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What to know about appealing a workers’ comp claim denial

On Behalf of | May 16, 2022 | Workers' Compensation

When injured on the job, most workers qualify for workers’ compensation benefits. These benefits cover wage loss and medical costs related to missed work. 

Unfortunately, there are situations where your employer or their workers’ compensation insurer may deny your claim. If you believe you are owed these benefits and that you have the right to receive compensation, you must go through an appeal process. 

Reasons for workers’ comp claims to be denied

There are a few reasons your workers’ compensation claim may be denied. One involves informing your employer about the incident that resulted in an injury. In Pennsylvania, you have 120 days to report your workplace accident and injury. Your employer has a deadline, too. If these deadlines aren’t met, your claim may be denied. 

Another reason your claim may be denied is if the injury did not occur at work or within the scope of your duties at work. It’s also possible for benefits to be denied if the worker was engaging in the use of alcohol, horseplay or did it on purpose. 

An insurer may also deny a claim for workers’ compensation if the injury or condition was pre-existing. Other reasons for denial include if medical treatment isn’t needed or if the worker did not follow the treatment recommended by their doctor. 

Appealing a workers’ compensation claim denial

The appeal process for a workers’ compensation claim denial is started by filling out a petition. It’s also necessary to file the petition by the date included in your denial letter. At this point, you and your employer must go and testify in court to a workers’ compensation judge. During this, you will present evidence supporting your claim. 

Protecting your right to workers’ compensation benefits

You have legal options if you are injured at work and believe you deserve workers’ compensation benefits, but your claim is denied. Going through the appeal process can be complicated, but this will help you recover your entitled benefits.