Filing a claim with your employer and their insurance carrier isn’t always going to go in your favor. They have plenty of technicalities they can point to to throw out even strong Workers’ Comp claims, and sometimes they go beyond good-faith excuses.
If your initial claim was denied, we can take them to court; you do not have to trust that their decision was final. Instead, a Claim Petition can get your case before a Workers’ Comp Judge, who can decide in your favor. We can also continue to negotiate with the insurance carrier and potentially get a settlement, all without even getting to the appeals stage of your case.
For a free case evaluation, call our Certified Pennsylvania Workers’ Compensation Lawyers at Cardamone Law today at (267) 651-7945.
What Should I Do After My Claim is Denied?
In the initial days after your denial, call a lawyer. We can guide you through any specifics for your case, but most cases will just require you to take simple steps to continue to protect your claim:
- Keep getting required medical care.
- Keep documenting what’s happening and saving any communications or letters from your employer or their insurance carrier.
- Deliver everything you have – medical bills, letters, etc. – to your lawyer.
Also try to refrain from talking about your case to others or venting on social media about your denial. This is really only the start of your case, and our lawyers can take care of the rest.
During this time, your medical care can often continue – and it may even be paid for. Sometimes the “denial” in your case is merely a denial of wage-loss benefits. Your employer might have no problem paying for ongoing medical care; they might just think your injury isn’t disabling.
We can help you understand what exactly was denied and work to get your claim granted.
What Our Lawyers Do
At this point, it might be hard to see what your case looks like and what our Philadelphia Workers’ Compensation Lawyers will do for you. For one, we will file the necessary documents and fight to get your claim granted by taking it through all of the stages discussed below.
In the immediate next few days or weeks, we will also seek out as much evidence as we can collect to help build the case: your medical records, any documents you have, etc. We may even contact the insurance carrier to let them know we are serious about getting you your benefits and that we are preparing a Claim Petition.
Sometimes this gets a settlement handled early, but often we need to go through the Claim Petition process.
Common Reasons for Denial
Workers’ Comp carriers and employers often deny claims for many different reasons, but the following are some of the most common:
- Problems with the information provided
- Unable to confirm the injury happened during work tasks
- Unable to confirm the injury is disabling
- They believe you caused the injuries intentionally, through alcohol/drug use, or through illegal acts.
In many cases, additional evidence is the key to disproving this claim.
In any case, the employer must give a legally valid reason for denial, or else we can potentially hold them responsible for your attorneys’ fees for their unreasonable denial.
Can I Appeal My Employer’s Denial of Workers’ Comp Benefits?
“Appeals” actually happen far later in a Workers’ Comp claim. Your employer or their insurance carrier’s initial denial is not a full and final denial, and it is really only the start of your claim. Your case will progress by filing a Claim Petition with a Workers’ Comp Judge, and only once they deny your case do we need to consider actually “appealing” the claim.
If your case does get to that stage without being accepted, we can indeed appeal the decisions.
The Process After a Workers’ Comp Claim is Denied in Pennsylvania
The petition must be filed within 3 years of injury or the claim is forever barred. An Answer must be filed within 20 days, or a Yellow Freight Motion may be asserted.
Assignment Notice Arrives
This notice tells the parties who the judge in the case will be. The judge in a Workers’ Comp Case is a Workers’ Comp Judge, not a normal Court of Common Pleas Judge that hears lawsuits. These are specialized judges who work under the Department of Labor and Industry to hear Work Comp cases and decide them, typically after years of experience working as Workers’ Comp lawyers themselves.
Hearing Notice Arrives
This notice notifies the parties when the first hearing is. The injured worker may or may not need to attend, depending on the judge. Many initial hearings are just “pre-trials” for the attorneys.
Talk with your attorney about what is needed from you. In some hearings, you may need to attend and explain what happened to the judge in person. If your testimony will be needed, we can prepare you for the hearing ahead of time.
Litigation Takes Place
The parties have 180 days in most cases to secure evidence – 90 days for each party – and there may be one to three more hearings depending on the case and judge. Parties will likely attend mediation – either mandatory or voluntary, we try to settle the case.
Briefing Period
If the case doesn’t settle, the lawyers write their briefs/written arguments to the judge, outlining the applicable law, facts, and why or why they didn’t meet the burdens of proof. The judges will often grant the lawyers between 30 and 60 days from the close of the record to submit their briefs.
A Decision is Rendered
This usually occurs about 45 days or so after the last brief is submitted, a written decision will arrive. Note that it can take longer than this, and 45 days is just an average.
Appeals
Any party can appeal to the Appeal Board within 20 days. If that appeal fails, then another appeal can be taken to the Commonwealth Court or Pennsylvania Supreme Court if a party doesn’t agree with the Commonwealth Court.
Not every appeal will be heard by Pennsylvania Supreme Court. They typically only hear appeals when there is something about the way the case was decided that compels them to clarify laws or rules.
What is a Yellow Freight Motion?
A Yellow Freight Motion is when the claimant’s lawyer asserts that the Answer to the Claim Petition wasn’t filed in a timely manner, which means the factual allegations in the Claim Petition should be admitted as facts in the case.
The Answer to a Claim Petition is due no later than 20 days from the assignment to a Workers’ Compensation Judge. If the judge finds that there is a lack of good cause for the late Answer, the facts in the Claim Petition will be deemed admitted. These facts can lead the Workers’ Compensation Judge to then make conclusions of law.
It’s the claimant’s burden to prove all elements of the case, but a late Answer can make this much easier.
Can I Settle a Denied Claim?
Within 21 days of when you initially gave your employer notice of your injury, they should return to you with four possible outcomes:
- They can accept the claim.
- They can deny the claim.
- They can offer a settlement.
- They can temporarily accept the claim and continue investigating for 90 days.
If they deny the claim then, that doesn’t mean a settlement is off the table forever. After we file a Claim Petition, many cases can be settled, getting you all the benefits you need.
Once we file before a Workers’ Comp Judge and start negotiations with the insurance carrier and employer, we can work to settle the case. Even if they initially denied your claim, the judge can order benefits paid or we can reach some sort of settlement on our own before getting to the judge’s decision.
Call Our Workers’ Compensation Attorneys for Help Today
Call Cardamone Law at (267) 651-7945 for a free case review with our Pennsylvania Workers’ Compensation lawyers.
