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    What to Do If Your Workers Comp Claim Is Denied

    A denied workers comp claim is a hard blow to anybody. You were counting on financial support during the time you need to recover from your workplace accident. Now you face the prospect of getting in debt, because you cannot pay your medical bills. 

    However, with the assistance of a Philadelphia workers comp lawyer, you may still get your benefits. Here is what you need to know on this sensitive topic:

    The Most Common Reasons Why Workers Comp Claims Are Denied

    The first thing a lawyer will investigate is the reason why your employer or their insurance company denied your claim for benefits. This will help the attorney devise a strategy to appeal the decision, if possible.

    The most common reasons insurers invoke to deny workers comp claims are:

    • Exceeded deadline 
    • Incomplete or incorrect paperwork
    • The independent medical examination doctor says your injury is pre-existing
    • The IME doctor believes that your injury does not prevent you from working
    • Refusal to take drug test
    • The employer suspects your injury is not work related

    Appealing a Denied Workers Comp Claim

    The first thing you can do is to file an appeal with the workers comp insurance company to reevaluate your claim. This step is successful if the main reason for denying your claim was a clerical error.

    Once an experienced lawyer reviews your paperwork and corrects the mistakes, they may be able to persuade the insurer to approve your claim. However, in most of the cases, you will have to take the administrative approach and address the Pennsylvania Bureau of Workers’ Compensation.

    do not lose hope if your workers comp claim is rejected

    Request a Hearing with a Workers Compensation Judge

    After you submit an application to reexamine your denied claim, your case will be assigned to a workers comp judge. The selection of the judge is made based on your place of residence, so you don’t have to travel too far. 

    The judge will notify both you and your employer’s insurer of the date of the hearing.

    Preparing for the Hearing

    At this point, you must consult with a Philadelphia workers comp lawyer, if you’ve gone through the process alone so far. Although the judge’s first attempt will be to settle the matter by mediation, it is not often resolved amicably.

    The hearing will be very similar to a civil court case. Both you and the workers comp insurer have to present evidence, arguments and witnesses. You will need a skilled attorney, who knows how to present the evidence and argue in your favor, relying on laws and similar cases.

    Next Steps If You Lose the Hearing

    If the workers compensation judge upholds the denial of your claim, you have 20 days to file an appeal with the Workers’ Compensation Appeal Board. Your attorney will help you fill in and submit Form LICB – 25/26.

    If you are still denied workers comp benefits, the last two legal options, in order, are:

    • Filing an appeal with the Commonwealth Court, within 30 days after the Board’s decision
    • Filing an appeal with the Pennsylvania’s Supreme Court within 30 days after the Commonwealth Court’s decision

    As your case escalates, your attorney will advise you whether further steps are likely to be successful, based on the specifics of your claim.

    Consult with an Experienced Philadelphia Workers Comp Lawyer!

    A denied workers comp claim is not the end of the road. You have many legal options to obtain the benefits you believe you deserve. The best thing to do is contact an experienced Philadelphia workers comp lawyer as early as possible during your claim process.

    We offer each new client a free case review, so collect all the evidence you have and schedule yours today at 267-314-8024!

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