What Happens If Your Workers' Compensation Claim Is Denied?
Pennsylvania workers’ compensation provides partial wage replacement and medical benefits coverage to employees. Following an injury or occupational illness, this can be a lifesaver when you require ongoing medical care to treat your condition and are unable to earn a living. If your workers’ comp claim is denied, you may forgo treatment in exchange for more pressing needs. However, a claim denial is never the final word; instead, it opens a multi-step process. If you or a loved one has recently faced a workers’ comp claim denial, do not hesitate to speak with our Gettysburg workers’ compensation lawyers at DiLoreto, Cosentino & Bolinger P.C., today.
Notice of Compensation Denial (NCD)
When the insurance company denies a claim, it issues a denial form explaining why it believes the injury isn’t compensable. Common reasons include disputes over whether the injury is work-related, missing paperwork, or late reporting. Pennsylvania law requires injuries to be reported to the employer within 120 days of the injury (or of realizing you suffered an injury). This is the absolute cut-off, although reporting within 21 days of the injury date will allow for retroactive benefits to kick in.
Filing a Claim Petition
Receiving the NCD gives you the official right to file a Petition with the Pennsylvania Bureau of Workers’ Compensation. While this legal action is not necessarily an “appeal,” it does open a full evidentiary proceeding before a Workers’ Compensation Judge (WCJ), rather than a review of paperwork already submitted. You generally have three years from the date of injury to file this petition (Form LIBC-362), and the case may go through voluntary mediation before proceeding to a hearing.
Hearing before a WCJ
Both sides present evidence, including medical records, testimony, and expert opinions, and the judge issues a decision.
Appeal to the Workers’ Compensation Appeal Board (WCAB)
If the judge denies your petition, you have 20 calendar days from the circulation date of the judge’s order and petition to appeal to the Board. The Board reviews only the written record, and it doesn’t hear new testimony or evidence. Rather, the Appeal Board evaluates whether the judge made a legal error. If they determine a legal error occurred, the Board may reverse, modify, or remand the case.
Commonwealth Court, then PA Supreme Court
If either party is dissatisfied with the WCAB’s decision, they may file a petition for review with the Commonwealth Court of Pennsylvania within 30 days. From there, a final appeal can go to the Supreme Court of Pennsylvania, also within 30 days. For most workers, though, the process doesn’t go past the Commonwealth Court.
Understanding Your Rights
Workers’ compensation insurance can provide much-needed financial security as you recover from a work-related injury or occupational illness. Unfortunately, neither your employer nor your insurance carrier is looking out for your best interests. That is why it is crucial that you work with someone who has a vested interest in your well-being and livelihood. At DiLoreto, Cosentino & Bolinger P.C., our legal team is dedicated to helping employees understand their legal rights and potential avenues for compensation after claim denials.
Reach Out to Our Gettysburg Workers’ Compensation Attorneys
An occupational injury or illness can strip you of everything you have worked so hard to earn. While there is no denying that this is far from unfair, experienced representation can help secure the benefits you deserve. At DiLoreto, Cosentino & Bolinger P.C., our Gettysburg workers’ compensation lawyers will investigate your matter to assess what evidence best supports your claim. If you are ready to get started, contact us online or by calling (717) 496-0070 to schedule your free consultation.