Workers in any industry in Wilkes-Barre can be injured on the job. Many assume they will be protected by their employer’s workers’ compensation insurance should an accident occur. While many states (including Pennsylvania) require businesses to have workers’ compensation insurance, this does not mean that every claim gets approved. The reality is that the workers’ compensation claims process is complex, and an employer or their insurance company will likely look for any reason to deny an employee’s claim. Legitimate claims are often denied simply because there was a simple paperwork error. If you need Wilkes-Barre workers’ compensation denial assistance, the work injury attorneys at Munley Law Personal Injury Attorneys are ready to help.
While it is not uncommon for Wilkes-Barre workers’ compensation claims to be denied, this does not mean that you are out of options if your employer tries to question the validity of your workers’ compensation claim. However, challenging and appealing a denied workers’ comp case can be complex, and you must work with a skilled Luzerne County workers’ compensation attorney to recover the benefits you are owed. An attorney can walk you through this process, including paperwork, documentation, workers’ comp hearings, etc.
Contact a Wilkes-Barre workers’ compensation lawyer at Munley Law if your Wilkes-Barre workers’ compensation claim has recently been denied. Keep reading to learn more about why workers’ comp cases are denied in Luzerne County and your rights after receiving a notice of a denied workers’ comp claim in Pennsylvania.
Common Reasons Wilkes-Barre Workers’ Comp Claims Are Denied
As we previously mentioned, employers and their insurance companies will likely look for any reason to deny a workers’ compensation claim. This is particularly true of large corporations with lawyers who will look for loopholes they can exploit. Even if your claim is legitimate, your employer likely will not be on your side and will try anything to avoid paying a settlement.
While this may seem unfair, insurance companies are within their rights to try to find a reason to dismiss a workers’ comp claim. This makes it essential that you are careful and thorough when filing for workers’ compensation in Luzerne County, as you do not want to give your employer any reasons to try to deny your claim. If you believe that your workers’ compensation claim was wrongly rejected, and you are not sure why, here is a look at a few of the most common reasons for workers’ compensation claim denials.
Your Employer Denies Liability for Your Work Injury
One of the most common reasons for a workers’ compensation claim to be denied is if the claim’s validity is disputed. Oftentimes, an employer will try to deny responsibility for an employee’s injuries, and they will try to claim that the employee was at fault, that the injury was the result of horseplay, or that the injury occurred outside of work. If an employee works more than one job, an employer may even try to claim that the injury happened at their other job.
Alternatively, an employer and their insurance company may agree that you were injured in the line of work, but they might try to downplay your injuries and argue that they are not as bad as you claim. They will try to say that there was no reason for you to miss work or go to a doctor for your injuries, potentially requiring help from a denied medical bills lawyer if medical treatments aren’t being covered.
There is Insufficient Evidence for Your Workers’ Comp Claim
Unfortunately, the burden of proof rests on you as the injured party to provide sufficient evidence that your injury happened at work or when you were doing work-related activities off-site. If you do not present significant evidence to justify your claim, your employer may argue that there is no proof that the injury was work-related and could have happened off the clock. This is particularly common if there were no witnesses to your injury, as your employer may try to claim that someone would have seen or heard the disputed incident if it had happened at work. This is why it is so essential that you inform your supervisor and coworkers as soon as possible after you sustain an injury at work. Without witnesses, especially in cases like repetitive stress injuries, it’s crucial to speak with a repetitive injury workers’ compensation lawyer to ensure you have properly documented your injuries and reported them promptly.
You Didn’t Report Your Wilkes-Barre Work Injury Soon Enough
Another common reason Wilkes-Barre workers’ compensation claims are denied is if you did not report your injury on time. Time is of the essence when filing workers’ compensation claims, as you must meet deadlines to receive compensation. In Pennsylvania, state law says that you must report your injury to your employer within 120 days of the accident or realizing you were first injured. However, if you report your injury to your employer within 21 days, you will receive retroactive benefits from the date of your injury. After 21 days, you’ll receive benefits from the day you first reported your injury. After the 120-day deadline, you will not receive compensation for your injuries. This makes it critical that you report your injuries to your employer as soon as they occur, especially in severe cases where families may later need to pursue workers’ comp death benefits.
You Didn’t Seek Medical Treatment for Your Work-Related Injury
After being injured on the job, you must seek medical treatment immediately, even if unnecessary. The main reason to do so is that it may be hard to tell the extent of your injuries immediately. You may feel fine at first, only to find out that you suffered internal injuries during your accident. Furthermore, if you do not seek immediate medical attention after being injured at work, this could cause your case to be denied. Your employer’s insurance company will likely try to use the fact that you didn’t go to the doctor against you by arguing that your injuries are not as bad as you claimed if you did not need medical attention. Seeing a doctor as soon as possible after you are injured at work can help demonstrate the seriousness of your case while also starting the process of documenting your injuries.
You Were Suspected of Being Under the Influence
Another way that employers and their insurance companies will try to deflect blame in workers’ comp cases is by claiming that the employee was under the influence of drugs or alcohol. Even if you had one beer on your lunch break, your employer may try to argue that this was the cause of your accident. This is another reason why it is so vital that you seek immediate medical attention following your accident. Go to the emergency room after your accident, and no illicit substances are found in your system. This documentation can go a long way in preventing a claim denial. However, if drugs or alcohol are found in your system, you will almost certainly be denied workers’ compensation benefits.
Ultimately, your employer and insurance company will likely go to great lengths to deny your workers’ compensation claim rather than pay a fair settlement. However, just because your claim was rejected, it does not mean you are out of options. In Pennsylvania, you have the right to appeal the denial.
What Are My Next Steps if My Work Comp Claim is Denied in Luzerne County?
Fortunately, if you believe your Wilkes-Barre workers’ compensation claim was denied in error, you have the right to appeal your case. Unfortunately, many people do not know they have the right to appeal a denied claim, which your employer is likely hoping for. Many employers routinely dismiss initial workers’ compensation claims in the hope that the injured employee will give up and not take further action.
So, what are your steps for challenging a denied workers’ comp claim in Luzerne County? The first step you should take upon receiving a denied claim letter is to reach out to your employer and/or their insurance company to double-check that the denial is accurate, if they made a clerical error. If not, you will need to prepare to appeal your case.
Your first step will be to file a claim petition. Your petition will then be assigned to a workers’ compensation judge in Luzerne County. You will then likely be assigned a date for a formal hearing, at which time you will be required to present evidence for your case. This may mean resubmitting medical paperwork, showing time cards, and gathering witnesses, particularly if your situation involves complex third-party claims in Wilkes-Barre resulting from the accident.
Before your hearing, you must consult a workers’ compensation attorney if you have not done so already. Appealing a workers’ compensation denial is complex, and an attorney will be critical in helping you to gather evidence and defend your case.
If your workers’ compensation hearing does not go favorably, you are still not out of options. Once the workers’ compensation judge has decided on your case, either party has 20 days to file an appeal to the Pennsylvania Workers’ Compensation Appeal Board. Following the Appeal Board’s decision, you will have 30 days to file an appeal with the Commonwealth Court, and you will have another 30 days following the Commonwealth Court’s decision to file a petition for allowance of an appeal with the Pennsylvania Supreme Court.
Why You Need an Attorney to Appeal Your Wilkes-Barre Workers’ Compensation Denial
As you can see, appealing a denied workers’ compensation claim can be a long, drawn-out, and complicated process. You will then want to make sure that you consult an experienced Wilkes-Barre workers’ compensation attorney who can support you during this confusing time. Without an attorney, you may quickly become lost in complex legal documents and find yourself woefully unprepared to defend yourself on the day of your hearing.
You must partner with an attorney who will fight for you and ensure you have someone by your side during this difficult time. An attorney will work tirelessly to gather evidence and build a solid case to support your claim, giving you the best chance of getting the benefits you deserve. Working with a personal injury attorney in Wilkes-Barre can also provide peace of mind, knowing that everything is being handled properly, allowing you to relax and focus on your recovery. Contact us today for a free consultation about appealing your Wilkes-Barre workers’ compensation denial.
Choose a Wilkes-Barre Workers’ Compensation Attorney You Can Trust
Being faced with a denied workers’ comp claim can leave you feeling frustrated, scared, and uncertain about how to proceed. When choosing an attorney to help you appeal a denied workers’ compensation claim in Wilkes-Barre, Pennsylvania, look no further than the experienced attorneys at Munley Law. We will be there to support you during this difficult time, and we will fight to ensure that you have everything you need to appeal your denied workers’ comp claim.
Furthermore, we believe that money should not stand in the way of justice, and we ensure that you are adequately compensated for your injuries. This is why we do not charge for our services upfront and only collect a fee if we recover your benefits. You should not have to worry about money during this difficult time, so you will not be required to pay anything upfront or out of your pocket as our client.
If you believe you have been wrongly denied workers’ compensation benefits in Wilkes-Barre, please get in touch with us. We can work with you to help you determine your next steps moving forward as you work to appeal your denied workers’ compensation claim.
