Why PA Workers’ Comp Claims Get Denied and How to Appeal

Filing a workers' compensation claim in Pennsylvania can sometimes lead to unexpected denials, leaving workers without the benefits they need. Understanding why these claims are denied and knowing how to effectively appeal using a Claim Petition can make all the difference.

Common Reasons for Denial

Claims may be denied for several reasons:

• Insufficient Evidence: Lacking enough medical documentation or witness statements to substantiate your claim.
• Late Reporting: Failing to notify your employer about the injury within the required timeframe.
• Non-Work-Related Injury: The injury is deemed unrelated to your work duties.

Appealing with a Claim Petition

If your worker’s comp claim is denied, filing a Claim Petition is the next step. This formal request initiates a hearing process where you can present evidence and argue your case.

Basic Hearing Steps

The hearing process generally includes:

• Filing the Petition: Submitting a detailed explanation of your injury and the reasons you believe your claim was wrongfully denied.
• Gathering Evidence: Collecting medical records, accident reports, and witness testimonies that were not included with your initial filing.
• The Hearing: Attending a hearing before a Workers’ Compensation Judge where both sides present their arguments and evidence.
• Decision: Awaiting the judge’s decision, which can take several months.

Evidence Needed

Strong evidence is crucial for an appeal. Ensure you have:

• Comprehensive Medical Records: Detailed notes from healthcare providers outlining the extent of your injuries.
• Workplace Report: Documentation provided by your employer regarding the incident.
• Witness Statements: Testimonies from coworkers or others who witnessed the incident.

If your workers comp claim was denied in Pennsylvania, don’t navigate the appeals process alone. Request a denial-letter review today to explore your options and strengthen your case.