Pennsylvania workers’ compensation law protects workers who have been injured on the job and can no longer work. Although it’s a crucial safety net for workers, an employer or their workers’ comp insurance carrier can deny or challenge benefits for various reasons. This denial can send the worker into a complex and time-consuming process of defending their claim and appealing the denial, wasting valuable time without essential benefits. If you’ve been denied workers’ compensation benefits, don’t try to navigate it alone. Let the experienced Allentown workers’ compensation lawyers at Saffren & Weinberg protect your interests and get you the workers’ comp benefits you deserve.
Under What Circumstances Can You Rightfully be Denied Benefits?
Not all workers deserve workers’ comp benefits. You can rightfully be denied benefits if:
- You were under the influence of drugs or alcohol when the injury happened, and your injury would not have occurred otherwise.
- Your injury happened because you violated work or safety rules.
- Your injury was self-inflicted.
- You failed to notify your employer before the 120-day deadline.
- You failed to meet with an employer-approved doctor within the first 90 days of your injury.
- The employer-approved doctor claimed your injury wasn’t disabling.
- Your injury was not directly related to your job.
- You provided incorrect or inconsistent information on your accident report or claim.
In these cases, an employer has a valid right to deny a claim. But just because you’ve been denied benefits based on one of these reasons doesn’t necessarily make it true or the denial final. Before you attempt to handle a workers’ compensation dispute on your own, you should get the guidance of our workers’ compensation lawyers in Allentown to understand your options and guide you in defending your claim.
What Can You Do if Your Employer Has Denied Your Workers’ Comp?
If your employer or their insurance carrier has denied your claim, you can take a series of steps to defend your claim and overturn the denial. First, you will want to petition the Pennsylvania Bureau of Workers’ Compensation to consider the dispute. You will be assigned a Workers’ Compensation Judge (WCJ) who will hear your case, review the evidence and testimony on both sides, and then make a decision.
Before appearing in front of the WCJ, you must collect enough evidence to defend and support your case. This evidence should include:
- Proof of the date and time you reported your injury to your employer.
- A detailed and accurate account of the accident or incident.
- Evidence that your injuries were immediately documented and treated by a healthcare provider.
- Statements from your doctor.
- Evidence that you adhered to all prescribed treatment plans and follow-up care. You also want to ensure that there are no gaps in your treatment.
- Photos or videos of your injuries.
- Photos or videos of the accident and the surrounding work environment.
- Any eyewitness statements.
Remember that your employer or their insurance company will likely have their own lawyers at the hearing, and they may challenge your evidence. It’s to your advantage to have an experienced workers’ compensation lawyer of your own to protect your rights at this hearing.
Common Challenges to a Workers’ Compensation Claim and Their Solutions
Paying medical costs and wage benefits for injured employees is expensive. Consequently, employers and insurance companies don’t want to pay workers’ compensation claims if they don’t have to. This leads to some common disputes in workers’ compensation cases.
A dispute over the cause of the injury
You may have been denied benefits if your employer suspected that your injury was not work-related. To defend your claim, you should provide clear evidence that the injury occurred during the course of your work, including the exact time, place, and nature of the work being performed. Be prepared with witness statements and photos, if possible.
A dispute over pre-existing conditions
You may have been denied benefits because your employer or the insurer maintains your injury was a pre-existing condition. But your employer must provide benefits if work-related tasks have caused a new disabling injury or aggravated a pre-existing one. Your treating physician should have been aware of any pre-existing injuries and thoroughly understood how the new incident further affected you. Medical expert testimony can be critical in this type of situation.
A dispute over inconsistencies in your claim
You may have been denied benefits due to some inconsistencies in your claim, your account of the incident, or your medical records have raised doubts about your claim’s validity. Developing a consistent picture of your injuries and proper support is essential in a workers’ compensation claim. This requires that all your statements are consistent throughout your claim and that medical records and other support materials are consistent and accurate. If you find any inconsistencies, address them and get them corrected immediately.
A dispute over non-compliance with treatment plans
You may have been denied benefits if you failed to adhere to your prescribed treatment plan or missed your medical appointments. This makes it appear that your injury isn’t that serious. In a workers’ compensation matter, it is critical that you follow all medical advice, attend all your appointments, and keep a detailed record of all your appointments and prescribed treatments. Whenever you can’t make an appointment, reschedule it immediately and document the reason for the change.
Mediation Before Your Hearing
When you’re involved in a workers’ comp dispute, you will probably be required to mediate a solution with your employer or insurer before your case is formally heard by the WCJ. During the mediation process, an independent mediator – usually another WCJ, will attempt to come to a fair settlement between all parties before it goes to litigation. You will want your workers’ compensation lawyer there with you during the meditation process to ensure your rights are protected, and you aren’t giving up essential benefits.
If it is unfair, you don’t have to settle your claim during mediation. Your claim can continue to be heard and decided by the WCJ. You still may settle later if negotiations between your attorney and your employer or their insurance carrier result in a more advantageous settlement. Furthermore, you can request another mediation if the first one fails. It is common for a workers’ compensation claim to get settled before it goes to the hearing. And if the WCJ’s decision isn’t favorable, you have the right to appeal that decision.
Contact Our Allentown Workers’ Compensation Lawyers!
You have rights under Pennsylvania workers’ compensation law if you have been injured in a work-related injury. We are here to help. The experienced Allentown workers’ compensation lawyers at Saffren & Weinberg clearly understand the process and are committed to getting you the benefits you deserve. Contact us to schedule a free consultation or call us at (215) 576-0100.
Disclosure:
This website is designed to provide only general information. The information presented on this website is not formal legal advice. You should not rely on any general information from any source for making legal decisions. Each legal matter is unique and requires specific attention from a qualified and experienced attorney. Unless a representation agreement has been signed with Saffren & Weinberg, we are not your legal representatives.