When you are injured or fall ill due to your job or workplace, you need to report the incident to your employer, ideally at the time it occurs. Legally, you have up to 120 days to report your work injury or within 120 days from the date you discovered your occupational illness. Your employer will then send the incident report to their Workers’ Compensation insurance company.
Within 21 days of reporting your injury, your employer can deny your claim. If they deny your claim, you can challenge this decision. You have up to three years to file a Claim Petition, but the sooner, the better. If you wait too long, an insurer or judge may question the severity of the injury or illness if you could wait so long to file an appeal. If you fail to file a Claim Petition within three years of the date of injury, your claim will be barred.
The following is an overview of the steps in the process to file a claim for your worker’s compensation benefits.
Most lawyers offer a free initial consultation on Workers’ Compensation cases. They will review the facts, evaluate the evidence to support your claim, and analyze the reasons for denial outlined in your denial letter. They will then let you know if you have a strong enough case.
If your legal counsel believes an appeal is warranted, they will file a Claim Petition on your behalf with the state’s Bureau of Workers’ Compensation., Your case will be assigned to a Workers’ Compensation judge, who works close to your geographic location, and then put on the schedule. The judge’s office will notify all the parties involved of the hearing date: you, your lawyer, your employer, and your employer’s insurer.
Your lawyer will begin building your case to present at the hearing. You will play an essential role in this process by helping collect evidence and records that substantiate your injury or illness and losses, such as lost income and medical bills. You may be asked to begin a journal of doctor and specialist visits, including dates, outcomes, instructions, and other information.
Meanwhile, your lawyer will interview co-workers and other witnesses to the incident.
The Workers’ Compensation Judge will schedule a hearing or a series of hearings. Your lawyer will present evidence that will usually include your testimony as well as medical evidence and other evidence relevant to your claim. The insurer’s lawyer will present evidence as to their side of the case.
In many instances, the Workers’ Compensation Judge will refer the case for Mediation in which another judge, not the judge who decides your case, attempts to get the parties to agree to resolve the case. However, if the mediation is not successful, all the evidence will presented to the judge, who will issue a ruling on your case.
If the judge’s ruling is not in your favor, you can appeal within 20 days to the Workers’ Compensation Appeal Board. You must allege that the judge misapplied the law or failed to consider facts in the evidence.
Within one to two months after an appeal is submitted, the Workers’ Compensation Board will hold a hearing with your lawyer and the employer’s lawyer. Each side will file briefs and present oral arguments before a panel of commissioners arguing the issues.
Your lawyer needs to show that the judge applied the wrong law or principle to the facts presented in your case or failed to consider evidence that was part of the record.
Within six to 12 months, the Appeal Board will either reverse or affirm the judge’s decision. If they reverse the decision, they remand the matter to the judge to address a specific issue, providing the judge with guidance as to the issue and the law that applies.
If the Appeal Board upholds the judge’s decision for claim denial, you can file an appeal with the Commonwealth Court. Both parties will submit briefs to the court. The Court may also have oral argument. Usually, a three-judge panel will decide your case. Decisions from the court can take from six months to a year or more and are based on evidence from the lawyers’ briefs. The court will send a written decision to all parties involved.
Note that cases generally do not go past the Commonwealth Court.
If the Commonwealth Court denies your claim, you have 30 days to appeal the decision to the Pennsylvania Supreme Court. The Supreme Court then decides whether or not to hear your case. They only hear cases they believe involve compelling legal issues. If they opt not to hear it, the decision of the Commonwealth Court stands as final.
If they opt to hear it, both sides will submit briefs to the court and may have to appear in front of the court to argue the case. The court will then issue a final decision, which signifies the end of the process. There are no more appeals.
Some employers may try to fire, demote, create a hostile environment, or treat a Workers’ Compensation claimant worse than other employees. Regardless of the outcome of your claim, stay vigilant at work for any mistreatment, discrimination, harassment, or other activity that appears to be retaliation for your claim.
The Workers’ Compensation appeal process in Pennsylvania is not easy. It can be overwhelming, especially if your injury or illness is severe. The last thing you need is to spend your time dealing with complicated requirements and deadlines when you should be healing.
A Workers’ Compensation lawyer will help you through this process. They know the process and how to build a strong case on your behalf. They know how to defend against insurance companies.
In some cases, you may be asked to testify on your own behalf somewhere in the process. Your lawyer can guide you through this often nerve-wracking process.
Working with an experienced lawyer can make you feel confident that your claim and appeal are in the best possible hands.
If you have been injured at work and your claim has been denied, one of our seasoned Philadelphia Workers’ Compensation lawyers at Galfand Berger LLP can assist. To schedule a free consultation, call us today at 800-222-USWA (8792) or contact us online. From our offices in Philadelphia, Bethlehem, Lancaster, and Reading, Pennsylvania, we help clients throughout Pennsylvania and New Jersey, including Allentown and Harrisburg.