How Long Does an Employer Have to Accept/Deny a Workers’ Comp Claim?

Being injured in a work accident is a serious interruption in your life.  The time from the day of your injury to the day you first get benefits from your employer’s Workers’ Comp can involve significant delays.  Just getting an answer from your employer’s insurance carrier might even take quite some time.

Under the Workers’ Comp Act, your employer/their insurance carrier is supposed to respond to your claim within 21 days.  At this time, they should inform you that they are either accepting your claim, accepting it on a temporary basis, or denying it.  In some cases, however, these parties simply will not reply at all, and our lawyers can help take them to court to get the answers you deserve.

For help, contact Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers today for a free case review by calling (267) 651-7945.

Timeline for Filing and Hearing Back About Your Workers’ Comp Claim in Pennsylvania

Workers’ Compensation claims can potentially start on the day of the injury, with an employer learning about the injury and starting to move the case through the systems in place.  Otherwise, they will be triggered by your notice.  After that, there are solid requirements as to when the insurance carrier or your employer needs to respond, and any problems with this timeline can allow us to file petitions in court to get the progress on the claim that you deserve.

Reporting Deadline

Most injury cases need to be reported within 21 days of your accident.  This means you need to tell your employer or their insurance carrier within that timeframe.  Ultimately, you might be able to wait up to 120 days and still get your claim filed, but 21 days is expected in most cases.

Employers are also required to report an injury to their insurance carrier and the Bureau of Workers’ Compensation, usually within 2 days for death and within 7 days for other disabilities.

Employer’s Response Deadline

Under the Workers’ Comp Act, employers have 21 days from your notice to give their response.  At that point, they can decide whether they want to accept the claim, deny the claim, or temporarily accept the claim to give themselves time to do additional investigation.

Within the first 21 days, they can also decide to offer you a settlement agreement instead of benefits.  If they temporarily accept, they pay your benefits for up to 90 additional days while they make their final decision.

If the employer fails to respond to your claim within 21 days, our Pennsylvania Workers’ Comp lawyers can file a petition in court to have them submit their response and answer for their violation, including a Penalty Petition to request penalties against them.

Your Employer’s Options for Accepting or Denying Your Workers’ Comp Claim

Within those 21 days, your employer can review all of the information submitted to them and make a determination.  This is the time set by law for them to make their decision, and it should be enough time.  However, insurance carriers and employers might sit on the filings and fail to take any significant steps, ultimately denying the claim at the end of the 21-day period – if they bother answering at all.  However, you can get a lawyer and fight the case if they issue a denial or ignore your claim.  If they accept the claim, there are a few potential results, and you should still get a lawyer for help.

Denial

Employers and insurance carriers know that if they simply deny a claim, many workers will simply accept that denial, and the case will be over.  Do not let this happen.

Our attorneys can file a Claim Petition in court in response to a denial.  This puts the issue before a Workers’ Comp judge instead of leaving the decision to your employer/their insurance carrier.  You often have 3 years to file this petition after your denial, but you likely need your benefits sooner and should call us to get started on your case as soon as you get a denial.

Ignoring the Claim

If your employer or their insurance carrier simply ignores the claim, they might try to get away with never having to actually issue you a denial.  When this happens, it is effectively the same as a denial; they have pretty clearly shown you that they do not want to pay the claim.  As such, we will have to go through the same process of filing a Claim Petition in court to get the claim addressed there.

As mentioned, we may also be able to submit a Penalty Petition to seek punishments for your employer/carrier’s violation of the 21-day response deadline.

Accepting the Claim

In the rare case that your employer/insurance carrier wants to accept your claim with no hassle, they can do so.  At this point, they will either accept that they have to pay you benefits and start doing so after the amounts are worked out, or they will offer you a settlement.

Accepting a settlement usually means getting a lump sum now instead of ongoing benefits.  Even if they accept your claim and send you an offer, you should still have a lawyer review how much the offer is for.  This will help ensure that it has enough to cover all of the ongoing medical care you will need as well as your ongoing lost wages.

Temporarily Accepting the Claim

Your employer can also drag out the case by temporarily accepting the claim.  This gives them an additional 90 days to look into the facts of your claim and determine whether or not they truly want to accept the claim going forward.  They can then change their mind before the 90 days run out and give you a final decision.

At that point, the case continues down the same possible paths listed above: they can accept your claim and pay benefits, they can offer you a settlement, or they can deny the claim and we can take them to court.

Call Our Workers’ Comp Lawyers in Pennsylvania Today

For a free review of your Workers’ Comp claim, call the Philadelphia Workers’ Compensation attorneys at Cardamone Law at (267) 651-7945.