You may expect your workers’ compensation claim to go through without a hitch. However, it is not uncommon for insurance companies deny claims. You should know that the state has put a process in place to protect you from a wrongful denial.
The Pennsylvania Department of Labor & Industry explains what happens when you fight a denial. Below, we have outlined the major steps in the process:
File a claim petition
You must file petition LIBC-362 within three years of the day your injury occurred. Or, you have three years to reopen your claim after the last day of an indemnity payment on your claim.
The notice you receive will include the name of the judge assigned to your case. The next notification should include information about your hearing, including the date, time and location.
Attend the hearing
Before the hearing, gather all medical records, witnesses, expert testimony and other evidence to present to the judge. Your employer and/or its insurance company will also provide evidence, so it is important to build a strong case to put yourself in a good position.
Judges often determine that the parties should try to settle the matter on their own through mediation unless the hearing convinces them that alternative dispute resolution would not be effective in a particular case.
During mediation, a neutral third party guides the discussion so that you and the other party may reach an agreement or settlement. However, the mediator does not determine the outcome as a judge would. You do not have to agree to an offer the other party makes to you in mediation.
Attend a conference with the judge
You or the other party could decide mediation is not working and request an informal or settlement conference with the judge instead.
Receive a decision
The judge considers all the evidence, circulates a written decision and closes the case.
File an appeal
There are three appeal stages if your claim is still denied. First, you may go before the Workers’ Compensation Appeal Board. You may then appeal that decision before the Commonwealth Court, and then finally, you may file a Petition for Allowance of an Appeal to the Pennsylvania Supreme Court.