Denial of Benefits

In the wake of a workplace injury, it is an injured employee’s responsibility to report the injury to her employer. As soon as reasonably possible thereafter, the employee must go see a doctor chosen from a list of recommendations made by the employer and the employer must report the incident to their workers’ compensation insurer.

If all goes according to plan with a claim, it will be approved and benefit payments will be made as dictated by the terms of the policy. Yet, even if all the appropriate steps are taken and an injury is valid to qualify one for the receipt of workers’ compensation benefits, the insurer may issue a Notice of Workers’ Compensation Denial.

What Next?

While you may be quite frustrated if this happens to you, do not be disheartened, because although this may mark the final word from the insurer, there are still forms of recourse available. Upon receipt of a denial notice, it becomes very important for you to contact a workers’ compensation attorney who will be able to represent you throughout the duration of the appeals process. There are potentially many steps, and you will be glad to have experienced legal counsel on your side.

The first action will be to file a Claim Petition to have the case assigned to a workers’ compensation judge. A hearing will be scheduled and held to review the outcome of the claim. The judge will review all arguments and oversee a formal mediation if it is considered probable that an agreement may be reached.

After all evidence has been considered, the judge will issue a decision. If she rules against your claim, you have three more stages of appeals. You can file an appeal with the following succession of entities, each pending rejection by the previous adjudicator:

• The Workers’ Compensation Appeal Board
• The Commonwealth Court
• The Pennsylvania Supreme Court

A denial of benefits does not have to be the end of the road, and the experienced Pennsylvania workers’ compensation attorneys of Lowenthal & Abrams, P.C., can help to secure your interests. Contact us at 215-329-3511.