A denial letter can feel like a door slamming shut. You’re hurt, you can’t work, and the insurance company has just said no. But a denial is not the end of your claim. It’s the insurer’s opening position, and many denied claims are won. Philly Injury Lawyer fights denied workers’ comp claims for injured workers across Philadelphia, and we know what it takes to turn a “no” into benefits.
Why Claims Get Denied
The most common reasons we see:
- The insurer says the injury didn’t happen at work or isn’t work-related
- The injury wasn’t reported in time
- There were no witnesses or the accident report is incomplete
- The insurer blames a pre-existing condition or an old injury
- The medical records don’t clearly connect the injury to the job
- The insurer says you’re an independent contractor, not an employee
Proving Your Injury Is Work-Related
Winning usually comes down to evidence. That includes:
- Your treating doctor’s opinion that the job caused or worsened your injury
- Witness statements from co-workers who saw the accident or your condition after
- The written report you gave your employer and when you gave it
- Job duties, especially for repetitive-motion and lifting injuries
- Photos, video and incident logs from the workplace
For injuries that build up over time, like carpal tunnel or back problems, we show how your daily work caused the damage. See our page on repetitive strain injuries.
How to Fight a Denial
- File a Claim Petition. This starts a case in front of a workers’ comp judge. It generally must be filed within three years of the injury.
- Hearings. The judge hears testimony, usually at hearing offices in Philadelphia.
- Medical testimony. Doctors on both sides give their opinions, usually by deposition.
- Decision. The judge decides whether you’re owed benefits, including back pay.
- Appeals. If needed, either side can appeal, first to the Workers’ Compensation Appeal Board and then to the courts.
The timeline is often several months, which is why it pays to move quickly.
Denied? Don’t Give Up. Call Us.
Call (215) 735-4800 for a free review of your denial letter. We only get paid if we win. We Win or It’s Free®.
Frequently Asked Questions
How long do I have to fight a denial?
A Claim Petition generally must be filed within three years of the injury. Waiting makes your case harder, so don’t sit on it.
Who pays my medical bills while I fight the denial?
Your health insurance may pay in the meantime. If you win, the workers’ comp insurer must repay those bills and your back wages. Don’t ignore medical bills; tell us about them.
What if my employer says I’m an independent contractor?
Your job title doesn’t decide it. Pennsylvania looks at how much control the company had over your work. Many workers labeled as contractors are really employees.
Pennsylvania Law in Plain English
After you report an injury, the insurer has 21 days to accept or deny it. If it denies the claim, you can file a Claim Petition with the Pennsylvania Department of Labor & Industry and a workers’ comp judge will decide. Appeals go to the Workers’ Compensation Appeal Board and must be filed within 20 days of the judge’s decision.
