The Pennsylvania workers’ compensation program is in place to allow injured workers to quickly and easily recover financial compensation to pay for their medical bills, lost wages and other losses after a workplace injury or illness. Unfortunately, the claims process is not always simple or straightforward. If you have been denied workers’ comp, our experienced personal injury lawyers in Pittsburgh explain the legal options you have.

Learn the Reason for the Denial

First, you need to understand why the insurance company or your employer rejected your workers’ compensation claim. The insurance company should give you a written explanation in your denial letter. If not, call the insurance company to inquire. It may be something you can remedy, such as providing additional proof of your injuries or evidence that they are connected to your work.

Common reasons why insurance companies reject workers’ compensation claims include late reporting of the injury, inadequate proof, missing information, missed filing deadline, employer dispute of claim, pre-existing injuries or conditions, horseplay or intoxication, lack of available coverage, and ineligible worker (not a qualified employee). If the reason for the denial can be remedied, submit your additional documentation or information, as needed.

Request an Internal Review 

The next option is to contact the insurance company or your employer to request a review of your claim. There may be a simple misunderstanding, mistake or clerical error that can be cleared up to restore your claim. An internal review will assign a new claims adjuster to your case to look at the original adjuster’s decision and potentially change or reverse the rejection.

Enter Into Mediation

If your employer and the insurance company still deny your workers’ comp claim, you can enter into formal mediation in an effort to resolve the issue without going to court. Mediation is a private meeting with the parties involved in a dispute and a neutral third party that acts as the mediator. The mediator cannot make any binding decisions about a workers’ comp claim, but he or she will try to encourage a resolution via settlement.

Appeal the Denial 

If an internal review and mediation still result in a denial of coverage, you can take the matter to the Pennsylvania Department of Labor & Industry – Bureau of Workers’ Compensation. In general, you have three years from the date of your workplace injury to file your appeal petition. However, it is important to act as quickly as possible to avoid delays in receiving financial benefits.

Collect all relevant information, evidence and documentation to support your claim. You will have to attend a hearing in front of a workers’ compensation judge to determine the outcome of the appeal. If you do not agree with the judge’s decision, you can file an official claim petition to appeal it electronically or by mail. Your appeal petition must be made no later than 20 calendar days from the circulation date of the judge’s decision.

Consult a Workers’ Compensation Attorney

If your workers’ compensation claim in Pennsylvania gets denied, do not attempt to navigate the complex appeals process on your own. Hire an experienced Pittsburgh workers’ comp attorney for assistance. Your lawyer can put his or her skill and workers’ comp knowledge to use for your benefit to fight for the best possible case results while you focus on healing. 

To schedule a free consultation about a recent workers’ compensation insurance claim denial, contact Dallas W. Hartman P.C., Attorneys at Law 24/7.