What happens if my workers’ comp claim is rejected?

There are several reasons your claim could be rejected, including that you did not report your injury within 21 days of the incident or within 120 days of having knowledge of a work-related disease. Another reason is that you did not file a northeastern Pennsylvania claim petition within 3 years of the date of injury or disability, or you did not seek medical treatment from an approved provider or follow the treatment plan.

Alternatively, another reason is that you did not provide sufficient evidence of your injury, disability or work-relatedness, or you were engaged in misconduct, horseplay or illegal activity at the time of the injury. Finally, you could be denied if you were intoxicated or under the influence of drugs at the time of the injury. Or, if you refused to cooperate with the investigation or submit to an independent medical examination.

Not the end of the road

Being denied does not mean that you have no chance of receiving benefits. You can appeal the denial. To do so, you need to file a claim petition with the Bureau of Workers’ Compensation within 3 years of the date of injury or disability.

Claim petition

A claim petition is a legal document that contains information about your injury, your employer, your insurance company and your request for benefits. You need to fill out the form completely and accurately, attach any supporting documents (such as medical records, witness statements or pay stubs), and mail it to the bureau. You also need to send a copy to your employer and the insurance company.

Once you file a claim petition, you will be assigned a workers’ compensation judge who will schedule a hearing. The hearing is an opportunity for you to present your case and explain why you deserve benefits. You can also bring witnesses, such as your doctor, co-workers or family members, to testify on your behalf. The employer and the insurance company will also have a chance to present their arguments and evidence.

The judge will review all the evidence and make a decision based on the facts and the law. The decision may be issued verbally at the end of the hearing or in writing in 30 days. The decision will state whether your claim is granted or denied and what benefits you are entitled to receive. If you are unhappy with the judge’s decision, you can appeal it to the Workers’ Compensation Appeal Board within 20 days of receiving it, and you can appeal it further to the Commonwealth Court and then, to the Supreme Court of Pennsylvania.