A workers’ compensation denial makes it difficult to pay medical bills and the stress and worry can lengthen recovery times. This is a common occurrence, but those decisions can be successfully challenged with appeals. The chances for this outcome depend on how well the claimant follows instructions and evidence, amongst other things.
Workers’ compensation claims are often denied because of incorrect or missing information on forms. Denials also happen when claimants do not follow proper procedures, like reporting an illness or injury within a specified time frame or using medical providers who do not participate in the insurance plan. Here are some of the other reasons why employers and insurance providers issue denials:
- The injury or illness happened outside the course and scope of employment.
- The injury or illness was not as serious as the employee claimed.
- The employee exhibited unlawful conduct at the time of the injury, such as being under the influence.
- A private investor was hired to monitor your social media or provide surveillance services. This provided evidence to challenge your medical condition.
Workers have the right to appeal these cases without legal help but an experienced workers’ compensation lawyer is often beneficial. You have 20 days to file an appeal, starting from the date shown on the written decision. This will be reviewed by the state appeals board.
When appeals are denied, claimants can appeal to higher courts. The order is the Pennsylvania Commonwealth Court, followed by the Pennsylvania Supreme Court.
How Can I Win a Workers’ Compensation Appeal?
There is more than one way to win an appeal, and your lawyer can advise you on the best strategy. First, you must ensure that you followed all of the instructions for the initial filing and understand exactly what kind of benefits you may be entitled to.
You may be advised to change physicians because there could be a conflict of interest – workers’ compensation providers are primarily paid by insurance providers. State laws vary on the procedures for changing doctors, so be aware of those when making your decision.
Your lawyer will also direct you to keep accurate records of any documentation related to the injury, including medical records and receipts. Follow the doctor’s instructions and do not miss appointments. You will also want to attend all of the legal meetings and court dates, unless your medical condition prevents you from doing so.
Downingtown Workers’ Compensation Lawyers at Wusinich, Sweeney & Ryan, LLC Help Clients With Appeals
A workers’ compensation denial does not have to be the end of a claim, but the appeal process can be difficult. Contact Wusinich, Sweeney & Ryan, LLC for a free consultation. A Downingtown workers’ compensation lawyer can review your case. Call 610-594-1600 or complete our online form today. Located in Exton, Pennsylvania, we serve clients in Downingtown, West Chester, Exton, Coatesville, Phoenixville, Malvern, Lyndell, Wagontown, Uwchlan Township, Parkesburg, Chester Springs, Lancaster County, Reading, and Morgantown.
