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Understanding denied workers’ compensation claims

Getting an injury on the job has long-lasting effects. Pennsylvania law requires that most employers have workers’ compensation coverage, but that may not mean instant approval.

A denied claim does not have to mean giving up. According to the Pennsylvania Department of Labor & Industry, the state’s Workers’ Compensation Appeal Board deals with approximately 1,000 appeals every year.

Common reasons for a denied claim

Claim denial happens for many reasons. Failure to meet eligibility requirements often tops the list. This may come in the form of not receiving medical treatment, missing the claims process deadline or inability to prove it happened on the job. In some cases, the insurance provider may not consider injuries severe enough for a claim. Another issue involves proving a work-related injury. For progressive injuries, such as carpal tunnel syndrome or mental stress, medical exams may not provide a clear answer.

Steps to appeal a claim

After having a clear understanding of the reason, an employee has the option to appeal the denial. The first step involves contacting the insurer to verify the claim denial. While rare, paperwork errors have happened. If that does not solve the issue, consider contacting a lawyer. Along with helping to determine the best course of action, the right team has appeal process knowledge vital to a case. A workers’ compensation appeal comes with strict deadlines, securing and presenting documentation to prove the claim and attending hearings.

While no one wants to file a workers’ compensation claim, the option provides relief. If denied, getting help makes navigating the complicated appeal process easier.