Appealing a Pennsylvania Workers Compensation Denial
Workers’ compensation in Pennsylvania is governed by the Pennsylvania Workers’ Compensation Act. If you believe you have a Pennsylvania workers’ compensation claim but your claim is denied, you have the right to appeal that denial. Read on to learn about the appeals process, or see "Workers Compensation Claims in Pennsylvania" for information on making your initial claim.
Covered Injuries and Diseases
Injuries stemming from activities outside the course and scope of your employment are not covered under workers’ compensation. Also, if your injuries are due to a violation of the law, such as drug use, you will not be eligible for worker’s compensation benefits as your injuries are not covered under workers’ compensation.
Occupational diseases are covered only if they are proximately caused by, or aggravated by, the conditions of your work For toxic exposure cases, your injury must arise within approximately five years of your last date of exposure to a hazardous substance for your occupational disease claim to be covered by workers’ compensation.
Pennsylvania has requirements for certain lung diseases to be compensable under workers’ compensation. This includes mandatory requirements that you were exposed to silica, coal, or asbestos for a minimum of two years in Pennsylvania for you to have a covered claim. If you have a lung disease, you should talk to an attorney in your area to determine whether you meet the specific criteria.
Appealing a Denial
If you believe you are a covered employee, with a covered injury or disease, and your claim is still denied, you have the right to appeal that decision. This involves filing a petition with the Bureau of Workers’ Compensation. Forms for filing a Petition with the Bureau can be acquired by calling (800) 482-2383. You must file your petition within three years of the date of injury.
The Bureau will assign your case to a workers’ compensation judge. The judge will likely schedule mediation to allow you a chance to discuss the issues in the case prior to a full hearing. You may request mediation or a settlement conference at any time during the proceedings.
If the case does not resolve at the mediation stage, the case proceeds to hearing. At the hearing, both you and your employer will be allowed to present evidence to support the respective positions. This includes medical evidence from doctors that have treated you or provided independent medical evaluations, and lay witnesses such as your co-workers. The judge will then issue a decision.
If you are unhappy with the decision, you may appeal this decision to the Workers’ Compensation Appeal Board. The Workers’ Compensation Appeal Board will review your case, and affirm, modify, or reverse the judge’s decision. If you disagree with the Board’s decision, you may appeal further to the Commonwealth Court.
In the written decisions issued by the judge and the Board, you will be informed of your appeal rights. Read this information carefully, as filing an appeal properly can be procedurally difficult.
Talk to an Attorney
An attorney can be a strong advocate on your behalf throughout your workers’ compensation claim. Appeals in workers’ compensation are complex, and require use of legal rules of procedure. Your employer will be represented, most likely, by an experienced workers’ compensation attorney. You should strongly consider hiring an attorney to represent your interests.