Can You Appeal if Your Workers’ Compensation Claim Is Denied?

Can You Appeal if Your Workers’ Compensation Claim Is Denied? Being injured on the job can be frightening and painful. Not only are you injured, but you are unable to work. That is what workers’ compensation is for. However, what happens when your claim for compensation is not accepted? You likely feel frustrated (and probably a little anxious) when this happens, but there is something you can do. The appeals process for a workers’ compensation claim is there for when you do not agree with the judgment you were given.

In this appeal, you can to explain to a judge why you believe your claim is a valid one. During this time, the process can become complicated, and it is a good idea to seek out a workers’ compensation attorney for assistance.

What is workers’ compensation and how does it work?

The definition and details of workers’ compensation can vary from state to state, but here in Pennsylvania, workers’ compensation is defined in the Pennsylvania Workers’ Compensation Act. Workers’ compensation provides benefits “if you suffer a work-related injury or illness. This covers your medical expenses related to the illness or injury, as well as wage loss compensation for as long as your injury or illness prevents you from returning to work.”

Per the Workers’ Compensation Act, as an employee, your benefits are not based on who was at fault for the injury. That means you do not have to prove negligence caused your accident to be entitled to benefits. While this is helpful to you, it also prevents you from securing pain and suffering compensation that comes with a personal injury lawsuit. That is why you should seek out an experienced York, PA workers’ compensation attorney at KBG Injury Law to help you secure all the benefits you need and deserve.

How much compensation can I get through workers’ compensation?

Pennsylvania calculates workers’ compensation using your weekly wages, and you will typically receive about two-thirds of your wages. This changes each year to reflect cost of living, and 2022’s average weekly wage is “$1,205.00 per week and represents an increase of 6.6 percent from 2021.”

On top of this, all of your medical expenses should be covered, too. Note that even if your employer stops or suspends your wage loss benefits, he or she cannot suspend your medical bill payments.

How do I file for workers’ compensation in Pennsylvania?

First, inform your employer of your injury and/or accident. While you technically have three years to file a claim, report your injury immediately. Failure to notify your employer could result in a delay or denial of your claim. The workers’ compensation insurance provider then has 21 days to make a decision.

Legally, employers are required to report your injuries and days missed at work to the Bureau of Workers’ Compensation using something called a “first report of injury.” This way, if you have told your employer of your injury as well as necessary medical expenses and recovery time, and your employer fails to report this, then you have this evidence to use against them. This is why it is important that you make your injury clear to your employer because if you do not, they can use that as a defense.

What happens if my workers’ compensation claim is denied?

If the Bureau of Workers’ Compensation denies your claim, it is not the end of the road. The state of Pennsylvania allows for you to appeal the decision made by the Bureau. This is something you can file online or through the mail, and it goes to the workers’ compensation appeal board.

In order to do this, you have to file your appeal within 20 days of the judge’s decision. When you fill out this form, the Pennsylvania Department of Labor & Industry wants you to include the following information, per its website:

  • Petition Type (listed on circulation sheet)
  • Circulation Date (the date listed on the front page of the judge’s decision)
  • Bureau Claim Number
  • Date of Injury (original date that injury occurred)
  • Addresses
  • Be specific in listing the reasons for appeal and state why you believe the Judge was wrong in his or her decision. Regulation 34 Pa. Code § 111.11 states: A statement of the particular grounds upon which the appeal is based, including reference to the specific findings of fact which are challenged and the errors of the law which are alleged. General allegations which do not specifically bring to the attention of the Board the issues decided are insufficient.
  • Proof of Service

Being injured at any point in time, anywhere is stressful and painful. When it happens at work, the legal system becomes involved and can make things more complicated and more difficult than they should be. Unfortunately, if your claim is not accepted by the judge at the workers’ compensation bureau, it is up to you to file an appeal to secure the compensation benefits that you need and deserve. That is where we come in.

If you are having difficulty with your workers’ compensation claim, call KBG Injury Law at 717-848-3838 for experienced legal advice and assistance to make things clear and simple for you. We have offices in York, Lancaster, Hanover, Harrisburg, and Gettysburg, PA. Feel free to use our contact page to schedule an appointment. We will fight for your right for wages and benefits after an on-the-job injury. You do not have to do this alone.