An employee injured at work is owed Workers Compensation Benefits which can include wage loss benefits, medical benefits and benefits for scarring and other types of permanent injury. The employer and insurance company are responsible to investigate and to notify the injured worker if the claim will be paid. However, workers’ compensation claims can often be unfairly denied. Sometimes the investigation of a claim can take an unreasonable amount of time. If you are unsure what to do after a workers’ compensation claim is denied, we can help. The attorneys at the Pittsburgh, PA, law office of Woomer & Talarico LLC have extensive experience handling workers’ compensation cases, and we can help. Contact our law office today
Understanding the Denial Process
Your claim can be denied in two ways:
Notice of Denial Sent to you in the Mail: If your claim is denied, you should receive a notice in the mail. In these cases, there is little ambiguity regarding the status of your claim. The carrier is not likely to pay benefits voluntarily unless you hire a lawyer and a claim petition is filed.
The Insurance Company Fails to Respond within 21 Days: It is possible for your claim to be denied without any written notice to you. If your employer or its insurance company fails to file documents with the Department of Labor and Industry, your claim is effectively denied under the law, even if medical bills are being paid by the insurance company. In such cases, your right to wage loss and medical benefits can expire if you fail to assert your rights in an appropriate and timely manner. If you are unclear as to the status of your claim, you should assume that it has been denied and you should retain an attorney to protect your rights.
You have the right to have the denial of your claim reviewed in court by a Workers’ Compensation Judge. To win your case, it is necessary to present factual and expert medical testimony in a courtroom setting. It is extremely important to have an experienced courtroom attorney representing you, because the insurance company will have an experienced and aggressive trial lawyers working for them. At Woomer & Talarico we have been investigating and litigating denied claims for decades. If we believe that your claim was denied unjustly, we can help prove your case in court.
Potential Workers’ Compensation Benefits
Workers’ compensation insurance can be made to reimburse you for more than basic wage loss or medical bills. You may be eligible to receive benefits for:
Scarring of the face, neck or head
Both mental and physical disabilities
Post-traumatic stress disorder (PTSD)
Concussions and closed head injuries
Reconstruction of your home with handicapped ramps, bathrooms, etc.
Prosthetics, hearing aids and glasses
If you are unsure what workers’ compensation covers, speak with one of our attorneys today. Rest assured, will work diligently to maximize your recovery.
If your workers’ compensation claim has been denied, we can see to it that you are justly compensated for your injury. Should you decide to settle, we can ensure that you don’t settle for less than your case is worth. At Woomer & Talarico LCP, we pay 100 percent of court costs and only charge fees when we are able to successfully litigate or settle your case. To schedule a personal consultation with one of our experienced attorneys, contact our law office today.
Independent Medical Exams
Generally, once a workers compensation claim is officially accepted by the insurance company, medical and/or wage loss benefits must be paid until the injured worker achieves a full recovery. However, the law permits the insurance company to investigate, challenge and deny benefits in numerous ways. Most challenges to Workers Compensation benefits begin with a medical examination called an “independent medical exam” or IME. Insurance Companies are permitted to require injured workers to be seen by company doctors every six months. Often these “independent” doctors state opinions contrary to opinions of treating doctors. This can lead to a challenge to your benifits before a Workers’ Compensation Judge in court. If you are being asked to be seen by an Independent Medical examiner, it is very likely that your case will need to be reviewed by an experienced Workers’ Compensation attorney.
Light Duty Job Offers
One way your employer can limit or eliminate wage loss benefits paid to you is to bring you back to work at a light duty job. Sometimes your employer will ask you to return to a job that isn’t approved by our own doctor. Other times the insurance company may ask you to interview for jobs or go to work for a different employer entirely. Frequently, insurance companies will find “made up” positions. Under certain circumstances, a decision to not accept light duty work can be used to eliminate the insurance company’s obligation pay wage benefits. We can work with you to protect you against these schemes and to ensure that you are not forced back to work too soon. We can also ensure that you receive partial benefits if you lose wages on light duty.
The Average Weekly Wage
At the time of your injury the insurance company will calculate an “average weekly wage” which is used to determine your workers’ compensation rate. The value of your case is very dependent upon a favorable wage calculation. Many times the insurance company will choose the method most beneficial to their bottom line. If the average weekly wage doesn’t seem fair to you or if your rate seems artificially low, we can help. Under the Pennsylvania’s Workers’ Compensation Statute, several methods can be used to calculate the average weekly wage dependent upon the length of employment, second jobs, overtime, tips and so on. You are entitled to the wage calculation most favorable to you.