If Your Claim Is Denied Filing Additional Information You will receive a denial notification letter from the Department of Administrative Services (DAS). The letter will inform you of your right to appeal. The letter also may indicate what information is needed, how to submit the information and the deadline for filing the information. It is very important to meet your deadlines for filing additional information. Third Party Medical Review If your claim is denied because of a medical issue, your claim will be reviewed by an independent third party physician chosen by DAS. You must request a third party medical review within 30 calendar days of the denial of your claim. The third party physician will not examine you. The doctor's decision will be based on all the medical information in your file. DAS will be bound to the decision of the third party physician. You will then be notified by mail of the decision. Appeals If you disagree with the physician's decision, or if your claim was denied based on a technical issue, you may request a hearing by filing an appeal. You must request a hearing within 30 calendar days of either the date of the notification letter or the ending date of benefits, whichever is later. Your appeal must be in writing. At the hearing, you may be represented by an attorney or yourself, and you may present evidence and examine witnesses. The hearing officer sends a recommendation on your claim to the Department of Administrative Services. The DAS legal office will send you a copy of the report and recommendation issued by the hearing officer. All parties involved in your appeal then have 10 calendar days to file an objection. The director of DAS then reviews the recommendations and objections, and issues a final order to all parties involved. If you disagree with the director's order, you will have 15 calendar days to appeal to the Court of Common Pleas.

WORKERS' COMPENSATION BENEFITS