What is a Workers’ Compensation Claim Denial?

What is a Workers’ Compensation Claim Denial?

Have you received a Denial of your workers’ compensation claim? After you suffer a work injury, you as the injured worker are required to give “Notice” to your employer of your injury as soon as possible but no later than 120 days from the date of the injury or from when you receive a diagnosis from a physician relating it to your work.

After you give “Notice” to your employer, your employer must relay the notice of the work injury to their workers’ compensation carrier. From the date the assigned workers’ compensation adjustor receives the claim, they have twenty-one (21) days to either accept or deny your claim. There are several ways that your claim can be accepted and if a Denial is issued, there must be a reason checked off as to why it is being denied. For purposes of this article, let’s focus on the reasons why your claim could be denied.

On the PA Workers’ Compensation Bureau Denial form, there are five (5) boxes that the workers’ compensation adjustor can choose from. These are:

  1. The employer did not suffer a work-related injury.
  2. The injury was not within the scope of employment.
  3. The employee was not employed by the employer.
  4. The employee did not give notice of his/her injury to the employer.
  5. Other good cause, to be explained fully by the workers’ compensation adjustor.

If you have received a Denial of your workers’ compensation claim, whatever the reason, the only option, if you want to try to receive workers’ compensation benefits, is for you to file a Claim Petition that will go before a workers’ compensation judge. Filing and litigating a Claim Petition is a process that an experienced workers’ compensation attorney can handle for you. You owe it to yourself to obtain representation for this process in order to have the best results to get the benefits you are so deserving of.

Thank you for taking the time to learn more about workers’ compensation through our Workers’ Comp Wednesdays with Kara Curry on 99.9 The Hawk.  If you or a loved one has a question regarding your work injury or claim I invite you to contact me via phone (215) 530-7166, email or the form to the right.  As a certified workers’ compensation attorney, I am happy to offer free consultations.  – Paula Robinson, Esq.