Workers’ compensation provides much-needed financial support when an employee is injured on the job. It is used to pay for medical expenses, to recoup lost wages and for other needs. There may be situations where the claim is denied and the employee needs to understand their options to pursue their claim.
In Pennsylvania, if the workers’ compensation claim is denied, the employee has a right to appeal the decision. There are several steps in this process.
Appealing a denial
The employee must file a petition for a hearing and it must include their name, contact information, employer’s contact information, a description of the injury or illness and other relevant information.
After the petition is filed, the employee should receive a pre-hearing notice, which is a conference with the employee and the employer or insurer. In this meeting, the parties may discuss the issues in dispute and determine whether they can be resolved without a formal hearing.
If the dispute is not resolved during the pre-hearing conference, the employee may be asked to participate in a mediation session. Mediation involves a neutral third party who helps the employee and employer or insurer reach a settlement agreement.
If the mediation is not successful, the parties will be asked to attend a formal hearing in front of a workers’ compensation judge who will listen to witness testimony and review evidence, then issue a written decision.
If either party disagrees with the judge’s decision, they have the option to appeal further to the workers’ compensation appeal board and through the court system. The appeals process can be lengthy, but it is available to employees with denied claims.