PA Workers’ Compensation Denials

As a state with a long history of being at the forefront of industry, manufacturing, natural resources, and transportation, Pennsylvania has a long relationship with the fight for worker rights.

The need to safeguard workers became increasingly apparent as Pennsylvania’s industrial revolution moved forward in the early 20th century. Hazardous workplace conditions caused injuries to grow in both type and frequency. This surge in workplace accidents highlighted the necessity for laws designed to protect employees, leading to the development of workers’ compensation regulations. The Pennsylvania Workers’ Compensation Act of 1915 was a law that provided employees with financial protection while requiring employers to maintain workers’ compensation insurance coverage.

If you have experienced a workplace injury in PA, you should be able to rely on this historic Pennsylvania state law to provide a financial safety net for you and your family while you recover.

And, if you have lost a loved one due to a tragic work accident or illness, you should be entitled to death benefits.

Steps to Filing a Pennsylvania Workers’Comp Claim

How does this process work? And what happens when the claim you are relying on gets denied? Filing a workers’ comp claim has a few steps, which include:

Report the Injury

When an employee is injured at work, they must report the injury to their employer as soon as possible, ideally within 21 days. Failure to report the injury within 120 days may result in losing the right to workers’ compensation benefits.

Employer Files a Report

Once notified, the employer must report the injury to their workers’ compensation insurance company and the Pennsylvania Bureau of Workers’ Compensation, initiating the formal claims process.

Medical Treatment

The injured employee should seek medical treatment. In Pennsylvania, for the first 90 days following an injury, the employee may be required to visit an employer-designated healthcare provider. After 90 days, they can choose their doctor.

Claim Acceptance or Denial

The insurance company has 21 days to either accept or deny the claim. If the claim is accepted, the employee will start receiving benefits. If denied, the employee may appeal the decision to a workers’ compensation judge or appeal board.

• Notice of Compensation Payable: If the claim is accepted, the employer or insurance company will issue a “Notice of Compensation Payable,” which confirms that the claim is valid and the worker will receive benefits.
• Notice of Compensation Denial: If the claim is denied, the insurance company will issue a denial form explaining why they believe the injury is not compensable.

Receiving Workers’ Compensation Benefits

If the claim is accepted, the injured worker will receive wage loss benefits (typically two-thirds of their average weekly wage) and coverage for medical treatment related to the work-related injury. Depending on the severity of the injury, these benefits can last for a limited or extended period.

So what happens when you do everything right, but your PA workers’ comp claim is denied?

When Your Pennsylvania Workers’ Comp Claim Is Denied

When your workers’ compensation claim in Pennsylvania gets denied, it can feel incredibly stressful, especially when trying to recover from an injury. You might be counting on those benefits to cover medical bills and lost wages, so receiving a denial can make you anxious and uncertain about the future. But don’t panic—this happens to many people, and it doesn’t mean the end of your claim.

This is where a Pennsylvania workers’ compensation lawyer can step in and help you navigate the next steps. They’ll explain why your claim was denied, whether because of missing paperwork, a technicality, or a dispute over the cause of your injury. Their experience can help gather the necessary evidence, like medical records or witness statements, and appeal the decision on your behalf.

Having a law firm in your corner eases the stress and boosts your chances of a successful outcome. They can guide you through the appeal process, represent you in hearings, and negotiate with insurance companies so you can focus on getting better.

If your claim has been denied, don’t give up. An experienced workers’ comp attorney at Munley Law will help you fight for your deserved benefits.

Common Reasons Workers’ Compensation Claims Are Denied In Pennsylvania

A denial can be frustrating, but there are many reasons an initial workers’ compensation claim get denied in Pennsylvania, including:

Failure to Report the Injury on Time

One of the most common reasons for a denial is not reporting the injury promptly. In Pennsylvania, you must notify your employer about your injury within 120 days, but the sooner, the better. Waiting too long to report can make it seem like the injury didn’t happen at work or wasn’t serious enough to warrant compensation.

Disputes Over Whether the Injury Is Work-Related

Sometimes, your employer’s insurance company or employer disputes whether the injury is work-related. Your claim could be denied if there’s any question about whether the injury happened on the job or if it was aggravated by something outside of work or a pre-existing condition. Remember, your employer’s insurance carrier’s job is to make money; they will sometimes do their best to deny or reduce your financial payout.

Failure to Seek Prompt Medical Treatment

If you don’t seek medical treatment immediately after your injury, it can weaken your claim for workers’ comp benefits. Delays in getting treatment can make it look like the injury isn’t serious, or worse, it can create doubt about when and where the injury occurred.

Insufficient Evidence of Disability

Workers’ compensation benefits are for injuries that cause you to miss work or limit your ability to perform job duties. If you don’t provide enough medical evidence proving that your injury is disabling, your claim may be denied.

How Our Pennsylvania Workers’ Compensation Attorneys Can Assist You

Do not give up hope if your PA workers’ compensation claim is denied. A workers’ compensation lawyer handles these cases all of the time.

Your first and most important step following a denial is to contact an experienced PA workers’ compensation attorney at Munley Law for a free consultation.

Your attorney, skilled in workers’ compensation law, will walk you through the next steps, ensuring your appeal is filed correctly, your paperwork is complete, and all legal time limits are followed.

If your claim for PA workers’ compensation has been denied or your workers’ compensation benefits have been stopped unjustly, call Munley Law today.

Hiring a workers’ compensation attorney will cost you nothing until we win your fair compensation and your case evaluation is free. Don’t miss your appeal deadline. Hire a lawyer who specializes in workers’ compensation cases. If you have a denied workers’ compensation claim, call Munley Law today.