How Long Does it Take to Receive My Workers’ Compensation?
Hurt at work? You will need a dedicated and experienced workers’ compensation lawyer to help you through the complex and confusing process.
When can you expect to receive your first workers’ compensation benefit check? For a wage-loss claim, under the best of circumstances and given practical considerations the answer is 21 to 28 days. Here is a timeline for wage-loss claims.
Day 0/Day 1: You are Hurt on the Job
If you are hurt on the job, first, seek ALL the medical help that is necessary. Call 911 and go to the emergency room immediately. Nothing is more important — including your benefits — than getting necessary medical attention. Your family cares more about you; they will worry about the money tomorrow. When your condition is stable, then there will be time to file for workers’ compensation.
Do not let your employer bully you into not calling 911 or waiting until the “end of your shift.” That will cause your injuries to be worse and potentially subject your employer to federal investigations and lawsuits. Just this last January, the federal Department of Labor announced a lawsuit against a West Virginia company that ordered an employee to hang up on 911 after a co-worker had sliced off his thumb in a meat cutting machine. Instead of an ambulance, the owner had a supervisor drive the bleeding worker to an urgent care clinic. See news release here. In January 2017, the government filed suit against the company and also the company’s owner personally, seeking back wages, fines, injunctive relief, and punitive damages. So, as said, do not let your employer bully you.
After you have gotten medical help, then you must report your injury to your employer. You must do this within 21 days. The timeline starts running from the moment you report your injury (or your employer knows of the injury). So, if you want a quick turnaround on your benefits claim, you should report the injury on the day that you suffer the injury.
Note that the timeline runs from when your employer knows of the injury. That might be your report, but notice might also be caused by the ambulance arriving with its sirens and the flashing lights. Your friends and colleagues often report on what happened. Those events are usually enough to begin the running of the timeline. But at some point, after you are better, forms must be completed and submitted.
Note that if you do not officially report your injury and fill out the proper forms within 120 days — that is only four months — from date of injury or becoming aware of a work-related illness, you will have lost your ability to seek workers’ compensation benefits and to seek recovery in commonwealth courts.
For this article, we assume you have reported your injury (or your employer knows of the injury) on day one.
Days 2 Through 11: Employer Must Report Injury, Prepare Wage Statement
Your employer is required to report immediately all workplace injuries to the insurance company or, if self-insured, to report them to the person responsible for management of the employer’s workers’ compensation program. Practically speaking, “immediately” means on day 2 or day 3 or thereabouts, depending on weekends and holidays.
Within 10 days, your employer is required to file with the Pennsylvania Department of Labor and Industry (“DLI”) what is called a “First Report of Injury” (DLI form # LIBC 344). If the accident resulted in death, this report is due within 48 hours of the accident. Most of these forms are now filed electronically.
During this same time period, your employer and the insurance company must complete the Statement of Wages (DLI form LIBC-494C) to calculate your wages. You should receive a copy and you must pay close attention to what is listed. Your average wages are the basis for how much you receive in each workers’ compensation benefits check. If the calculation of your wages is incorrect, you will be underpaid.
Day 21: Initial Decision From Insurance Carrier
On Day 21, the employer/insurance carrier must provide a written decision. The insurance company has three options:
- Agree that the claim is valid
- Ask for more time
- Deny the claim
If the insurance company agrees the claim is valid, then various forms are completed and submitted to the DLI including a Notice of Compensation Payable (DLI form LIBC-495) or an Agreement for Compensation (DLI form LIBC-336). Thereafter, the insurance company will begin making payments. Given standard business turn-around and mailing, etc., it is reasonable to assume the first benefit claim check will arrive somewhere around Day 28.
If a lump-sum settlement has been arranged, then more days and weeks might be expected since it takes time to finalize the settlement and to prepare the paperwork.
Sometimes, more time is needed for the insurance company to make a decision about whether the claim is valid or not. In that case, on Day 21, the employer/insurance carrier issues a Notice of Temporary Compensation Payable (DLI form LIBC-501). This extends the investigation period to 90 days. In the meantime, temporary payments begin. As above, it is reasonable to assume the first benefit claim check will arrive somewhere around Day 28.
Under this scenario, on Day 90, the insurance company must then either agree the claim is valid and continue paying or deny the claim.
Sometimes, on Day 21, the employer/insurance carrier can deny your claim. At this point, it is going to take months and maybe years before you will receive a workers’ compensation benefit check.
If your claim is denied, the insurance company issues a Notice of Workers’ Compensation Denial (DIL form LIBC-496). From the standpoint of the Workers’ Compensation Board, the claim is closed. It is now up to you — the injured worker — to pursue your claim through appeal and litigation process, a very long time-consuming process. That process is:
- Within three years from the date of injury, worker must file a Claim Petition (DLI form LIBC-362)
- Claim Petition given case number and assigned to a workers’ compensation judge according to the county in which the worker resides
- All parties involved in the case are notified as to date, time and place of hearing
- Parties undergo what is called “discovery” which is an exchange of evidence — six months to two years
- Worker gathers proof that claim is proper (documents, medical reports, etc.)
- Employer gathers proof that claim is not proper
- Worker undergoes independent medical exam
- Doctors write various reports and provide copies of medical records
- Judge will schedule the case for mediation and/or settlement conference
- Eventually, judge hears evidence presented at one or more hearings — one to several days
- Judge issues written decision — a week to several weeks after the last day of hearing
- From after the date of the Judge’s decision, either party has 20 days to file an appeal with the Workers’ Compensation Appeal Board (“WCAB”)
- Various papers are filed with WCAB — six months to a year
- WCAB issues decision affirming or overturning the judge
- From after the date of the WCAB decision, either party has 30 days to file an appeal with the Commonwealth Court — very long process
- From after the date that the Commonwealth Court makes a ruling, either party has 30 days to file a Petition for Allowance of an Appeal with the Pennsylvania Supreme Court — again, very long process.
Krasno, Krasno & Onwudinjo Can Help
If you have been injured at work, seek advice and legal assistance from an experienced work injury lawyer at Krasno, Krasno & Onwudinjo. Krasno, Krasno & Onwudinjo is a leading Philadelphia workers’ compensation law firm. Call today. You cannot receive your benefits check until you report your injury and file your claim. There is no reason to delay. Call today at 866.948.9088 or use this form on our website.