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What can I do if my workers’ compensation claim was denied?

It is difficult enough to be injured in an accident at work. It can be especially disheartening when your worker’s compensation claim is denied, but do not lose hope. If your claim is denied, you can take steps to appeal the denied claim. However, it is important to understand ahead of time that this process can be long, sometimes taking up to a year to complete the litigation process.

Getting started

It is important to understand why your claim was denied, so you can determine if litigation is the right step for you. Knowing the reason for denial will also help prepare you to address that reason in court, if you choose to appeal the denied claim.

The reason for denial should be included in the denial letter. Common reasons include the injury not being reported in time, the claim not being filed in time or insufficient evidence the injury is work related.

If appealing the denied claim is the right decision for you, the process can be initiated by filling out a Claim Petition (LIBC-362). You have up to three years to file it, though it is generally best to do this as soon as possible. The Claim Petition can be filed with the Workers’ Compensation Bureau in Harrisburg, which will assign your petition to a judge in your county. Then, the judge will set the date, time and place for a hearing.

Workers compensation hearing

At the workers’ compensation hearing, the judge will look at evidence presented by you and your employer about the incident. Sometimes, this is done over several hearings. In many cases, the judge will then schedule the case for mediation to try to resolve the case with a settlement.

Most cases do end in settlement, but you will also be able to ask for an informal conference or settlement conference with the judge. If the judge ultimately rules against you, you can challenge that decision by filing an appeal with the Workers' Compensation Appeal Board within 20 days of the decision.

A denial of a workers’ compensation claim does close the claim, but that does not necessarily mean you are out of options. Although appealing a denied claim can be a long and complicated process, sometimes that is what it takes to ensure you end up with the benefits you deserve.

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