Workers’ compensation generally covers all employees. This program benefits workers who have suffered illnesses or personal injuries while working. Unfortunately, there are cases where employers do not approve a claim. If this happens to you, what should you do?
Review why your claim was denied
First is to know the reason why your claim has been denied. It could be a lack of evidence, failure to report the injury on time, your pre-existing conditions, the failure to follow medical advice, fraud or misrepresentation or even the failure to meet legal requirements. By understanding the specific reason for denial, you may better address the issue and determine your next steps.
Consider filing an appeal
The denial letter will detail the deadline for filing an appeal. Pennsylvania requires the appeal to be filed within 20 calendar days (not business days) of receiving the letter. It is important, however, that you discuss your issue with your employer to fix any misunderstandings or potential errors before filing an appeal.
Once you’ve decided, you can file an appeal with the workers’ commission. The process involves a hearing before an administrative law judge and may include many levels of review. Consider consulting a legal professional for comprehensive guidance.
Appealing, however, does not guarantee an approval.
What if you receive a denial for the second time?
When an appeal with the workers’ comp commissioner results in another denial, consider working with a lawyer to understand your options. One is to bring your case to the relevant circuit court. Be prepared as the legal process for this can be complex. A strong case and compelling evidence will be necessary to support your claim.
By working with an experienced attorney, you may better understand the complex workers’ compensation processes related to your case. Additionally, a lawyer can help you gather information, negotiate with insurance companies and protect your rights. Their support can also help reduce the stress that may arise from this complicated situation.