What are My Options if My Worker’s Compensation Claim Was Denied?

Have you filed a claim for workers’ compensation (WC) benefits after being injured on the job and received the dreaded denial letter in your mailbox in response? There are various reasons why your workers’ compensation claim may have been denied, but you do have options for pursuing your claim and possibly having the denial reversed. Today we’re taking a look at some of the best next actions you can take after your worker’s comp claim was denied in Pennsylvania.

Hire a workers’ compensation lawyer

Once your claim is denied, you are faced with a critical decision, and that’s whether to engage an experienced workers’ compensation lawyer to help you pursue the benefits you may rightfully deserve. Without an approved claim, neither your employer nor their insurance company is required to pay any of your medical bills, pay your wage loss, or most importantly, accommodate any physical limitations you may have when you to return to work. You could lose your job as a result of your injuries and be faced with the nightmare scenario of having no income. There is even the possibility that you would be ineligible for unemployment if you are not “able and available” for work.

It’s true that people are sometimes concerned that hiring a lawyer will jeopardize their job, or they are simply unsure whether their injuries even qualify for workers’ compensation, especially after receiving that denial from their employer or their employer’s WC insurance carrier. Here at Westmoreland Injury Lawyers, we’ve found that fear of hiring a lawyer to be unfounded over the course of the 30 years we have been handling workers’ comp cases. When you pursue a claim for workers’ compensation through your lawyer, most employers are less likely to lay you off or fire you over concerns that it would look bad in court. With strong legal support behind you, your employer is more likely to take your claim seriously.

But is hiring a lawyer to assist you with your denied claim expensive? It’s really not. Many clients are pleased to know that many lawyers handle all WC cases on a contingency fee basis, which means we are only paid if we win your case. There is never a fee or cost to the client unless we are successful in getting you your rightful benefits or a settlement.

Resolve the dispute with your employer

Before you take the step of hiring a lawyer, you are certainly encouraged to meet with your employer and/or their WC insurance company representatives to see if your denial was the result of a simple clerical error or misunderstanding. This is sometimes helpful if your employer is disputing your claim for some more subjective reason, such as reporting that your injury was caused by “horseplay” or that you were not actually hurt during the course of your workday. It’s always a good idea to keep your relationship with your employer amicable even if you believe they are being unfair in denying your claim. Keep the lines of communication open, and you may be able to resolve the issue informally.

If you do not feel that you can meet with your employer without assistance from an impartial third party, you may undergo a more formal process called alternative dispute resolution, which involves a workers’ compensation judge to help settle differences between parties through mediation, settlement conference, or other informal conference. You or your employer may file a petition with the Pennsylvania WC Office of Adjudication to begin the process. You may choose to hire a lawyer to represent you in this process, but it is not required. And it is important to note that if you do not hire an attorney for alternative dispute resolution, your employer is not entitled to involve one either.

It’s true that claims denied for the reason that your injury was not reported on time or your claim was not filed on time are more difficult to solve without legal help. Under the workers’ compensation laws in PA, you only have three years to file a claim petition for a new injury and even less time if this is a reoccurrence of an old injury. Failure to take action could result in you losing the right ever to be compensated for your injuries. If you are denied for reasons having to do with time limits, you should contact an experienced WC attorney like us here at Westmoreland Injury Lawyers right away.

Appeal the denial to the Pennsylvania Bureau of Workers’ Compensation

More formal and complex than the alternative dispute resolution process we already discussed, you are entitled to file a claim petition with the PA Bureau of Workers’ Compensation to appeal your employer’s denial. This process also involves a WC judge but is much more difficult for individuals than dispute resolution.

The PA Department of Labor & Industry strongly suggests considering hiring an attorney for workers’ compensation proceedings due to the fact that your employer and/or their insurance company will definitely have experienced representation. If a WC judge decides in favor of your employer, you can further appeal to the Workers’ Compensation Appeal Board and then to Commonwealth Court, and you will likely want an experienced attorney by your side through those advanced steps.

Have you recently been denied workers’ compensation benefits and need help working through dispute resolution or appeals in the Greensburg, PA area? Westmoreland Injury Lawyers will consult with you for free to determine whether you have a case and work through your potential next steps. Contact us today to get started and don’t lose right your benefits without a fight.