Pennsylvania Workers’ Comp. Denials

Workers’ Comp is there to cover your injuries, but when your employer or the insurance company they work with denies your claim, it can feel like no one is there for you.  Our attorneys work to help injured workers get denials overturned – or avoid denials in the first place.  As such, you should take the following steps when your Workers’ Comp is denied.

First, do not panic.  There are many legal routes to getting denials overturned, but it can take some work.  Collect all of the records and evidence that you have and call a lawyer.  Our attorneys can file your case before an administrative law judge to have the insurance carrier’s petitions reversed or overturned.  We can also reach out to the insurance company directly to try to negotiate a settlement that gets you your benefits.

If your Workers’ Compensation claim was denied in Pennsylvania, you’ll need a Claim Petition filed and the sooner the better.

You have 3 years from the date of the work injury or from the date you first learned that your condition could be related to work. Don’t hesitate, however, because your claim will be stronger if filed soon after the injury date. Your recollection will be clearer and you’ll need the guidance of an experienced workers’ compensation lawyer from the outset, to maximize your claim.

For a free review of your claim, call (267) 651-7945 to speak with Cardamone Law’s Certified Pennsylvania Workers’ Compensation attorneys about your case.

Steps to Take After a Workers’ Compensation Denial in Pennsylvania

It’s simple enough for us to say that there is only one step to take after your Workers’ Comp claim is denied: call a Pennsylvania Workers’ Compensation lawyer.  While you should definitely do that, there are some steps you can take immediately that will help us help you, and even without our help, will put you in a better position to win your claim.

Do Not Panic

Medical bills can be incredibly high, and if you cannot work right now, you may be looking at your expenses and beginning to lose your cool.  A denial is not the end of your case, and it does not mean that everything is over or lost.  There are plenty of chances left to get the denial overturned, and you could end up getting all the coverage you need.  So, for now, do not trust that the denial is the end of the story.

Do Not Pay

You may have already gotten medical bills for the care you received, but this care is supposed to be covered under your employer’s Workers’ Comp coverage.  Do not start paying everything out of pocket or using your own health insurance to cover these bills.  Simply save all of the bills you get and bring them to us.

Collect All Records

If you have any bills or mail that was sent to you from the hospital, your employer, or their insurance company, keep it all together.  Our lawyers can help you collect additional records like your medical records, but try to hold on to anything else you might already have.

Call Our Lawyers

Once you have all of your ducks in a row, call our attorneys.  We can help you collect missing information, but more importantly, we have the training and experience to help get denials overturned.  Let our attorneys handle this case for you while you focus on getting better.

Understanding Reasons for Workers’ Comp Denials in Pennsylvania

Workers’ Comp claims are denied for various reasons, and it is important to understand the reasons given in your case.  Not only will the excuses and processes behind the denial help us understand what needs to be done to overcome the denial legally, but it will also help us understand the thought process behind the insurance carrier’s denial and ways we might be able to simply get them to change their minds.

Injury Not “Work-Related”

If the insurance carrier says that the injury was not work-related, then the way to get them to change their mind is usually by providing more evidence.  In many cases, insurance carriers say an injury is not work-related because they simply do not have enough proof to believe it was related to your job.  If we can get accident reports from your manager, get statements from coworkers, or just send the insurance carrier more details about how the accident happened and what your job tasks are, they may reconsider their ruling or propose a negotiated settlement.

If the case goes to court, we will need this additional evidence to overcome the carrier’s case.

Injury Not “Disabling”

Sometimes, the insurance carrier accepts that they have to pay your medical bills, but they do not think that you are “disabled enough” going forward that they should pay you ongoing wage-loss benefits.  In these cases, it is often harder to supply evidence of your disability without medical examinations.  This new evidence might be enough to overcome the denial and get the insurance company to change its mind.  Otherwise, we can file in court to have a judge make this decision.

Disability Deemed “Partial”

Insurance carriers might not want to cover you for the full value of your lost work.  This could lead to them saying that your disability is only partial and that you should be able to return to work.  That would lower the overall value of your wage-loss benefits.

If this is incorrect and you and your doctor believe you are not able to work at all, then you should be entitled to higher benefits than you would get if you were working part time.  Classifications of “total” versus “partial” disability can also come up down the road after you have already received 104 weeks’ worth of benefits, at which point an impairment rating exam (IRE) is likely.

Supersedeas Denials

It means you will keep getting your indemnity (wage loss) checks- and this, of course, is a good thing. If Supersedeas is granted, your checks will stop. In either case, you need an experienced workers comp lawyer to assist you- and to maximize your settlement.

Are You Out of Luck?

Absolutely not. Many insurers will deny claims under the Pennsylvania Workers’ Compensation Act for various reasons- some good, some bad. Regardless, you should immediately call a workers’ compensation attorney so that he or she can file a Claim Petition on your behalf. The insurers/employers are hoping that by denying your claim, you will give up. A denial only means you have to prove your case in court.

Filing in Court and Negotiating Settlements for Denied Workers’ Comp Claims in Pennsylvania

When the insurance company denies your case, we can often take it to them first to try to get the denial overturned.  If they are willing to reconsider new evidence, they might simply accept the claim, and you can start drawing benefits.  Otherwise, we can seek to negotiate with them to get a settlement that covers your needs.

If the insurance carrier is unwilling to work with us or negotiate, then we can leave the decision to administrative law judges and file any responses to the insurance company’s filing or make filings of our own to get the case accepted.

If You Were Injured and Your WC Claim was Denied, Our Attorneys Can Help

We can file a Petition on your behalf and pursue the benefits you are entitled to. Do NOT let the insurer have the last word. They often deny claims for no reason whatsoever. There are time limits, so the sooner we file the Petition, the better.

Call me for a free and comprehensive evaluation of your case at (215) 206-9068. I am available for day, night, week day and weekend appointments- at your convenience.