Workers' Compensation Appeals Attorney in Philadelphia, Pennsylvania

A workers’ compensation claim is a critical source of financial assistance for employees who have suffered a workplace injury or illness. Unfortunately, it is possible for employers and their insurance providers to deny workers’ compensation claims. There are options available, however,  for appealing the decision and obtaining the benefits you deserve if your employer has denied your workers’ compensation claim. 

If your workers’ compensation claim was denied, reach out to H. Rosen Law, P.C., to discuss your options for appealing the denial. Our workers’ compensation appeals attorney in Philadelphia, Pennsylvania, can help you fight for the benefits you deserve and guide you through every step of the appeals process. With an office in Philadelphia, we serve workers throughout Southeastern Pennsylvania, including Scranton and Harrisburg. 

Reasons a Workers’ Compensation Claim May Be Denied 

Understanding why your workers’ compensation claim was denied can help you decide which course of action to take to appeal the denied benefits. There are several reasons why a workers’ compensation claim may be denied, including but not limited to: 

• The claimant waited too long to report the injury. In many cases, workers must report their injury as soon as possible after it occurs in order for their claim to be approved. Typically, claims should be reported within 30 days though this period varies by state, so it is important to research your state’s requirements regarding reporting an injury. If you wait too long to report your injury, then your claim will likely be denied. According to Pennsylvania’s Department of Labor & Industry, employees must give employers notice of the injury within 21 days.  

• The injury/illness was not work-related. Your injury must have been caused by something directly related to your job duties in order for your workers’ compensation claim to be approved. If the injury or illness was not related to any activities that occurred while you were on the job, then the claim will likely be denied as there would not be sufficient evidence that it was work-related.  

• The injury/illness was due to alcohol intoxication or intake of drugs. If any alcohol or illegal drug use played a role in causing your injury or illness, then your workers’ compensation claim will most likely be denied. Furthermore, if toxicology tests are conducted and drugs are found in your system, this could also result in the denial of benefits for similar reasons mentioned above.   

• The claimant engaged in horseplay or intentional neglect. If you engage in horseplay at work or behave negligently and end up getting injured due to these activities, your workers’ compensation claim may also get denied. 

• There is insufficient medical evidence. Finally, if there is insufficient medical evidence, then a workers’ compensation claim may also be denied since the employer has no way of verifying that the injury or illness is due to the employee’s job duties.  

Not all denials are valid. Just because the employer’s insurance company denies your workers’ compensation claim does not necessarily mean that you will be unable to obtain your benefits. Consult with a workers’ compensation appeals attorney in Philadelphia to discuss your options for appealing the denial of your claim.  

Notice of Controversion 

If your employer denies your workers’ compensation claim, they will issue you a “Notice of Controversion.” This document outlines the reasons why they have denied your claim and provides instructions on what to do next. It is important that you read this document carefully and respond as soon as possible in order to begin the appeals process.  

What to Do If a Workers’ Compensation Claim Is Denied 

If your workers’ compensation claim has been denied, there are several steps you can take to appeal the decision. First, you should file an Application for Adjustment of Claim with the Workers’ Compensation Commission within three years from the date of injury or diagnosed illness.  

You may also want to gather evidence such as medical records and notes from witnesses in order to support your case during the hearing process. When appealing denied benefits, you may need to file a Declaration of Readiness to Proceed, which essentially means requesting a mandatory settlement in front of a judge conference at your local Workers’ Compensation Appeals Board office.  

Why You Need a Workers’ Compensation Appeals Attorney 

An experienced workers’ compensation attorney can guide you through each step of appealing a denied workers’ compensation claim. They can review all documents related to your claim and advise on any errors that may have been made during the initial filing process that could have led to its denial.  

Additionally, an attorney knowledgeable about workers’ compensation law can provide valuable advice on how best to proceed during the appeals process, including determining whether or not it makes sense for you to accept any settlement offers from your employer prior to going before a judge at a hearing.