Hanover, PA workers’ compensation lawyers handle denied claims by reviewing the insurer’s denial letter, gathering medical and workplace evidence, and filing a Claim Petition with the Pennsylvania Bureau of Workers’ Compensation. They represent injured workers at hearings before a judge, cross-examine employer and insurance witnesses, and utilize expert medical testimony to establish that the injury is job-related and benefits are owed.
At Mooney Law, our workers’ compensation team in Hanover understands how claim denials impact injured employees. We handle complex appeals, develop evidence-driven strategies, and hold insurers accountable for wrongful denials in accordance with Pennsylvania law. Our familiarity with local courts and procedures enables us to pursue effective results for clients across South Central Pennsylvania.
What Steps Should You Take After a Workers’ Comp Claim Denial?
If your workers’ compensation claim is denied, the first step is to review the denial letter and determine the reason. From there, you should begin gathering medical records, workplace reports, and witness testimony to strengthen your appeal. In Pennsylvania, you may request a hearing before a Workers’ Compensation Judge, who will evaluate evidence and decide whether benefits should be granted. Here’s how the appeals process typically works under Pennsylvania law:
1. Gather Medical Evidence
Collect all treatment records, diagnostic tests, and physician opinions that connect your injury to your workplace duties. Testimony from medical experts is often required to establish the injury’s cause and extent.
2. Review Employer Reports
Employers may dispute whether an injury occurred at work or argue that you were not acting within your job duties. Reviewing accident reports, time records, and coworker statements helps counter these claims.
3. File a Claim Petition
If the insurer refuses to reverse the denial, you can file a Claim Petition with the Pennsylvania Bureau of Workers’ Compensation. This begins the litigation process before a judge, where both sides present evidence.
4. Attend Hearings
A Workers’ Compensation Judge will schedule hearings to hear testimony from you, your doctors, and other witnesses. Insurers will also present their defense, often relying on independent medical examinations.
5. Appeal Further if Needed
If the judge denies your petition, you can appeal to the Workers’ Compensation Appeal Board, and eventually to the Commonwealth Court of Pennsylvania. Each stage requires strict adherence to deadlines and legal procedure.
Why Do Insurance Companies Deny Workers’ Compensation Claims?
Insurance carriers often deny claims to reduce costs. Common reasons include disputes over whether the injury is work-related, claims of pre-existing conditions, or alleged failures to report the injury in a timely manner. In Pennsylvania, insurers may also deny claims based on missed statutory deadlines or insufficient medical documentation. Other common denial tactics include:
- Claiming the injury happened outside the course of employment
- Arguing that the worker failed to notify the employer within 120 days.
- Disputing the severity or duration of the disability
- Using “independent medical exam” results to suggest no ongoing impairment.
Without legal guidance, employees often struggle to navigate insurer tactics and gather the necessary evidence to overturn a denial. Carriers use strict deadlines, complex medical language, and aggressive defenses to minimize payouts. A missed form, late filing, or lack of expert medical testimony can result in the permanent denial of benefits. An experienced lawyer manages these challenges, builds strong evidence, and advocates before judges to ensure injured workers receive the compensation they are entitled to.
What Role Does a Claim Petition Play in Challenging a Denial?
A Claim Petition is the critical first step in formally challenging a denied workers’ compensation claim in Pennsylvania. Filed with the Bureau of Workers’ Compensation, it provides the legal basis for your case by describing the injury, how it occurred, and the benefits you are seeking. Once filed, the petition triggers the litigation process and ensures your case is reviewed by a Workers’ Compensation Judge.
Because insurers rarely reverse denials voluntarily, the Claim Petition becomes the foundation of your appeal. It allows you to present supporting documentation, medical testimony, and workplace evidence that demonstrate your injury is job-related. Judges rely heavily on this petition and the evidence attached to determine whether benefits should be awarded.
Supporting evidence may include:
- Detailed medical records and physician reports
- Testimony from treating doctors or specialists
- Workplace records and accident reports
- Statements from coworkers or supervisors
- Proof of wage loss and disability impact
By filing a strong Claim Petition, injured employees create a formal record that protects their rights, compels insurers to respond, and provides the legal framework for pursuing benefits through the appeals process.
Can Litigation Pressure Insurers to Reconsider a Denied Claim?
Yes. Once litigation begins, insurers face the real risk of being ordered by a judge to pay wage loss and medical benefits, along with possible penalties, interest, and attorney fees for unreasonable conduct. The process also opens the door to discovery tools, such as depositions of doctors, company representatives, and independent medical examiners, which can uncover inconsistencies in the insurer’s defense.
By exposing these weaknesses, litigation puts significant pressure on insurers to reassess their denial. Often, the threat of a judge’s ruling and the potential for additional costs motivate them to negotiate a settlement or resolve the case on more favorable terms. For injured workers, litigation not only provides leverage but also ensures their claim is fully presented and supported by evidence, increasing the chances of a fair outcome.
How Long Do You Have to File an Appeal in Pennsylvania?
In Pennsylvania, you generally have three years from the date of injury to file a Claim Petition if your workers’ compensation benefits are denied. This is the statute of limitations, and missing it can permanently prevent you from pursuing your claim. In addition, you must notify your employer of the injury within 120 days, or you may lose your right to benefits entirely.
Other deadlines may apply depending on your case, such as timeframes for filing appeals after an initial judge’s decision or challenging a specific denial of medical treatment. Because these rules are strictly enforced, even a slight delay can harm your case. Acting quickly ensures your rights remain protected, gives your attorney time to build a strong case, and increases the likelihood of securing compensation without unnecessary delays or setbacks.
Can Expert Testimony Strengthen a Denied Workers’ Comp Case?
Yes. Expert testimony, particularly from medical professionals, can be one of the most potent tools in overturning a denied workers’ compensation claim. Judges rely heavily on explicit, credible medical opinions to decide whether an injury is truly work-related, the extent of the disability, and whether ongoing treatment is necessary. Medical experts can also counter the findings of independent medical examiners hired by insurers, which often minimize or dispute the severity of injuries.
In addition to medical experts, vocational specialists may testify about how the injury limits your ability to return to your prior job or perform alternative work. They can also assess the impact on your long-term earning capacity, which is critical in cases involving partial or permanent disability. By presenting unbiased, professional testimony, experts help clarify complex medical and employment issues, strengthen your appeal, and significantly improve your chances of receiving fair benefits.
FAQs
What if my medical treatment is denied, but I am approved for wage loss benefits?
You can appeal medical denials separately through the Pennsylvania workers’ compensation system. A judge will review medical records, expert testimony, and treatment notes to determine whether the care is both reasonable and necessary for your recovery. If proven, insurers may be required to cover the cost of treatment, including surgeries, therapy, and long-term medications. It’s essential to act promptly, as delays can affect both your health and your claim.
Can I still receive benefits if I had a pre-existing condition?
Yes. Under Pennsylvania law, benefits are available if your work duties aggravated or accelerated a pre-existing condition, even if you had prior medical issues. For example, repetitive motion at work could worsen arthritis, or a fall could aggravate a prior back injury. Medical testimony is typically required to prove that the workplace aggravated the condition, but courts frequently award benefits in these cases when supported by substantial evidence.
Does a denial mean my case is over?
No. A denial is often just the start of the litigation process, not the end. Many claims that are initially denied are later won through hearings before a Workers’ Compensation Judge, negotiated settlements, or appeals to higher courts. With proper evidence, witness testimony, and legal guidance, it’s possible to reverse a denial and secure wage loss or medical benefits even months after the initial rejection.
What if my injury got worse after the initial denial?
If your condition worsens after a denial, you may submit updated medical records, diagnostic tests, or specialist evaluations to show the progression of your injury. This evidence can strengthen your appeal by proving that the disability is more severe than initially believed. New or worsening conditions can also justify additional benefits, such as long-term wage loss or expanded medical coverage. Acting promptly ensures the new evidence is considered during litigation.
How long does it take to resolve a denied workers’ comp claim in Pennsylvania?
The timeline varies depending on the complexity of the case, the nature of medical testimony, and the appeals process. Some cases are resolved in a few months, but more complex claims may take a year or longer, particularly if multiple hearings and appeals are involved. Although the process can seem lengthy, settlement negotiations may offer partial relief before a final decision is made. An experienced lawyer can advance the case and explore interim options to alleviate financial strain.