If you suffered a work-related injury and are now fighting for workers' compensation benefits, you likely have many questions regarding why your claim was denied. Unfortunately, insurance companies are never eager to pay out workers' comp benefits, even when medical treatment keeps you away from your job for an extended period. However, you have a right to those benefits and can appeal if they are denied.
At Munley Law, our PA workers' compensation lawyers represent injured workers who have been denied coverage for their medical bills. Let us test our decades of experience as you focus on recovery.
What Happens to Medical Bills When Workers' Comp is Denied in PA?
If you've received a notice of compensation denial, you may wonder who is responsible for your medical bills. In general, this means that you are responsible for your medical expenses. While you may have insurance, it likely won't be enough to cover your losses.
Sometimes, health insurance will not pay for workplace injury medical care, as they argue worker's comp benefits should cover it.
This leaves you in a financial mess, but you can appeal the workers' compensation denial.
What Is the Workers' Compensation Appeals Process in Pennsylvania?
If you have been denied workers' compensation, there is a specific appeals process in Pennsylvania you must adhere to.
The first step is to file an appeal with the Workers' Compensation Appeal Board. This can be done online or via the mail. However, you must send a copy of the appeal to all parties listed in the judge's decision, including the judge.
You must file your appeal no later than 20 days from the circulation date of the workers' compensation judge's decision.
When filing, be sure to have the following pieces of information complete. Failure to do so may result in your appeal being denied.
- Petition Type
- Circulation Date
- Bureau Claim Number
- Date of Injury
- Addresses
- Specific reasons for appeal and why you believe the Judge's decision was wrong. Your appeal will be deemed insufficient if you are not specific in details.
- Proof of Service
The more specific you can be in your appeal, the better your chances of getting the compensation you need and recovery for your medical expenses.
Why Did My Workers' Comp Claim Get Denied?
Studies suggest that over 10 percent of all workers' compensation claims get denied on first submission. However, there are common reasons this occurs, and often, these situations can be resolved in an appeal.
Workplace Injuries Are Excluded From Workers' Comp
There are situations where a workplace injury is excluded from worker's compensation benefits. This includes injuries or deaths that were intentionally self-inflicted or caused by recklessness. Injuries that result from breaking the law, such as the illegal use of drugs, are also excluded from worker's compensation.
You Did Not Report Your Injury Promptly
Under Pennsylvania law, you must report your injury on time to receive compensation coverage for your injury claim.
The time limits for reporting your injury include a 21-day period to report to your employer; if the injury is not reported within 120 days, no compensation payment will be allowed.
The exception to this rule is for progressive illnesses.
Your Employer Disputes the Reason for Your Injury
Your comp claim may be denied if your employer disputes the reason for your injury. For example, if your initial claim states that you were hurt while operating machinery, but your employer believes you were not following safety protocols, your medical benefits can be denied.
However, an experienced law firm can dispute this rationale in the appeal process without evidence.
Previous Injuries or Pre-Existing Conditions
Sometimes, a workplace accident will aggravate an old injury or a pre-existing medical condition. While your employer may argue that the old injury or condition was unrelated to your employment, under the law, these conditions are still covered, including:
- Arthritis and joint damage, including to the knees and shoulders
- Back injuries, including herniated discs
- Broken bones and fractures
- Soft tissue injuries
A skilled Pennsylvania workers' compensation attorney can review past medical records and contact your healthcare provider to learn how a workplace accident could cause additional injuries.
Incomplete Claim Form or Missing Information
A workers' compensation insurance company makes money by denying claims–not paying them out. They'll look for any minor form flaw to dismiss your comp claim. While workers' compensation law is very specific, engaging with a comp lawyer can assure you that your initial claim is filed correctly or your appeal petition is correct.
Contact a Pennsylvania Workers Compensation Lawyer
If you suffered a work-related injury in PA and have been denied workers' comp benefits, you must call Munley Law. With our extensive knowledge of Pennsylvania workers' comp laws, our experienced lawyers will fight for your wage benefits and medical costs until a solution is found.
No one plans to get hurt at work, but you need a legal team to stand by your side when it happens. Legal costs are not a barrier, as we work on a contingency fee basis, meaning you pay nothing upfront and only pay if we win.
Injured workers need Munley Law. Call the Pennsylvania workers' compensation attorneys of Munley Law today for a no-obligation, free consultation for your workers' compensation case.
