesses in place to present a strong case.

What if My Claim Is Denied?

If your claim is denied, you have the right to appeal within three years from the date of injury in Pennsylvania and within two years in New Jersey. A judge may encourage parties to consider mediation to discuss solutions and avoid a formal hearing. However, should a formal hearing be necessary, evidence will be presented by both sides in front of a judge. In this case, it will be necessary to gather information such as medical records, doctor and witness statements, paperwork filed with Human Resources, and any other documentation that may support your claim.

If the judge denies the claim, it can be appealed to the Workers’ Compensation Appeal Board (WCAB). Denial by the board would lead to an appeal to the Commonwealth Court within 30 days from the date of the decision, which could then be appealed to the Pennsylvania Supreme Court.

Get Assistance With Your Workers’ Compensation Claim From the Philadelphia Workers’ Compensation Lawyers at Freedman & Lorry, P.C.

Workers’ Compensation cases can be complex, but you do not need to handle them on your own. The Philadelphia Workers’ Compensation lawyers at Freedman & Lorry, P.C. will work hard to get you the benefits you deserve. Call us today at 888-999-1962 or contact us online to schedule a free consultation. With office locations in Philadelphia, Pennsylvania, and Cherry Hill, New Jersey, we proudly serve clients in Pennsylvania and New Jersey.