A denial of Workers’ Compensation benefits typically occurs due to an employer’s insurance doctor claiming an employee’s injuries are not severe, or are due to a pre-existing condition, or if paperwork or medical evidence are incomplete. Once a claim for Workers’ Compensation has been denied, an employer may expect an injured employee to return to work sooner than he or she is able, while forcing them to use available vacation time to cover lost wages. At Quatrini Law Group, our lawyers represent injured workers who have been denied Workers’ Compensation benefits. We can help you to file an appeal and challenge the denial.

Why Workers’ Compensation Claims Get Denied in Pennsylvania

Most employers view an injured worker as a financial liability: their insurer must pay medical expenses and lost productivity costs the company money. Added to this is the fact that insurance companies are in business to make money. As a result, doctors working for an employer’s insurance carrier often minimize the injured person’s losses, which can result in a denial of benefits.

Workers’ Compensation Cases Involving Denied Claims

Being denied benefits does not necessarily mean you are not entitled to benefits. Unclear documentation, incomplete medical records, or even a different medical interpretation of your injury or illness can result in a denied claim.

Initial Claim Denials

If your employer or its insurance carrier contests or denies your claim, you should receive from them a Notice of Workers’ Compensation Denial. You have a right in Pennsylvania to appeal that denial.

Medical Evidence & Documentation Issues

If medical evidence from the employer’s physician is vague or incomplete, it can result in a denial. Getting a second opinion early in the process not only ensures your injuries will be objectively evaluated by a doctor who has no financial stake in your case, but also establishes the scope and nature of your injuries. Further, additional tests and diagnostic procedures can be undertaken to challenge negative findings by your company’s insurance doctor.

Disputes Over Work-Related Causation

Especially if you have a pre-existing condition, it is not uncommon for an insurance doctor to claim an injury is not covered under workers’ compensation. For example, suppose you have a herniated disk from an old car accident injury. One day, your back goes out while lifting a 50-pound box at work. The examining physician for your employer’s insurance company claims it was the car accident that caused your back problem — not lifting the box. You need to build a strong case to prove you deserve help.

Reporting and Timing Disputes

You MUST pay attention to deadlines and be as thorough in your reporting as possible. Late or incomplete reports can result in your claim being denied.

How Appeals and Reviews Work in Pennsylvania

Under the Pennsylvania Workers’ Compensation Act, you are entitled to appeal a denied claim. You will need to file the appeal and you may have to appear before a Workers’ Compensation Judge. A seasoned Workers’ Comp firm, like Quatrini Law Group, can help you to navigate the process.

How Quatrini Law Group Helps With Denied Workers’ Compensation Claims

When our clients’ Workers’ Comp claims are denied, we review the denial reasons and then start to gather evidence and documentation to demonstrate why you may not be finished with medical treatment or ready to return to work. Quatrini Law Group will assist with filing and communicating with your employer and insurance company so you can focus on your health. We never charge any upfront legal fees.

Meet Our Workers’ Compensation Attorneys

Understanding Denied Workers’ Compensation Claims Under Pennsylvania Law

If you receive a Notice of Workers’ Compensation Denial in Pennsylvania, you have a right to appeal. It is usually beneficial to engage a knowledgeable attorney to assist you. You will have a hearing before a Workers’ Compensation Judge, and may even have to continue appealing to the Workers’ Compensation Appeals Board. Your attorney will make sure you don’t miss deadlines or important paperwork.

Related Workers’ Compensation Issues We Handle

Frequently Asked Questions About Denied Workers’ Compensation Claims

Why was my workers’ compensation claim denied?

Common reasons include: the injury wasn’t reported within the time limit; the injury was not work-related; a pre-existing condition is blamed; the employer disputes that an injury occurred; or required medical documentation is missing or insufficient.

What can I do after a denied claim?

You can file a Claim Petition with the Pennsylvania Bureau of Workers’ Compensation. This triggers a formal hearing before a Workers’ Compensation Judge (WCJ), where both sides present evidence. If the judge rules against you, you can appeal further to the Workers’ Compensation Appeal Board, then to Commonwealth Court, if needed.

Do I need a lawyer if my claim was denied?

You’re not required to have one, but it’s strongly advisable. Workers’ comp hearings involve legal procedure and medical evidence. Plus, your employer will have an attorney – so should you!

How long do I have to challenge a denied claim?

Generally 3 years from the date of injury to file a Claim Petition in Pennsylvania. However, the sooner you respond, the sooner you can receive benefits to help you recover.

Talk With Quatrini Law Group About Your Denied Workers’ Compensation Claim

Our Workers’ Compensation attorneys know how to challenge denials of Workers’ Compensation benefits. Get the information and legal representation needed to leverage your case — contact Quatrini Law Group today or call 888-534-6016.