Philadelphia Work Injury Lawyers / Workers’ Comp Attorney

An injury at work can leave you physically unable to return to work for a long time or on a permanent basis. In many cases, your injuries will be the result of a true accident where no one can really be held liable for your injuries. Fortunately, Pennsylvania’s Workers’ Compensation is there to cover you, and our attorneys are here to help you get the benefits you are entitled to.

Insurance companies and employers will often do whatever they can to shut down your claim and deny you the benefits you deserve. Our attorneys will help you file your claim and fight through every stage, from gathering medical evidence to hearings, appeals, and settlement negotiations, all with the goal of getting injured workers their entitled benefits.

For a free case assessment, contact Cardamone Law’s Certified Pennsylvania Workers’ Compensation Specialists today at (267) 651-7945.

How Workers’ Compensation Works in Philadelphia

Injured workers might have some familiarity with liability insurance or with personal injury lawsuits, but Workers’ Compensation is a different process altogether. In a lawsuit, you would sue the person who injured you for damages, but many work accidents are not any one particular person’s fault, and there is no possible target for a lawsuit. With liability insurance, the policyholder’s insurance policy pays claims instead of requiring you to go through a lawsuit, but again, that only works in cases where someone is liable/at fault.

With Workers’ Compensation, your employer has an insurance policy that will pay you and any other injured workers at your job for nearly any injuries sustained in the course of your employment. That means that when you get hurt operating a forklift, carrying boxes, driving a truck, or handling hazardous materials, your employer should cover all the medical care and a portion of your lost wages to help you recover and get back to work. If the accident leaves you permanently disabled or results in the death of a loved one, those benefits should be ongoing to help you and your family move forward.

In most cases, you cannot sue your employer for injuries. This bar on lawsuits might also extend to coworkers – if they have the funds to pay you anyway – and you certainly cannot sue yourself. This means that even if someone can be pinpointed as being “responsible” for your accident, getting damages from them in a lawsuit or insurance claim would still be impossible or unlikely. Instead, Workers’ Compensation is your best – and perhaps only – route to getting your injuries and medical care covered.

Workers’ Compensation Benefits in Philadelphia

Pennsylvania Workers’ Compensation is governed by the Pennsylvania Workers’ Compensation Act. This law specifies what is covered, what employees are covered, how benefits should be distributed, procedures, and more.

Many injured workers are entitled to 2/3 of their pre-injury average weekly wage, in addition to medical benefits. Low-wage earners receive 90% of their pre-injury average weekly wage in most cases. Additionally, there is a maximum compensation rate for each year. In 2024, that is a maximum weekly benefit of $1,325.

Other benefits, such as “specific loss” benefits, are available for amputations or for total loss of use in a body part rather than actual physical loss. For example, the loss of an arm should result in 2/3 of your wages for 410 weeks. Moreover, there are specific loss tables for disfigurement of the head, face, or neck if it is permanent, unsightly, and not usually incident to the employment.

Death benefits are available as weekly compensation benefits and burial expenses.

Qualifying for Workers’ Compensation Coverage in Philadelphia

To have a viable claim in Pennsylvania, you need to be injured in the course and scope of your employment and have that injury result in a disability of some kind.

Coverage for Employees Only

Workers’ Comp is designed to cover employees (or “employee” as the Act says). This covers many workers, but there are specific carve-outs for longshoremen, realtors, and some other workers. People who work for the federal government, such as federal courthouse or postal workers, are usually covered under federal systems, not the Pennsylvania Workers’ Compensation system.

If you are an independent contractor, then the Pennsylvania Workers’ Compensation Act does not apply to you. However, there are many cases where there is a dispute as to whether a person is an “employee” or an “independent contractor,” especially given the prevalence of work in the so-called “gig economy,” where many workers traditionally classified as employees are now passed off as independent contractors. While there are many factors that the Workers’ Compensation Judges will analyze in making this determination, one of the key factors is who has control over the time, place, and manner of the work being performed. The more control the worker has, the more likely the person is to be an independent contractor; and the more control their boss has, the more likely they are to be an employee.

Work-Related Injuries

The Act specifies that Workers’ Comp should cover any “injury in the course of” the worker’s employment. The Act also covers “disease or infection” that “naturally results” from the injury, such as ongoing pain or disabilities that result from the initial injury.

“Occupational disease” is also covered, with § 108 of the Act laying out specific qualifying diseases and illnesses. This list includes certain types of poisoning, cancer, and lung diseases, but it also has a broader catch-all category with specific elements that your case must meet to qualify. Most of these elements require that the illness have a higher incidence in your specific job/industry and that it actually resulted from exposure at your job. If you have an illness that you are not sure qualifies, our Certified Pennsylvania Workers’ Compensation Specialists can investigate your illness and its cause to see if it qualifies you for coverage.

Fault Not an Element

The Act specifically states that benefits should be paid “without regard to negligence.” This means that the insurance carrier and the courts do not have to determine who caused the accident or who was at fault. However, coverage does not apply when the victim causes their own injury intentionally, because of the victim’s own intoxication, or during the course of an illegal act (e.g., illegal drug use).

Elements for a Workers’ Compensation Claim in Philadelphia

There are other requirements and processes that you have to follow to get the benefits you deserve. Our lawyers can walk you through all of these steps as they come up in your case, but it is important to have a bird’s-eye view of the process so you know what to expect.

Jurisdiction

Any injury occurring in Pennsylvania falls within the Pennsylvania Workers’ Compensation Act. However, the Act may still apply even if the injury did not occur in Pennsylvania. For example, the Act might apply when the job is principally localized in Pennsylvania, even if the accident occurred across state lines. An agreement that provides exclusive jurisdiction shall be in another state is not enforceable if it contradicts the Act.

Establishing Notice

Once a worker is injured on the job, whether from a traumatic, sudden, acute injury or from repetitive work activities (i.e., repetitive typing), the worker should give notice as soon as possible to their employer as to what was injured, when, and how. Notice is a critical element for a viable Pennsylvania Workers’ Compensation claim, and the claim will fail no matter what if notice was not given within 120 days of the incident.

Once notice of a work injury is given, the employer, insurer, or third-party administrator (TPA – a company similar to an insurer but that does not spend its own money) must investigate the claim and issue one of three documents within 21 days: a Notice of Compensation Payable, a Notice of Denial, or a Temporary Notice of Compensation Payable. The employer/insurer/TPA can accept wage loss and medical benefits or “medical only.”

A medical compensation-only decision means they admit a work injury took place but do not accept the claim that it is disabling and will keep you out of work.

Getting Medical Treatment

An injured worker must be out of work for 7 days or more to trigger a wage loss claim. However, you cannot usually wait until then to start seeking medical care; if you need care, get it immediately.

At the beginning of a case, the employer usually has a list of panel doctors, and the worker gets treated there for 90 days. There are ways around this, so it is important to speak to our Certified Pennsylvania Workers’ Comp Lawyers about whether you can get treatment from a physician outside the panel.

Panel doctors are trained to minimize injuries. However, they work for the employers and tend to label injuries “contusions” or “sprains” and “strains” rather than investigating further.

Once the 90 days are up, you can go to any provider who will accept you. There are often disagreements between the physicians in terms of what the diagnoses are and what caused the injury/condition. It is important to keep your Workers’ Compensation attorney in the loop, as we might be able to guide you as to when you should seek an outside opinion. Injured workers should always tell all physicians their complete medical history regarding any injuries or treatment to the affected body part, as it could be important in their diagnosis and treatment plan.

Gathering Medical Evidence

You cannot win your case without a doctor on your side who can unequivocally state with a reasonable degree of medical certainty that your injuries are work-related and that they cause a loss of earning power. If you doubt your doctor’s qualifications or find they are reluctant to diagnose you, consider talking to your lawyer about how to find a different doctor.

Absolute certainty is not required, as the standard is “reasonable medical certainty.” Some physicians do not discuss causation in their reports, focusing instead only on the diagnosis. There, the injured worker’s attorney will have to specifically request a report addressing that issue.

You will always want your Workers’ Compensation attorneys to carefully review your medical records to determine whether your doctors support the claim that your injury was work-related.

How Long Do Workers’ Compensation Claims Last in Philadelphia?

A claim can be accepted via a Notice of Compensation Payable or a Supplemental Agreement, a Stipulation, or a Court Order. Once you are on Pennsylvania Workers’ Compensation benefits, you can theoretically (although it is quite unusual) be on the benefits for a lifetime. However, in most cases, an injured worker is at some point deemed “partially disabled,” which has a 500-week cap on lost wage benefits.

Partial status can arise from a determination that the injured worker still has some earning power (i.e., that they are able to return to work at partial capacity) or when a worker is actually working but earns less than their preinjury wages.

Getting Independent Medical Exams for Workers’ Compensation in Philadelphia

An insurer/employer/TPA can request an Independent Medical Exam every 6 months, and the physicians used for these exams are usually quite biased. Employers and carriers rely on these doctors to disagree with the treating doctors’ opinions, hoping that they will be able to cancel your benefits.

This often causes litigation in the form of a Petition to Terminate, in which they allege you have fully recovered; a Petition to Suspend, in which they allege you are back to your preinjury earning potential; or a Petition to Modify, in which they allege you have some earning power back, but not necessarily all of it.

An Independent Medical Exam can also result in a challenge to the medical benefits and lead to a Utilization Review, which is a challenge as to whether treatment is reasonable and necessary.

Another very common Petition is a Petition to Review, which challenges which diagnoses are work-related. As you probably know, insurers will always try to pin a diagnosis on a “pre-existing” condition. However, under the Act, aggravation of a pre-existing condition is still a qualifying work injury. For example, if you injured your back a year ago outside of work but made it worse by heavy lifting at work, then the aggravation is its own work injury.

If you have been informed of an upcoming Independent Medical Exam, speak with our Workers’ Compensation lawyers right away for help preparing evidence and preparing yourself for the exam.

Philadelphia Workers’ Comp Settlements

In most cases, the insurer/employer/TPA will wish to settle your Pennsylvania Workers’ Comp case. A settlement of all issues and benefits is called a Compromise and Release Agreement and is often referred to as a “global settlement.”

The normal terms for a Compromise and Release Agreement are a lump-sum payment, plus medical benefits paid until the date of the Compromise and Release hearing, and then a clean break, meaning no more ongoing benefits. In many cases, employers also require that you formally resign your position with them.

In some cases, the parties bargain for a period of ongoing indemnity checks (i.e., wage-loss payments) and a limited period of ongoing medical benefits, but the majority of cases result in a one-time lump-sum deal.

Many factors determine the amount of a Pennsylvania Workers’ Compensation settlement, and no two cases are the same. Your attorneys will take into account things like the effect your settlement will have on any short- or long-term disability benefits, unemployment compensation, Social Security benefits, and outstanding/pending employment discrimination matters (e.g., things handled with the EEOC or similar agencies).

Litigating Your Workers’ Compensation Claim in Philadelphia

Litigation is common in Pennsylvania Workers’ Compensation cases. Litigation means taking the case to court, where a petition is filed and heard by a Workers’ Compensation Judge. There are many types of petitions that can be filed, including a Claim Petition (when a claim has been denied) or a Petition to Terminate, Suspend, Modify, etc.

Litigation can take up to a year or more, depending on many factors. Under the Special Rules of Administrative Procedure in Pennsylvania Workers’ Comp cases, each side has 90 days to secure their medical evidence, resulting in 6 months of available evidence (90 days/3 months for each side).

Some witnesses, usually lay witnesses (i.e., not medical experts), will testify at a hearing or at depositions. Medical expert depositions are most frequently done in the doctor’s office, not in court before the presiding judge. Some judges will have multiple hearings, while others will have just one hearing for a petition; each judge has their own style.

At the end of litigation, the attorneys are asked to submit written arguments called “briefs” outlining their respective positions. The judge will issue a written decision to the parties anywhere from a month to several months later, depending on their schedules and other factors.

Hiring a Workers’ Comp Lawyer in Philadelphia

The most important thing for injured workers to realize is that having the benefit of counsel will statistically increase the probability of a favorable outcome – and sometimes dramatically so.

Insurance companies are not on your side and do not work for you, even if they seem friendly for a while. Their goal is to pay out as little as possible in each and every case. They will also rely on you having little to no experience with Workers’ Compensation, hoping that you will either give up on a denied claim or otherwise accept abbreviated benefits. This power imbalance puts unfair pressure on claimants and is one of the best reasons to get a lawyer.

It is strongly recommended that every injured worker retain a Certified Workers’ Comp Attorney to maximize their entitlement to benefits. Workers’ Comp law has become quite complicated, and letting the insurance company dictate your benefits is not likely to result in you getting the benefits you need.

These insurance carriers have attorneys giving them advice, and so should you. Additionally, fees in Pennsylvania Workers’ Compensation cases are usually contingent, meaning they are paid out of the winnings in your case rather than out of pocket. This gives you the ability to hire a lawyer without any up-front investment and usually ends up costing you 20% of the wage loss benefits you receive. Contrast this with the 33% fee that personal injury lawyers will usually take.

Our Firm’s Exclusive Focus is Workers’ Compensation

We are a rare firm in that we only handle Pennsylvania Workers’ Compensation cases for injured workers. The vast majority of law firms on TV and billboards claiming to be Workers’ Compensation lawyers focus on lawsuits for personal injury cases rather than fighting your Workers’ Compensation claim. Not at Cardamone Law! And we don’t pass your files around to five lawyers for every hearing like those firms when they need to bring in outside counsel to work on the Workers’ Compensation aspects.

Attorneys Cardamone and Silver are heavy-hitting, highly experienced Pennsylvania Workers’ Compensation lawyers with over 60 years of combined experience. They and the rest of our team map out a case strategy for each case using our vast experience. In fact, our attorneys teach other lawyers about Pennsylvania Worker’s Compensation law.

We do not hand off your file to a rookie who is trying to learn the ropes. We all need to start somewhere, and we respect rookies, but we won’t give you one on your case. At many of the large Workers’ Compensation firms, your file will be handled by a different lawyer at each hearing, deposition, mediation, meeting, etc. Not with Cardamone Law, where our attorneys follow your case from initial consultation to final settlement.

At Cardamone Law, we have a high winning percentage. We know how to position a case for success, and – while we can never guarantee any results – we will estimate what percent chance we think we have of winning your case. That chance is usually quite high when you work with us.

We are known to be aggressive with getting every penny possible in a case. Other firms may leave money on the table and accept the first or second offer. We fight tooth and nail until we have every penny for our clients. We are also financially leveraged to compete with any defense firm, and we routinely defeat the state’s largest employers.

Contact Our Certified Workers’ Compensation Specialists in Philadelphia Today

If you were injured in a workplace accident, call Cardamone Law at (267) 651-7945 for a free case assessment with our Philadelphia Workers’ Compensation attorneys.