When you file your initial Workers’ Compensation claim, it is in your employer’s hands. With their insurance carrier, they will typically deny your claim and leave you to file a claim in court. However, you typically need a lawyer to get you through this process, especially given the fact that courts are reluctant to move forward without one.
When we represent you, we fight for you. We want to see your benefits paid, and we will do what we can to collect evidence, file petitions, and make arguments to the judge to get your claim granted. We typically do not get paid unless you do.
Call Cardamone Law at (267) 651-7945 for your free case evaluation with our Certified Pennsylvania Workers’ Compensation Lawyers.
Who Decides Workers’ Compensation Claims?
In the initial claim, you file with your employer. This gives them the power to accept or deny your claim, but it is not that simple.
Employers are not usually the ones paying the claim and instead have to rely on their insurance carrier. This means they cannot truly accept your claim without getting the insurance carrier’s approval, so a denial might ultimately be the insurance carrier’s fault.
After a denial, you can file before a Workers’ Comp Judge (WCJ). When the case gets to them, they make the final determination. This can overrule whatever your employer’s insurance carrier decided.
Our Workers’ Comp lawyers can appeal WCJ decisions to the Workers’ Comp Appeal Board (WCAB), and then the Commonwealth Court and even the Pennsylvania Supreme Court, but cases usually do not have to go that far.
How Do Doctors Decide Disability Status?
For your claim to get paid, you usually need to provide proof that you are disabled. Otherwise, you will be expected to return to work, and you cannot get wage-loss benefits.
Factors
Doctors make determinations through exams and report back to the court about your disability status. When making these determinations, they will take into account the following and more:
- How severe your injury is
- The amount of rest needed for recovery
- The risk of reinjury during early stages of recovery
- What physical tasks your job demands
- How hard you can push the injury
- What tasks will and will not aggravate the injury
- What other tasks you can perform while recovering.
For example, a serious leg injury might cause so much pain in the initial days that you cannot focus on work. However, in the following weeks, someone who works seated at a desk might be able to return to work at full capacity, while someone who is on their feet for work cannot.
Accommodations
Another important factor is accommodations. If your doctor can point to specific accommodations that will allow you to work while recovering, and your employer can provide them, you may be able to return to work at full or partial capacity.
IMEs
Independent Medical Exams (IMEs) are often a part of your Workers’ Comp claim. An employer can request one through a Yellow Freight Motion when your disability status is in doubt at the beginning of the case. They can also request new IMEs every 6 months after the first 2 years of benefits.
In an IME, a doctor the employer chooses analyses your health and condition to determine whether you are disabled and to what degree (full or partial). You usually have to attend these or risk losing your benefits, but you can seek outside opinions to counter these doctors’ results.
What Injuries Are Eligible for Workers’ Compensation?
Workers’ Comp can cover any injury that was “work-related.”
Traumatic/Acute Injuries
Many accidents happen from one single accident where you suffer an acute or traumatic injury. For example, falling and hitting your head might result in a traumatic brain injury, or getting your arm caught in a machine could result in amputation.
Repetitive Stress Injuries
Other injuries happen over time, and they also qualify for coverage. For example, tendon and muscle injuries from repetitive stress can make it impossible to perform common work tasks, resulting in a compensable disability.
Illnesses and Cancer
Similarly, illnesses acquired at work also get coverage. This can include things like mesothelioma, asbestosis, “black lung,” and cancer.
“Work-Related” Requirement
For an injury to be “work-related,” it must occur during work tasks. It does not have to be at your usual work site, so long as you were performing your work duties when the injury happened.
When to Call a Lawyer for a Work Comp Claim in Bristol, PA
You should call a lawyer as soon as you have a work-related injury and are considering a Workers’ Comp claim. We can walk you through the process of submitting notice to your employer and getting your initial claim sorted. From there, we can file a claim petition and start gathering evidence to support your case as soon as possible.
How Long Does a Workers’ Comp Case Take?
Many Workers’ Comp cases can be resolved within a few months. The initial notice has to be given to your employer within 21 days, then they get 21 days to decide to deny you. From there, we can file a petition in court, and both sides get opportunities to argue issues to the judge, the judge holds multiple hearings, and the judge needs time to decide the case.
Ultimately, if everything goes smoothly, you can get your benefits paid within 6 months for most cases – though settling a claim can get it paid faster.
Can You Settle a Workers’ Comp Claim?
Many claims are settled so that insurance carriers do not need to continue to administer claims, and injured workers can get on with their lives without worrying about ongoing IMEs or scrutiny from their employer. Never settle a case without speaking with a lawyer first, as it is your one chance to make sure the settlement covers your full benefits.
Call Our Experienced Workers’ Comp Lawyers in Bristol, PA Today
Call Cardamone Law for a free case assessment with our Workers’ Compensation attorneys at (267) 651-7945.
