Options after a workers’ compensation claim denial

If you have suffered a work-related injury or illness, Pennsylvania has a workers’ compensation insurance program that may provide you with benefits.

Workers’ compensation process

First, it’s important to report the injury or illness to your employer as soon as possible and to seek medical attention. Your employer may have a list of approved workers’ compensation healthcare providers to choose from and will likely have specific instructions to follow about receiving treatment.

If you file a claim and it is approved, you may receive benefits such as medical coverage, wages, and other compensation depending on the extent of your illness and injury. If your claim is denied, you have a right to appeal.

Addressing a denied claim

Your claim may be denied for several reasons, including a failure to report the claim to your employer promptly, a dispute over whether the injury or illness is work related, and if you fail to respond to questions about the incident. It may also be denied if the injury was related to a pre-existing condition.

You can file a petition with the Pennsylvania Bureau of Workers’ Compensation if your claim is denied. A judge will hold a hearing to decide whether to uphold the denial or to approve benefits. Sometimes, the denial can be resolved by providing missing medical records or other evidence to support your claim.

If the judge upholds the denial, you can appeal to the Workers’ Compensation Appeal Board. The appeals process can be complex and it’s important to follow all deadlines for filing your appeal.