Denied Workers’ Compensation Claims

Workers who are injured or become ill at work depend on workers’ compensation benefits for an important source of financial support to cover medical bills and supplement lost wages while they are unable to work. Yet these benefits are not guaranteed.

Workers’ compensation insurance carriers can deny claims for a variety of reasons, leaving workers with a heavy financial burden. There are steps you can take to improve your chances of having your claim approved or to successfully appeal one that has already been denied.

Common Reasons for Denied Workers’ Compensation Claims

Workers’ compensation claims are denied for a host of reasons including:

  • Conditions that do not meet state workers’ compensation guidelines
  • Delays in reporting workplace accidents and injuries
  • Filing a workers’ comp claim after leaving your job
  • Inconsistencies between accident reports and medical records
  • Indications of illegal substances in your system at the time of your accident
  • No eyewitness accounts of your accident
  • Refusal to sign insurance documents or medical authorizations

Remember, it is in the workers’ compensation insurance provider’s best interest to prove an accident did not occur at work, did not occur the way the employee described it, or did not directly cause the worker’s injuries. A denied claim means less money they have to pay out. That is incentive enough for insurance carriers to look for any reason to deny your work injury claim.

What to Do if Your Workers’ Compensation Claim is Denied

In the state of Pennsylvania, employers have 21 days from the time you first report your work accident to deny the company is responsible for your injuries. They will send a notice of denial to you and the state Workers’ Compensation Board.

It can be discouraging to find out your claim was denied. The possibility of not earning an income while facing costly doctor bills for your care can be overwhelming. But your Philadelphia workers’ compensation lawyer reminds you not to give up on these benefits even if your initial claim has been denied. You can appeal this decision.

First, your attorney will review all of your paperwork to determine if your employer and insurance carrier simply made a mistake on the paperwork. Clerical errors do happen and are generally easily resolved. If your denial was not the result of a mistake, you will move forward with the appeal process.

Appealing a Denied Workers’ Compensation Claim

The appeals process varies by state. The letter you received regarding your denied claim contains instructions for how to appeal or file a Claim Petition in the state of Pennsylvania. In most cases, the first step is a hearing with a workers’ compensation judge. Here, you and your attorney provide medical reports and other evidence to support your claim. After hearing evidence from both sides, the judge renders a decision.

If your Claim Petition is denied, the appeals process proceeds as follows:

  • Complete form LICB – 25/26, found on the Pennsylvania Department of Labor and Industry website. Attach this form to the original judge’s letter denying your claim.
  • Complete the Proof of Service page on the form mentioned above. List all the names and addresses included in the letter from the judge. These individuals should receive a copy of your appeal.
  • In your appeal, include all pertinent facts and data including: your claim number, accident date and injuries, date of the judge’s denial decision, and the reasons why you feel your denial is unwarranted.
  • Consult with your Philadelphia workers’ compensation lawyer to ensure you have completed the appeal process correctly and on time. They will review your appeal to ensure the facts are accurate and your request for an appeal makes sense.

If you can prove the judge failed to consider key facts or evidence regarding your accident, the Appeal Board may ask the judge to rehear your case. Because appeals are not always successful, it is in your best interest to enlist an experienced workers’ compensation lawyer to oversee your appeal.

Philadelphia Workers’ Compensation Lawyers at Freedman & Lorry, P.C. Oversee Appeals for Denied Claims

Appeals are complex and are best left to the skilled Philadelphia Workers’ Compensation lawyers at Freedman & Lorry, P.C. We will carefully review every detail of your work accident to ensure the judge has all the information they need to approve your benefits. If you have been hurt at work, we exhaust every effort to fight for the compensation you deserve. To discuss your work injury, call 888-999-1962 or contact us online to schedule a free case review in our Philadelphia office. Freedman & Lorry represents clients throughout Delaware County, Pennsylvania, New Jersey, and North Carolina from our offices in Philadelphia, Cherry Hill, and Pinehurst.