As a member of the workforce in Pennsylvania, you likely had peace of mind about the welfare of your family if you should suffer a workplace injury. After all, your workers’ compensation benefits will pay medical expenses and provide financial assistance if you become temporarily disabled. However, were you disillusioned when your company’s insurance provider recently denied you claim?
This can leave you in an unenviable predicament, but it is no reason for you to throw in the towel. There are steps you can take, and with the appropriate support and guidance, you can appeal the rejection of your workers’ compensation benefits claim.
Reasons for denied claims
The letter you received to inform you of the rejection would also inform you of the reason for denial. Here are some of the most common reasons:
- Missed deadlines — You must notify your employer of your injury within a particular time — that limit typically gives you a few days, and it may be best to provide written notice and keep a dated copy for your own records. Furthermore, your employer then has a prescribed period within which he or she must file your claim with the workers’ compensation insurance provider. Missing any of these deadlines can lead to a claim denial.
- Disputed claim — Your employer might dispute your claim that you were injured while on duty. He or she might insist that your injury is not work related or that you were hurt while partaking in horseplay.
- Non-compensable injury — Although the Pennsylvania workers’ comp system accepts claims for stress-related injuries such as anxiety or PTSD, proving that these are work related can be tough, and such claims are often denied due to a lack of substantiating documentation.
- No proof of medical treatment — Without proof of medical expenses related to an on-the-job injury, there can be no claim.
Where to turn for help after a claim denial
The denial letter will indicate a date by which you can file an appeal. However, this is a complicated process and it may be unwise to rush into it. Consulting with legal counsel may be the most appropriate first step to take. After assessing the claim and the circumstances of your injury, your lawyer can start by meeting with the insurer and/or your employer to discuss the possibility of a misunderstanding or clerical error that might resolve the issue.
If no resolution is possible, your attorney can proceed with the appeals process that will likely involve a hearing with an administrative law judge, followed by several levels of appeal. If you provide your lawyer with the necessary documentation to prove your injury and the fact that it happened while you were on duty, he or she will do whatever is necessary to get you the maximum compensation allowed by the laws of the state.