What happens after a denial of your workers’ compensation claim?

Nov 10, 2021 | Workers' Compensation

There are numerous requirements for an injured worker in Pennsylvania who needs workers’ compensation. They have to tell their employer about their diagnosis in a timely manner. There are also specific timelines that apply to benefits claims and employer reporting to insurance companies and the state.

The insurance company that covers your employer will have to respond to you within three weeks of your claim. When they approve your claim, you can start receiving benefits if you need disability or can submit medical bills for reimbursement.

When they deny your claim, you may need to ask for an appeal. What does that process involve?

You have to file a claim petition to see a workers’ compensation judge

When the insurance company has rejected your benefits request, you have to ask a judge to overrule their decision. There are specialized judges who handle workers’ compensation cases in Pennsylvania. They are familiar with the law and the standards for disability used by workers’ compensation.

These judges can review medical evidence and information from the employer or the insurance company to make a decision. Applicants have the ability to present evidence, including records about their treatment. Employers and insurance companies can provide reports or testimony from their own experts as well. If a judge rules against you, you can appeal their decision by going to the Pennsylvania Workers’ Compensation Appeals Board.

How do you appeal the decision made by a workers’ compensation judge?

As with every other step of the Pennsylvania workers’ compensation process, an appeal to the Workers’ Compensation Appeals Board must adhere to a specific timeline. You only have 20 calendar days from when the judge rules against you to submit your appeal request.

Having the right help with that process is crucial, as you will have to outline your explanation for why you deserve an appeal in the petition that you submit. You need to have a legal argument about how the judge erred in the decision made in your case. With the right help, an appeal can potentially get you benefits even if you have gone months without them.

Understanding the various stages of workers’ compensation appeals can help you prepare to make or appeal a claim.


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