Suffering an injury at work is never ideal, but at least you have workers’ compensation to help you out, right? What happens when they deny you claim? What do you do then? This is something many workers in Pennsylvania have to go through. Luckily, the claims denial process is straightforward, so at least you will know what to expect and how to proceed.
The Department of Labor and Industry explains that when you get a claim denial from workers’ compensation, you will receive it within 21 days. You will also receive a notice that the insurer is stopping your compensation if you have been receiving it.
If you get a denial, you have three years to reopen your case. You can file a claim petition, which will trigger a hearing where you and your employer may present your case. This will allow you to show evidence of your injury and any associated expenses. You may also have to go through mediation to resolve the claim.
The judge will issue a ruling in writing. If you receive another denial, you have 20 days to appeal to the Workers’ Compensation Appeal Board. If you again do not get the decision you want, you may take your case to the Commonwealth Court within 30 days. After that, you may appeal to the state Supreme Court within 30 days. The Supreme Court has the final say in the matter.
Hopefully, somewhere along the way, you are able to prove your case and get your claim approved. This will allow you to then receive benefits, which may include medical payments and loss of wages payments. This information is for education and is not legal advice.