Denial of Workers’ Compensation Claims

Sustaining an injury at work is a stressful and often painful experience, filled with uncertainty about the future as well as your physical and financial well-being. Employees often expect that their employers have their best interests in mind when it comes to helping them get back on their feet and back to work when possible. However, the bottom line of some employers, and their insurance companies, can get in the way of what is right and lead to the denial of a valid workers’ compensation claim. The Philadelphia area lawyers at Brilliant & Neiman LLC are dedicated to helping injured employees pursue the compensation that they need to recover. We represent individuals who are dealing with workplace accidents or illnesses throughout Southeastern and Central Pennsylvania.

Under the Pennsylvania Workers’ Compensation Act, an employee is generally eligible for benefits after an accident sustained in the workplace or an illness that arises from a job-related condition. To qualify for workers’ compensation, the accident or illness must be severe enough to require medical treatment and/or involve disability. For instance, injuries may include a back strain that results from heavy lifting while on the job, or repetitive stress sustained from a constant movement required by an individual’s job responsibilities. Pennsylvania law does not require a minimum period of employment for a worker to qualify for benefits. Employees are entitled to coverage when they begin working.

The first step following an accident at work, or a diagnosis of a job-related illness, is to notify your employer as soon as possible to make sure your injury is properly documented, recorded to satisfy the notice requirement of the Workers Compensation Act. Once an injured employee files a claim for workers’ compensation benefits, an employer has 21 days to either accept or deny the claim. During this time, , an employer could choose to issue a temporary acceptance of the case, which would allow it an extension of 90 days with a reserved right to still deny the claim. Some reasons a claim may be denied, appropriately or not, include if:

• A doctor states that an injury is not disabling;
• The injury was not sustained during the course of employment;
• The injured worker was classified as an independent contractor, not an employee; or
• Additional information regarding the accident or illness is necessary to make a proper determination.

Additionally, if an injury is related to a pre-existing condition, a claim may be denied based on a finding that the accident or illness pre-dated the current employment. However, the aggravation of a pre-existing condition caused by job activities or a workplace environment may qualify as a new injury, which could be subject to coverage under the workers’ compensation law.

If your claim has been denied, either by your employer or its insurance carrier, you may file a petition with the Pennsylvania Bureau of Workers’ Compensation. At that stage, a judge will hold multiple hearings to review your case. Testimony of your doctor as well as the injured worker may be necessary. The process is often lengthy and complicated, so consulting an attorney who can help advocate for your rights may be a valuable step to take.

If your workers’ compensation claim has been denied, whether due to a pre-existing condition or another reason, the Pennsylvania attorneys at Brilliant & Neiman LLC can help you determine your next step in the legal process. Our firm has several decades of experience assisting injured individuals throughout Southeastern and Central Pennsylvania areas, including Philadelphia, Bucks, Montgomery, and Lehigh Counties and the surrounding counties. Contact us online or call us at 215-638-7500, at 610-740-1002 to discuss your situation and explore your options.