Commonwealth law requires most employers with at least one employee to provide protection to all their workers. If your injury occurred on the job and left you unable to work, these policies can provide reimbursements for related losses such as treatment costs and lost wages.
Obtaining workers’ compensation benefits should be a straightforward process. However, denials of these claims are common. An insurance company may not believe that your injury is work-related. In other cases, they may not offer a benefits package that accurately reflects the impact of the condition on one’s ability to return to work.
All workers in Bustleton, South Philadelphia, and across the state have the right to begin the process of appealing a workers’ compensation decision. Regardless of the stated reason for a denial, an appeal is the only way to reverse this devastating result. If your claim has been rejected, a Philadelphia workers’ compensation denial lawyer is ready to evaluate the reason for the denial and pursue an appeal on your behalf. Contact our firm today to discuss your unique situation with a dedicated attorney.
Insurance companies can deny workers’ compensation benefits for many reasons. However, the denial letter must specifically state the reason for rejection in order to be valid.
Perhaps the most common reason why is a lack of a connection between doing one’s job and the harm sustained. Pennsylvania 1915 Act 338 § 301 defines a workplace accident as an injury or illness that results from an employee performing their job duties. If an insurance company does not make this connection, they may deny the claim.
Similarly, many claims attempt to collect benefits by showing the presence of an occupational disease. This can be a physical condition that worsens over time, a diagnosed disease connected to one’s job duties, or even mental health concerns that arise from consistent stress.
Insurance companies have a variety of justifications for denying coverage. These can also include a lack of notice to an employer, a failure to follow up with medical treatment, or the injury not being sufficiently serious to meet the Commonwealth’s required waiting period. A Philadelphia attorney serving Bustleton and South Philly could help injured employees understand the reason for their workers’ compensation denial and evaluate the next possible steps.
Regardless of the stated reasons for a denial, all workers in Philadelphia have the right to pursue an appeal. This can take on many forms.
The first option is to seek out a settlement with the insurance company. Here, a local workers’ compensation denial attorney could work to bring both sides to the negotiating table to discuss their differences and hopefully resolve the claim.
If this fails, a worker may file a request for a full hearing before a Workers’ Compensation Judge. Here, the judge will listen to testimony, collect documentary evidence, and decide what benefits are appropriate. Before the case progresses to a final trial, the court may hold severe pre-trial sessions in an attempt to get the parties to settle.
Even if a judge does not return a favorable decision, injured parties can still pursue a further appeal with the Pennsylvania Department of Labor & Industry. This Department could review the decisions of the Workers’ Compensation Judge to determine if any error of law has affected the rights of an injured worker. If so, the Department may award compensation that overrules the judge’s decision. Appealing a workers’ compensation decision can be a lengthy and complex process, making it vital for injured or ill workers to seek experienced legal help.
After suffering a workplace injury in Bustleton or South Philadelphia, receiving a denial for workers’ compensation benefits can be a demoralizing experience. You may be relying on these payments to take care of your family or cover the costs of your medical care.
A denial does not have to be the end of your legal journey. You have the option to request that the Pennsylvania Department of Labor & Industry hear an appeal concerning your denial. Whether this denial alleges a failure to file a claim on time, that the condition was not related to work, or that the injury is not sufficiently severe, you could ask a judge to reconsider your claim.
It is important to note that there is a limited time after receiving a rejection to act. Take a step towards appealing your denial by speaking with a diligent Philadelphia workers’ compensation denial lawyer today. Do not hesitate to contact our firm to schedule a consultation.
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Personal Injury Attorney Philadelphia | Gross & Kenny, LLP