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What to Do if Your Workers’ Compensation Claim Is Rejected in Pennsylvania

Workers’ Compensation insurance is the safety net that guards Pennsylvania employees from the harm of an injury or illness sustained at work that prevents them from earning an income while dealing with costly medical bills.

Unfortunately, many of these insurance claims are denied for a variety of reasons every year. Not all of these denials are valid. If you recently received a rejection of your Workers’ Compensation claim, you have options at your disposal to appeal the rejection to a higher body.

The first step in pursuing your claim further is contacting one of the dedicated Pennsylvania workplace injury lawyers at Lerner, Steinberg & Associates. When you call us today at (215) 355-6400, you can obtain your first case assessment free of charge.

Identify Why Your Workers’ Compensation Claim Was Rejected

When you file a workers’ compensation claim, your employer’s insurance provider will review the application to determine whether it is valid or not. These insurance companies issue more denials than you might expect, and receiving a denial often surprises claimants. Below are some of the most common reasons that Workers’ Compensation insurance companies provide as the basis for denying a claim.

Inaccurate or Incomplete Information

It is important that you paint the full picture in your initial application for Workers’ Compensation. You should include information about the time, date, and location of the accident, the likely causes of the accident, your communication of the accident to your employer or supervisor, and medical records and treatment.

Failure to Report the Injury in Time

You cannot wait around forever without filing a formal report of your injury. In Pennsylvania, workplace injuries must be reported within 120 days of the accident that caused them. If you contracted disease or illness at work, but were not aware of the illness immediately, this timeline changes slightly, but you still face a time requirement for reporting. Some employers will handle the reporting for you, but you should not assume that this critical step is handled. Contact a Pennsylvania workplace accident lawyer for help in meeting the proper reporting requirements.

Failure to Prove the Validity of the Injury

In order to get your Workers’ Compensation claim approved, you will need to demonstrate that you suffered a real injury or illness at work. The most critical step to meeting this criterion is visiting an emergency room or urgent care facility as soon as you become aware of the harm you may have sustained. A medical record showing your diagnosis and treatment is the best form of evidence that your injury is valid.

Failure to Prove the Severity of the Injury

To get Workers’ Compensation coverage, your injury must not only be real, but also severe enough to prevent you from meeting some or all of your job responsibilities for an extended period of time. To this end, your doctor may write a letter on your behalf stating the nature of your injuries and the limitations that they will likely cause. Your doctor cannot state that you should qualify for Workers’ Compensation in the letter, but you can use the state’s requirements for covered injuries to get the critical points featured in the letter.

Course and Scope of the Employment

Workplace injuries must happen “at work” to be compensable through Workers’ Compensation insurance. This could mean a variety of different things depending on the nature of your job and workplace. For instance, if you slipped and fell while carrying materials on a construction site, it is fairly plain that you suffered your injury in the course and scope of your employment. However, there are many situations that can be less clear, such as where you got into an accident while stopping for gas in a vehicle owned by your employer. A Pennsylvania workplace injury attorney will be critical in establishing that your injury occurred at work.

Claimant’s Reckless or Illegal Behavior Caused the Accident

Workers’ Compensation benefits do not extend to workers who bring their injuries upon themselves. This is a common reason for rejection that insurance companies use in their rejections in the hope that the claimant believes they were responsible for their own injuries and backs off of their claim. Never give up on your Workers’ Compensation claim without discussing it first with a Pennsylvania workplace injury lawyer.

Appealing a Workers’ Compensation Claim Denial in Pennsylvania

If you do receive an unfavorable decision from your employer’s Workers’ Compensation insurance provider, you are not out of options. Your Pennsylvania workplace injury lawyer can appeal your denial to the Pennsylvania Workers’ Compensation Bureau.

Once you submit your appeal, the government will assign your case to an administrative judge, who will set a date and location for a hearing. You and your lawyer will prepare for the hearing by collecting all medical records, doctor’s reports, and statements from witnesses to the accident.

Even if the administrative judge rules against you, you have 20 days from the date of the decision to appeal that decision to the Workers’ Compensation Appeal Board. If the Appeal Board hearing doesn’t go your way, you have an additional 30 days to bring your case to the Commonwealth Court of Pennsylvania. Even then, you can appeal a Commonwealth Court decision to the Pennsylvania Supreme Court.

This is all to say that, if and when the insurance company denies your claim, you still have plenty of opportunities to make your situation right through the legal system. You should never give up on your claim just because you received an initial denial. In any case, your odds substantially improve when you make the decision to enlist a Pennsylvania workplace injury attorney who is familiar with the local procedural rules of the Workers’ Compensation appeals process.

Our Pennsylvania Workplace Injury Lawyers Can Help You Appeal After a Rejected Workers’ Compensation Claim

To get a first-time case assessment of your Workers’ Compensation claim for no charge, call (215) 355-6400 to speak to the dedicated Pennsylvania workplace injury attorneys at Lerner, Steinberg & Associates.

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“I was involved in a slip and fall accident. I called Benjamin Steinberg for assistance on what to do. He was professional while being so compassionate and caring. He advised me on what to do, answered my questions and was very patient with me. I knew he was the attorney to handle my case. Ben spoke to me several time to keep me up to date on what was happening with my case and of course he was always concerned about how I was feeling. After several months of medical treatment I felt I was feeling better and spoke to Ben about settling the case. Much to my surprise, I received a larger settlement than I had expected. Wow, Ben is terrific! I would highly recommend him to anyone who is looking for legal help in any type of accident. He is tops as far as I am concerned.”

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About Lerner, Steinberg & Associates

Our law firm takes pride in dedicating itself to the rights of injured workers and to attain the best possible financial result(s) in all cases. We work hard to make sure that you get the necessary skilled medical treatment that you deserve. We handle all Workers’ Compensation cases on a contingency fee. This means that there is no fee until we recover for you.

If you have been injured at work, you may be entitled to weekly benefits, payment of your medical bills and/or a lump-sum settlement.

Whether you have recently been injured at work or you are already receiving benefits that your employer is trying to terminate, our experienced attorneys can help you. It is important to retain a lawyer as fast as possible to ensure your employer does not take advantage of you.

We will review your medical records and wage information to make sure that you are receiving all of the benefits to which you are entitled. If you are being pressured to return to work before you are medically ready, we can help you extend your benefits until you are ready to return.

Our promise is that our attorneys will use their experience and knowledge of the Pennsylvania Workers’ Compensation Act to make the strongest case possible on your behalf.

Michael Lerner
Founding Partner