Pennsylvania is a good state to be working in if you have an accident while at work or develop an industrial or workplace related illness. All employers, even those that employ casual workers or only a single worker, must be insured to cover injuries or illnesses at work as long as they are genuinely work related. Despite the state’s progressive laws, it doesn’t mean that every claim is honored. Some claims may be denied for a number of reasons. Insurers are always very cautious about releasing payments for compensation. It is possible to appeal a claim denial, but it is strongly advised that you use a workers’ comp. attorney to help you through what can be a long process. Workers’ Compensation Law in Pennsylvania In Pennsylvania the Department of Labor and Industries administers workers’ compensation claims and disputes. Workers’ compensation is governed by a state law, the Pennsylvania Workers’ Compensation Act. Employees are expected to inform their employers as soon as practicable if they become ill or are injured while at work. Information must include the date and exact nature of the injury or illness. The employer will then submit the information to the Department of Labor and Industries. Insurers include private carriers and the state’s own insurance fund which covers around 50% of workers. Some employers are able to self-insure. Compensation is available for medical costs and temporary and permanent disability as well as fatality. As a rough rule of thumb you should be able to claim around two thirds of your average wage although the exact amount depends on a number of factors that have to be taken into consideration. Why a workers’ comp claim is denied in Pennsylvania Workers’ compensation claims are regularly denied or the amount reduced below what was claimed. The reasons are varied and sometimes it’s simply because the employee has failed to provide sufficient accurate information to their own employer or failed to submit the claim on time or provided insufficient evidence in the form of medical documentation. Insurers may also claim that the employee failed to use the proper safety equipment which was provided by the employer or failed to follow the proper procedure.Claims may be denied if it was thought that the employee did not become ill or did not have an injury while genuinely at work. Administrative mistakes can sometimes cause misleading errors in dates which may prompt an insurer to insist that the employer was not at work on the day he or she said they were. Claims may also be denied if the employee was drunk or had been affected by drugs while at work. How to File an Appeal for a Workers’ Compensation Denial in Pennsylvania There are a series of steps that can be taken to appeal a claim for denial. The further down the appeal process you feel that you have to go the more important it is to have professional legal help in the form of a workers’ comp. attorney. The first step in the appeal process is to file an appeal with the Pennsylvania Workers’ Compensation Appeal Board. You need to do that within 20 days of the denial. The Appeal Board may decide to have a full hearing or it may not. It will review all the information and evidence available and then issue a decision. Note that the insurer will be well prepared if it is called on for evidence so you should be well prepared too. Failing a decision you agree with you then have 30 days to appeal to the Pennsylvania Commonwealth Court. They will also review all the same material and issue an independent decision. At this point, few employees take the appeal further if the claim is still denied. The final appeal is to the state’s Supreme Court, which should be done within 30 days of the Commonwealth Court’s unfavorable decision being made. Consult with a Workers' Compensation Attorney If your initial claim was denied, it is perfectly within your rights to make an appeal, but this decision should not be taken lightly and preferably you should discuss the claim, together with all the evidence that you have available with a workers’ comp. attorney. The attorney can advise you about your chances of appealing and help you to prepare for any appearances you have to make.
