What Can I Do if My Workers’ Comp Claim Is Not Approved?
Dec. 10, 2021
It was just like any other day. You left your house, went to work, clocked in and started about your business. Then it happened, you suffered an injury — one that needed immediate medical attention. You sought medical treatment and then, when you could, filed a report with your employer and a claim for workers’ compensation benefits. You expected receive those benefits to cover your losses, but either your employer or the insurance company decided to deny your claim. Now what happens?
The sad reality of workers’ compensation claims is that employers and insurance companies deny many of them or only provide partial benefits. This leaves many hard-working Pennsylvania residents like you left to try to figure out how they are going to get by. Luckily, a denied workers’ comp claim is not the end of your story. You may still have a way to get the relief you need.
Reasons Claims Fail to Receive Approval
There are quite a few reasons why your workers’ compensation insurance provider may refuse to approve your claim. Some of them are as follows:
Not reporting the injury within the required time frame
Failure to file the claim within the required time frame
The insurance provider does not deem medical treatment necessary
Your employer disagrees with your claim
Your injury was not deemed work related
After you file your workers’ compensation claim, you should receive a written notice of approval or denial. If your claim does not receive approval, the reason for denial should be included in that notice.
What Can You Do if Your Claim Is Denied?
If you are one of the many whose workers’ comp claims fails to receive approval, you have every right to file an appeal. If you wish to pursue this avenue, you only have so much time to do it — generally 30 days from receiving your notice.
When you file your appeal, you need to include any information you have about your claim and a statement about why you feel it should receive approval. You may have to attend a hearing to present your case, but this is not something you have to do on your own. You have the right to have legal counsel present, which may increase your chances of receiving the benefits you need.
At the end of the day, workers’ compensation benefits are supposed to offer you protection if you suffer a work-related injury. When they don’t due to a denial of your claim, it does not mean you are out of luck. With help, you may still be able to take steps in order seek relief for your losses.