What happens if your workers comp claim comes back denied?

On Behalf of | Jun 21, 2019 | Claims Process, FAQs, Workers' Compensation

If you suffered injuries while you were at work, you understand how complicated your life can become. You may have to miss work while you are in the hospital with injuries or at home recovering, which will have a direct impact on your paycheck. After a few days or even weeks of missed work, you could find yourself in a seriously precarious financial situation. 

Pennsylvania workers who are in an accident at work or who become ill as a result of their jobs may have a rightful claim to financial support through a workers’ compensation claim. If you find yourself in this position, securing help during this difficult time is critical. It can be devastating to learn that your claim came back denied. Fortunately, it is not the end of the road for you 

Why a denial? 

Even with a valid work injury and the appropriate documentation, it is not always easy to get workers’ compensation benefits. Insurance companies are more worried about their own bottom lines than they are about your financial and physical recovery. If you received notice that your claim came back denied, you will probably want to start with finding out the reason for the denial, which should be in the letter sent to you from the insurance company. Some common reasons include:

  • You did not file the claim in the appropriate amount of time.
  • Your employer disputes what happened or denied your claim.
  • You did not report your injury to your employer in the appropriate amount of time.
  • There is no evidence that medical treatment was necessary.
  • Your work injury is not compensable for some reason, or there is no evidence the injury is because of your work. 

This is certainly frustrating, and it feels like a significant setback, but you have options. You have the right to continue fighting for what you need to get better by moving forward with an appeal.

Appealing a denied claim 

It’s not always easy to walk through the workers’ compensation claims process, especially when you are also dealing with injuries, stress and accumulating medical bills. When a claim comes back denied, one of the first things you will want to do is seek guidance regarding the legal options available to you.

Many injured workers find it beneficial to reach out for guidance even from the initial stages of the claims process. You have the right to seek the support of a legal advocate as you gather important documentation, prepare your claim or appeal a denied claim.