Workers’ Compensation is the primary system for getting workers’ injuries covered. For any injury that happened within the scope of your work, you can typically file a claim to see your medical care covered, a portion of your lost earnings paid back, and additional coverage for certain listed injuries.
These benefits can be difficult to get if your employer or their insurance carrier puts up a fight. Many will even deny claims under any excuse they can find, leaving it to our attorneys to fight for your benefits.
For a free case evaluation, contact Cardamone Law’s Certified Pennsylvania Workers’ Compensation Specialists at (267) 651-7945.
When Can I Get Workers’ Compensation?
Workers’ Compensation is there to cover employees in most industries after a work injury. Benefits can cover medical care for your injury any time you needed it, especially if you will face ongoing care needs. On top of that, wage-loss benefits can be claimed if you are out of work for more than 7 days. If you are out for at least 14 days, you can get paid back to the first day.
You typically need to give notice to your employer within 21 days of the injury, though claims are barred entirely if you wait more than 120 days. From there, your employer gets time to respond, but after a denial, you need to file your claim before a Workers’ Comp Judge before 3 years elapse after the injury.
When Will I Get Paid Under Workers’ Comp?
Workers’ Comp payments come at different points depending on which benefits you are talking about.
Medical benefits are not typically paid to you. Your care providers bill the Workers’ Comp insurance carrier as the treatments and services occur.
Wage-loss benefits are paid on a weekly or bi-weekly basis once they are approved. Approval can come as early as 21 days after your initial notice if the claim is accepted. However, some are only accepted on a temporary basis, and employers can turn them back off again. Once your case goes before a judge, it can take a few months to reach a final decision and start your benefits.
The other “specific loss” benefits you can get for certain injuries are paid on a weekly basis, typically after your disability ends. These benefits are paid for permanent injuries, amputations, lost function, lost hearing, and lost vision, as well as serious facial scars. The Workers’ Comp Act sets a number of weeks for each listed injury.
What is My Benefit Rate?
You should always consult with a lawyer to determine your benefits. In most cases, medical bills are covered at 100% and wage-loss benefits equal 2/3 of your average weekly wage (AWW) before the injury. Specific loss benefits also equal 2/3 of your average weekly wage, though both also include floors and caps.
Wage-Loss
Wage-loss benefits are 2/3 of your AWW, but they have a maximum equal to the statewide AWW. They set this value each year based on available data.
If you are a low-wage earner, you instead receive the lesser of 1/2 the AWW or 90% of your AWW.
Should you return to work, instead of 2/3 of your pre-injury wage, you get 2/3 of the difference between pre-and post-injury wages.
Specific Loss
The rate listed in the statute is 2/3 of your AWW, but this rate also has caps and floors. The cap is the same statewide AWW, but the floor is calculated a bit differently. Here, the minimum you can get is 1/2 of the statutory cap, which means 1/2 of the statewide AWW.
How Long Do Benefits Last?
The length of your benefits depends on your disability status. For an injury where it is determined you cannot return to work, you are deemed totally disabled.
Total disability allows ongoing wage-loss benefits indefinitely. However, these benefits do not increase over time with cost of living or inflation. That means staying on benefits indefinitely might not be tenable.
After 104 weeks of total disability, the insurance carrier can request an Impairment Rating Evaluation (IRE). If the IRE shows you are under 35% whole body impairment, then you are switched to partial disability status.
If you are put on partial disability status, your benefits can only last for 500 weeks before your benefits end.
As mentioned, specific loss benefits are often paid after total disability ends, meaning you may still receive a check.
You can also modify all of this by settling your case, in which case, benefits are typically paid in one sum.
Do I Need a Lawyer for Workers’ Comp?
You should always consult with an attorney when seeking benefits or damages for an injury. Employers and insurance carriers will often try to pressure you out of your claim, and unrepresented workers might not understand their rights.
While your union rep or HR department might be able to help you understand your rights, they are not a substitute for an attorney.
Our attorneys can represent you in court, explain your rights, and fight for fair compensation. We can also represent you in negotiations with your employer and/or their insurance carrier, something your HR reps certainly cannot do.
Do I Have a Strong Case?
Workers’ Compensation claims must be based on an injury that happened during your work tasks. There is no requirement that your employer has to be the one at fault or that there needs to have been a specific safety violation. All kinds of accidents can be covered, even if you were the one to cause them.
As long as there is good documentation and proof of the injury, it was obviously caused by work tasks and not outside factors, and you are definitely disabled by the injury, your claim should be strong. If there are any questions or issues, we can look into the facts and try to build up those weaknesses with additional evidence.
Call Our Workers’ Compensation Lawyers in Limerick Today
Call Cardamone Law at (267) 651-7945 for a free case evaluation with our Certified Pennsylvania Workers’ Compensation Specialists.
