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It doesn’t matter if you’re the most dedicated employee in your company, never missing a day because of sickness, always reporting on time, receiving glowing performance reports. Sometimes even the best employees can get hurt. Depending upon which industry you work in, your chances of sustaining an injury during your career will either be higher or lower than the average.
Remember, as well, that not all workplace injuries involve serious accidents. Sometimes the stress of their job profoundly affects employees, or perhaps they’ve injured themselves through the repetitive motion of doing the same tasks day after day after day. Regardless of the reason for the injury, Pennsylvania law entitles you to file a workers’ compensation claim if you get injured on the job.
What Should I Do If My Workers’ Comp Claim Is Denied?
If the Appeal Board denies your appeal, your next step is to file a workers’ compensation appeal with the Commonwealth Court. Either you or your employer has 30 days to appeal the Appeal Board’s decision to the Commonwealth Court.
The Commonwealth Court in Harrisburg is one of Pennsylvania’s two intermediate appellate courts. It is the job of the court to review your case and decide if someone has made a mistake or an error, and whether the evidence presented supported the judge’s ruling. The court will then issue a written decision.
Many workers’ compensation appeals do not go beyond the Commonwealth Court. However, there is one step left, and that is to file an appeal with the state’s Supreme Court.
How Do I Send an Appeal to the Pennsylvania Supreme Court?
If the Commonwealth Court denies your appeal, you have 30 days to file an appeal with the state Supreme Court. The Supreme Court then decides whether or not to hear your case. If they opt not to hear it, the decision of the Commonwealth Court stands as final.
If they do, however, decide to hear your case, your lawyer and the lawyer for your employer will submit briefs to the court, and there is a chance they will have to appear in front of the court to argue your case. The court will then issue a decision, which will be the end of the process.
What Is the Workers’ Compensation Appeals Process in Pennsylvania?
If your Claim Petition gets denied, you can appeal the judge’s decision to the Workers’ Compensation Appeal Board, using form LICB – 25/26, Appeal from the Judge’s Finding of Fact and Conclusions of Law. You have 20 days from the postmark of the letter informing you of the judge’s decision to submit your appeal. Here are some more crucial things to know about the appeals process:
- Make sure you attach a copy of the judge’s denial of your claim, also known as a circulation sheet.
- You need to complete the Proof of Service page on the form listed above. You must list all the names and addresses that appear on the copy of the judge’s decision you received, including the judge. You then need to mail a copy of your appeal to all these parties.
- Before you send in your appeal to the Workers’ Compensation Appeal Board or send copies to all of the appropriate parties, double-check your appeal to ensure all your data and facts are correct. That includes the type of petition — which will be on the judge’s decision letter — the date you received the judge’s decision, the claim number assigned to you by the Workers’ Compensation Board, the original date of your injuries, correct addresses and why you feel the judge was wrong in their decision.
- This last item is vital. You need to concisely summarize why you feel the judge made a mistake in denying your claim. Here is where working with a workers’ comp lawyer is a good idea. An attorney can help you accurately articulate your reasons for disputing the judge’s decision.
The Workers’ Compensation Appeal Board doesn’t overturn a judge’s decision very often. But if you can argue successfully that the judge overlooked a valuable piece of evidence or did not appropriately consider all the facts of the case, the Appeal Board can direct the judge to rehear the case.
How Long Does the Appeals Process Normally Take?
There is no set timeline for how long the appeal process for a workers’ compensation claim can last. Many factors can affect the timeliness of the decision, including:
- The workload of the judge or judges hearing the case or appeal
- How hard your employer fights your claim
- How far you wish to take the appeals process
If your original claim gets denied and you decide to go through the appeals process, litigation may last more than a year. Fortunately, most claims do not take this long to settle. One of the things that you may have in your favor is that your employer may not wish to spend a lot of money to fight your appeal, and it is easier for them to settle with you.
In any case, it’s essential to realize that fighting for your benefits may take some time. But the further you go in the appeals process, the better your chances that you will be successful.
Why Did My Workers’ Compensation Claim Get Denied?
The first thing you need to do is to determine why your claim was denied. This information should be contained in the decision letter that the judge will send to all appropriate parties.
Infographic – Common Reasons Workers’ Comp is Denied
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Some of the reasons that your claim may be denied include the following.
1. You Did Not Report Your Injury Promptly
As noted above, Pennsylvania state law says you need to report your injury to your employer within 120 days of suffering that injury while on the job or when you first realize you were injured.
However, if you report your injury to your employer within 21 days after your injury, you’ll receive your benefits from the date of your injury. If you report after the first 21 days but before 120 days, you’ll receive benefits from the day you reported your injury, rather than the day you were injured.
If you wait longer than 120 days to report your injury, you will not receive compensation. The moment you get injured or believe you have suffered a work-related injury, report it immediately to your employer.
The process for notifying your employer may vary based on where you work. If you’re not sure about the correct procedure, speak to the human resources department at your place of employment. They will let you know about time limits and about the proper steps to formally report the injury. Ask questions about anything you don’t understand, as you want this process to be as smooth as possible.
2. Your Employer Disputes the Reason for Your Injury
Your employer may deny responsibility for your injury. Your employer could say your injury was the result of carelessness on your part, some form of horseplay on the job or that the accident that resulted in your injury happened outside of the workplace or regular work hours.
Employers who want to dispute your claim will try every excuse in the book to avoid paying you the benefits to which you are legally entitled.
3. Your Employer Disputes the Severity of Your Injury
Another reason your workers’ compensation claim may get denied is that your employer, or the employer’s insurance company, claim that your injury was not as severe as you claim it was and that there was no reason for you to miss time on the job or to see a doctor.
4. Your Employer Claims You Engaged in Illegal Activities
Employers and their insurance companies frequently try to use the excuse that you were doing something illegal to persuade the judge to deny your claim. For example, your employer may suggest that you were using drugs or intoxicated while on the job. Unfortunately, this is a popular excuse for employers and insurance companies to use.
If you go to the emergency room after your injury and your medical records do indicate that you had illegal drugs present in your system, you will almost certainly get denied your workers’ compensation benefits.
5. Your Injury Does Not Fall Into the Category of Injuries That Qualify for Compensation
Another reason you may face a workers’ comp denial is that your injury doesn’t fall into the category of compensated injuries.
Sometimes, it can be challenging to prove that injuries, conditions or even diseases are job-related. For instance, a stress-related injury can be hard to prove. Your employer’s insurance company may also cite a pre-existing condition or issue as the result of your injury to avoid liability.
6. You Did Not Receive Any Medical Treatment for Your Injury
You should see a doctor as soon as possible after sustaining your injury. Mention to your health care provider that this injury is job-related so the documentation process can begin. You may need to select from an employer-approved list of doctors within 90 days after you received your injury. Beyond these 90 days, you may go to your physician.
Some companies have health care providers on staff. If you are injured on the job, you may be able to visit the on-staff nurse and immediately notify them of the injury. If your injury is severe, you may need to go to the emergency room. Notify the medical providers there that you were injured at work.
Sometimes, we don’t notice any pain until a few days after sustaining an injury. As soon as you begin to feel discomfort or pain, visit your doctor. Let your physician know about the injury you received at work and how it happened.
If you do not receive any medical treatment after you’ve been injured, your claim will likely get denied. If you don’t receive medical attention, or if you delay the visit to your doctor, your employer’s insurance provider may fight your claim, arguing that you aren’t injured as badly as you are alleging. That’s why it’s crucial to see your doctor or to go to an emergency room after you have suffered a work-related injury that does not require immediate hospitalization.
7. A Lack of Evidence That the Injury Was Job-Related
Sometimes, it is not completely clear that an accident happened at work or when an employee was doing work-related activities off the job site. Your employer may argue that your injury occurred during your lunch break, for example.
If you don’t have any witnesses to your injury, your employer and their insurance company may also use this fact as a lack of evidence that your injury happened at work. In this case, inform your supervisor and coworkers about your injury as soon as possible and ensure you tell each person exactly the same thing about how you received your injury.
Again, if you’re injured, and it is job-related, make sure you see a doctor. It will help your claim.
When You’ll Know if Your Workers’ Comp Claim Got Denied
If you are injured on the job, you need to report your injury to your employer within 120 days of the injury. If you fail to report within this timeframe, or when you first realized you had a work-related injury or disease, you’re not eligible for compensation. As soon as you think you have been hurt on the job, you need to report to your employer.
- Your employer then needs to send reports of all employee injuries to their insurance company as soon as they learn of them. They must also file a First Report of Injury with the Pennsylvania Bureau of Workers’ Compensation. If an accident results in the death of an employee, they must do so within the first 48 hours. For all other injuries, they have seven days.
- Your employer, or their insurance company, may choose to accept liability for your injury and attempt to work out compensation. If your employer or the insurance company tries to talk you into accepting compensation that you believe will not come close to covering lost wages or medical expenses, do not sign anything without first speaking with a workers’ comp lawyer.
- Within 21 days of when you report your injury, your employer can also deny the company is liable for your injury. They will provide you with a Notice of Workers’ Compensation Denial and send a copy of the denial to the Workers’ Compensation Board.
- You can then file a claim petition with the Workers’ Compensation Board. You have up to three years from the date of the injury to file a workers’ compensation claim.
Once again, if your employer has denied liability for your injury, it is always a good idea to talk to a workers’ comp lawyer who can help you file your claim so that it takes into account all the damages you believe you have suffered, such as lost wages or medical expenses.
After you file a claim, it will get assigned to a workers’ compensation judge who handles cases near where you live. The judge will then call a hearing and take evidence from both parties. Often, the judge will attempt to settle any dispute over a claim through mediation. If mediation is unsuccessful, and all evidence is in, the judge will render a decision.
Do I Need a Lawyer to Help Me With My Denied Claim Appeal?
Hiring a lawyer is highly recommended. You can see that the workers’ compensation appeals process in Pennsylvania is not an easy one. It requires you to gather evidence that supports your claim, keep records of all your medical expenses and lost wages, perhaps get statements from witnesses who may have seen you be injured on the job, fill out a lot of forms and meet a lot of filing deadlines.
It can be overwhelming, especially if your injury is severe and the last thing in the world you feel like doing is spending all your time preparing a workers’ compensation appeal, rather than recovering and healing.
A workers’ comp lawyer’s job is to help you through this process. While you’re recovering, they are preparing all the paperwork, gathering all the evidence, filing all the correct forms on time and letting you know where and when you have to make an appearance to support your claim.
The other reason you want to hire a lawyer who knows how to appeal a workers’ compensation denied claim is that they have years of experience in helping people like you. And let’s face it, the lawyers for your employer’s insurance companies also have plenty of experience in using every trick in the book to deny you the benefits to which the law entitles you. Working with a trusted workers’ comp lawyer is the best way you can stand up to the lawyers for the insurance company and win your initial claim or, if need be, your appeal.
Let the Experienced Lawyers at Frommer D’Amico Help You With Your Workers’ Comp Appeal
When you are looking for a trusted lawyer to help you with your workers’ compensation claim or appeal, contact Frommer D’Amico. We are a workers’ compensation firm in Pennsylvania with years of experience in helping our clients recover the benefits they deserve after suffering a workplace injury.
Our firm believes that a small and efficient group of highly experienced lawyers and paralegals can provide the best in legal services to every one of our clients. We treat each case with the care and attention it deserves.
Contact us today for a free consultation to get the compensation owed to you. Leave us details about your case or call us at 717-400-1000. A member of our team will be in touch with you as soon as possible.