Workers’ compensation benefits in Pennsylvania are governed, in large part, by the PA Workers’ Compensation Act.
Workers need to be aware of the risks of being hurt in workplace and prepared to take action to get benefits. This includes knowing what constitutes a work-related injury, what an insurance carrier’s investigation may entail, when to hire a workers’ compensation attorney and more.
So before you get started with your workers’ compensation case, read this guideline to fully understand the process that you are about to undergo.
What is the Pennsylvania Workers’ Compensation Act?
The majority of employees in Pennsylvania are covered by a Pennsylvania Law called the Workers Compensation Act.
You can learn more about it through the Department of Labor and Industry website, but we’ll give the full overview here.
Although self-inflicted injuries and those that occur during a break are not covered under workers comp laws in PA, an employee can be compensated even if the accident or injury was their own fault.
What are the basics of Workers’ Compensation Laws in Pennsylvania?
If you work in the Commonwealth of Pennsylvania, you are most likely covered by workers’ compensation insurance through your employer. Employers agree, by purchasing workers’ comp insurance, to pay employees for illnesses and injuries that occur because of job duties covered under PA workers’ comp laws.
Even if you assume that you are entitled to recovery under a claim, you should be prepared to fight back if this claim is denied despite a legitimate work injury. Sadly, far too many employees who have solid claims for workers’ compensation give up after their claim has been denied once.
Maximizing the workers’ comp appeals process increases the chances of success for those who need and deserve compensation under the Pennsylvania Workers Compensation Act.
Which accidents most often lead to workers’ comp claims in PA?
It’s important to realize that workplace accidents can and do happen everywhere; from construction sites to offices. Workplace accidents most often leading to serious injuries include falls from ladders, heights, and scaffolding.
Other accidents can include burn or fire incidents, crush accidents, machine malfunctions, occupational disease and even breathing in toxic fumes, which can cause workplace illnesses.
All of these can cause catastrophic injuries such as puncture wounds, lacerations, scars and disfigurement, broken bones, internal organ damage and bleeding, concussions, fractures, and sprains.
Do I have to tell my employer before filing under the PA Workers Compensation Act?
One of the first steps to recovering compensation is informing your employer of the accident or incident that led to the injury or illness. The claim can be time-barred if the employee waits too long, and wage loss benefits unfortunately can be denied.
Hurt workers have a maximum of 120 days to give notice of the injury to the employer. It’s important to notify the employer even if you’re not yet sure you intend to file a workers’ comp claim for your personal injury.
Can my employer retaliate if I file under Pennsylvania workers compensation law?
A common reason for a worker to feel nervous about a claim is due to the belief that the employer will retaliate by demoting or firing that worker. This kind of discrimination is illegal and might allow an employee to file another lawsuit because of retaliatory behavior.
If you have reason to believe that your employer has violated your rights because you chose to file a claim under the Pennsylvania Workers Compensation Act, you will need a PA workers’ compensation lawyer to review your case immediately.
Examples of retaliation include demotions, termination, refusing to make medical accommodations, targeting the employee for undue disciplinary measures, blocking promotion opportunities, or unfairly evaluating the employee in performance reviews.
Is there a statute of limitations for PA Workers Compensation Laws?
Much like an employee has a responsibility to promptly notify his or her boss about a workplace injury, the law also places limits on how long that employee has to file a workers’ compensation claim.
Currently, all workers compensation claims in Pennsylvania should be filed within three years of when the incident took place.
What happens after I give my employer notice of the injury?
If you’ve taken immediate action to tell your employer about the accident and injury, the next step under the PA workers compensation law is for the insurance company to open an investigation.
At that point, once you’ve triggered a filing under the Pennsylvania Workers Compensation Act, the insurance company can approve or deny that claim. If approved, you should begin to receive payments equal to a percentage of your average weekly wage.
Are there any forms I shouldn’t sign?
Even though it is your responsibility to report your injury immediately to your employer, you must be mindful of your rights during this critical period.
Read all documents carefully and have them reviewed by a lawyer who knows PA workers comp laws so that you don’t give up your rights without realizing it.
The employer will likely ask for an authorization for medical records and an employment verification form. You should be prepared to sign both of these to get the benefits you’re entitled to under the Pennsylvania Workers Compensation Act.
However, if you are presented with a supplemental agreement or a final receipt, be wary of signing these without a lawyer’s review.
A supplemental form might include language stating that your benefits are terminated. You should never sign this form until you’re fully recovered from your injury.
What benefits Are covered under PA workers’ comp laws?
Payments to an injured worker include medical expenses like medical equipment, lab tests, medicine, doctor’s visits, and surgery. That employee could also be entitled to partial, total, or permanent disability payments.
You are eligible to get benefits if your doctor puts you on medical work leave for over seven days. If you want to receive payments for that first week, you’ll need to be off of work duties and under a physician’s care for a minimum of 14 work days.
Should I take a lump sum settlement?
The offer of upfront cash for your injuries as a lump sum settlement can be a tempting one, but it’s often not in your best interest.
Early on in the recovery process, you might not know the full scope of your injuries and how your life will be changed. No settlement offer should be taken until you’ve had a chance to talk it over with your lawyer.
What happens if my workers’ comp claim is denied?
If you took all the proper steps to notify your employer and submit your evidence with a claim and still receive a denial, your case is not over.
In plenty of cases, the insurance company is counting on you to give up at this point. However, you have the right to appeal your claim.
Once there is a Notice of Denial, you would need supportive medical evidence to prove your injury is work related and then file a claim petition. It is a good idea to have a lawyer do this for you so it is done correctly.
Once the claim petition is assigned to a judge, you will have to present evidence in the form of testimony from you and your doctor to establish your case.
Here’s what you need to know about appeals:
- You will be informed about a denied claim through a Notice of Workers’ Compensation Denial.
- You can then file a petition with the Workers’ Compensation Board to appeal that denial decision.
- You should file this claim immediately to keep your case moving forward.
- Your case will be assigned to a PA workers’ compensation judge in your area, who will review evidence from both sides.
What is the most common reason a claim is denied in PA?
Figuring out why the claim was denied is the first step in gathering your evidence for an appeal. The following reasons are often listed as the cause for a denied claim:
- You failed to report the injury to your employer within 120 days of the incident
- The employer has disputed the cause of the injury
- The employer claims you were involved in illegal activities at the time of the injury
- The employer disputes your injury severity
- Your injury or condition allegedly does not qualify for payment under PA workers’ comp laws
- You didn’t get medical treatment for your injuries
As these common denial reasons illustrate, priming your application with solid evidence helps to avoid mistakes.
If you can submit a compelling application with the help of a lawyer, your chances of being approved right away or early on in the appeals process will be much higher.
Do I need a lawyer to help with a Pennsylvania Workers Compensation Act claim?
As a hurt worker, it can be very hard to figure out your rights through workers’ comp laws in PA. Going it alone can also increase the chances of errors or omissions that cost you valuable time and benefits payments.
If you’ve been hurt on the job, you already have enough to worry about. Severe injuries and follow-up care, pain, and medical bills can all take their toll. The last thing you need to worry about is whether or not you’ve considered every detail of your PA workers compensation laws application.
Yet, these details are important for whether or not you’ll recover payments for your accident and resulting injuries.
Entrust your case to a law firm that is familiar with the inner workings of workers compensation. Your attorney will review your application, help you gather supplementary materials, respond to delays or denials in the process, and help you navigate the complex system through which you can receive the compensation you deserve.
The attorneys at Krasno Krasno, and Onwudinjo know the common challenges with PA workers’ comp laws and can assist you with the initial filing or appeals processes.
If you feel that you are eligible for benefits under the Pennsylvania Workers Compensation Act, contact Krasno Krasno, and Onwudinjo at 844-243-4846 today to take the next step. We have local offices in Philadelphia, Harrisburg, Pittsburgh, Pottsville and several other locations ready to help.