Archive for December, 2025

When you’ve been injured on the job, the Pennsylvania workers’ compensation system will not pay you outrageous sums of money, but it is supposed to provide medical care to meet your needs and funds to make up for much of the income that you are missing because you’re unable to work. These benefits are critical to meeting your basic needs.

Unfortunately, the insurance company or employer responsible for providing those benefits may decide that you’re not eligible to receive them. This is what they “determine” after reviewing most claims. They seem to routinely deny everything and hope they can get away without paying. And many times, employees give up. They accept the insurance company’s answer and try to manage on their own. Or they try to appeal the denial, but they lack the knowledge and experience necessary to succeed.

There’s a better way. If your workers’ compensation claim is denied in Lancaster or elsewhere in Pennsylvania, an experienced attorney can work to pursue the benefits you deserve. But it is important to act quickly to protect your rights because time is limited.

Check the Reason for the Denial

If you have filed a workers’ compensation claim and received notice telling you that your claim was denied, it is important to examine the notice closely and take note of the reasons given for the denial. Claims are frequently denied in Pennsylvania because:

• Not enough evidence was submitted regarding the severity of the injury
• The employer was not given proper notice of the injury (the appropriate supervisor must be given notice within 120 days)
• The injury was preexisting
• The injury was caused by something outside of work
• The employee’s wrongful behavior was the cause of the injury

In some cases, insurance companies issue a conditional denial because they have not yet received or reviewed the evidence of the injury. It is a good idea to contact the workers’ compensation insurance company to determine whether they have received documentation of your injury. While the employer is obligated to report your injury to their insurance company and to the Pennsylvania Bureau of Workers’ Compensation, employers do not always fulfill their obligations. An experienced attorney can work to obtain benefits in this type of situation.

Understanding the reason a claim was denied is the first step toward remedying the situation. It will be important to build a record of evidence to refute the reason given for the denial.

The Workers’ Compensation Claim Petition

The first formal step in the process of appealing a claim denial is to file a Workers’ Compensation Claim Petition with the Pennsylvania Department of Labor & Industry’s Workers’ Compensation Office of Adjudication. It is vitally important to ensure that proper procedures are followed when filing and that the submission contains all the evidence needed to support the claim. The evidence and assertions you submit will be reviewed by a judge to determine whether the claim should be approved.

While the workers’ compensation program does not require claimants to work with an attorney in the appeals process, it is important to remember that the insurance company and employer who are fighting to deny the claim will have experienced legal teams arguing on their behalf, and it is difficult to overcome this type of legal assault without having a knowledgeable legal advocate on your side.

Demonstrating That an Injury or Illness Should Be Covered by Workers’ Compensation

When making legal arguments to support a claim for benefits, it is important to remember that nothing should be taken for granted or assumed, even if it appears to be obvious. You will need to present evidence of every detail. Missing a single link in the legal chain of reasoning can give the judge grounds to deny your claim. Examples of information that must be submitted authoritatively:

• You will need evidence of what happened when the injury occurred to prove it occurred during the course and scope of your employment. (For instance, eyewitness accounts of where you were and what you were doing at the time of the injury.)
• You will need evidence of your injury from a medical examination right after the accident.
• You will test results, images, and other medical evidence showing the extent of your injuries
• You will need medical records showing that you received follow-up care as advised by the doctors
• You will need evidence showing what your regular job duties were and your regular rate of pay before the injury
• You will need a report from a doctor explaining why your injuries prevent you from performing the duties of your job
• You may need evidence of long-term disabilities resulting from the injury

The Pennsylvania Department of Labor & Industry’s Workers’ Compensation Office of Adjudication has specific requirements for what to include and how to submit it. If you work with an experienced attorney during the appeals process, your attorney can manage the details. If you’re proceeding on your own, be sure to review the Department’s requirements carefully. While the law allows three years from the time of injury to file a Claim Petition, it usually makes sense to file as soon as you are prepared.

A hearing will usually be held based on the evidence presented by both sides. An administrative judge will review the written materials and may ask questions from both sides. Although the hearing is less formal than a courtroom jury trial, it is still an official proceeding, and it is essential to follow proper procedures.

If the judge renders an unfavorable decision, it is possible to appeal to the Workers’ Compensation Appeal Board. An appeal must be filed no later than 20 days after the decision. Further appeals may be made in Pennsylvania courts if necessary.

Get Experienced Guidance and Advocacy with Workers’ Compensation Appeals

The workers’ compensation system was intended to be simple, but insurance companies have made it a complex nightmare. Workers who try to obtain benefits find themselves pitted against corporate insurance teams intent on denying everything they can. To receive appropriate benefits, many workers have no choice but to fight back with their own legal representation.

At Vanasse Law, we know how employers and workers’ compensation insurance providers fight to keep workers from receiving full benefits for injuries caused by workplace conditions. We also know how to work effectively to recover full benefits for injured workers. For a free, confidential discussion about the assistance we could provide with a claim or an appeal, call us at 717-397-1010 (after hours, our call and text line is 717-471-2168) or contact us online.