PA Denied Workers’ Comp Claim Settlement Calculator

Why Use a Denied Workers’ Comp Claim Calculator?

Workers compensation insurance companies in Pennsylvania regularly deny valid work related injury claims. Common excuses include:

• “The injury wasn’t work-related”
• “No medical proof”
• “The claim was filed too late”
• “You’re not an employee”

In many cases, you can still win your denied claim by filing a Claim Petition before the deadline. Our calculator gives you an estimate of what your case might be worth before you take the next step.

How the Denied Workers’ Comp Settlement Calculator Works

The calculator gives you a customized estimate using these key factors:

1. Your Average Weekly Wage (AWW)

This is your pre-injury income. Use our guide to the average weekly wage to calculate your wages.

2. Work Status

• Not working: Eligible for full compensation rate. You can calculate your workers compensation rate using our free benefit rate calculator.
• Working with reduced earnings: The estimate relies on the wage difference. Partial disability is 2/3 the difference between current earnings and the preinjury AWW.

3. Injury Severity

We apply an adjustment based on practical outcomes. The more serious an injury, generally the more valuable the claim:

• Mild (limited medical care, return to work): –15%
• Moderate (active treatment): No change
• Severe (e.g., surgery required): +15%

4. Duration Multiplier (Based on Real Case Data)

We use a range of 52 to 200 weeks. This relies on how insurance companies usually resolve denied cases. These resolutions happen through litigation, mediation, and settlement.

5. Minimum Value Threshold

If your estimate is below $10,000, we apply a minimum range of $10,000 to $30,000, which reflects common settlement floors in denied claims. Insurance companies call these claim values the “cost of defense” or “nuisance value” claims.

Example Calculation

Let’s say:

• AWW = $927
• Not working
• Moderate injury

Estimated range: $32,000 – $123,600

This gives you a realistic starting point for deciding whether to pursue your claim.

What Affects Denied Claim Settlement Value?

Multiple factors influence claim values:

Average Weekly Wage (AWW)

Higher wages lead to higher compensation rates and larger settlements

Work Status

Not working = greater wage loss = higher value

Injury Severity

More serious injuries typically lead to stronger claims

Benefit Duration

Based on expected resolution, not lifetime entitlements in most workplace injury claims

Medical Evidence

Strong documentation increases chances of success

Important: Medical Benefits Are Not Automatically Covered

If your employer filed a Notice of Compensation Denial (Form LIBC-496), they do not have to pay for medical treatment. This is true unless you win your case later in court.

We often file claims just for medical benefits. This is common when a worker hasn’t missed work but still needs treatment.

What to Do After a Denial

Review Your Denial Letter

This is typically a LIBC-496 form. The Notice of Workers’ Compensation Denial also gives the reason for the claim denial.

Gather Your Documentation

• Medical records
• Doctor’s notes
• Witness statements
• Pay stubs and tax records

Use the Calculator to Estimate Value

Know your potential settlement before calling an attorney.

Consider Filing a Claim Petition

You have three years from the date of injury to file in most cases. However, you must provide notice to your employer much sooner.

Common Denial Reasons (and What They Mean)

• “Injury not work-related” → Can be challenged with medical evidence
• “Filed too late” → You have up to 120 days to notify your employer
• “Independent contractor” → Many workers misclassified; you may still qualify
• “No injury on file” → That’s what the petition process can prove injury occurred
• “Pre-existing condition” → Medical evidence can show aggravation

These claims can often be reversed when challenged correctly.

FAQs About Denied Workers’ Comp Claims in PA

How long do I have to file a workers’ comp claim?

You have three years from the date of injury to file a Claim Petition. However, the sooner you act, the better your chances of preserving evidence and winning your case.

Can I file just for medical bills?

Yes. A claim petition can seek payment of only medical bills. Not every work injury or illness results in lost wages.

Do employers have to pay anything after a denial?

No. If your claim was denied with a LIBC-496, the employer does not have to pay for wage loss or medical bills. A claim petition can force the employer to pay benefits.

Bottom Line

Being denied workers’ compensation doesn’t mean your case is over. Many injured workers in Pennsylvania receive significant settlements — even after an initial denial.

Use the Denied Workers’ Comp Claim Settlement Calculator to understand your options. Then talk to a workers’ comp attorney about next steps. At McMenamin & Wing, we can guide you through the process to receive the workers compensation benefits you deserve.

Disclaimer: This calculator is for educational purposes only and does not constitute legal advice. Every case is different. Contact a licensed workers’ compensation lawyer in Pennsylvania for personalized guidance.