Workers’ Compensation helps injured workers get compensation after work-related accidents. If you were hurt in any industry where you worked as an employee, your employer should be required to cover your medical care costs, some of your lost wages, and other potential damages.
For help with your case, work with a lawyer. Filing these cases on your own can be stressful, and the specialized nature of the legal process makes it difficult even for experienced lawyers in other fields to help with these cases.
Call our Pennsylvania Certified Workers’ Compensation Specialists at Cardamone Law at (267) 651-7945 to get started on your case today.
Do I Need a Lawyer for Workers’ Comp?
Workers’ Comp claims are filed with your employer’s insurance. Many people think of insurance as an alternative to lawsuits, and something you do not need a lawyer for. In many cases, Workers’ Comp claims are denied at this level, and the only way to get your benefits paid is to negotiate with the insurance company and take your case before a Workers’ Comp Judge – both of which our attorneys are perfectly equipped to handle.
Our Workers’ Comp attorneys have certifications in Workers’ Compensation that allow us to hold ourselves out as specialists. We can help with your initial filing and help pressure the insurance company to accept your claim the first time. If they refuse, we can file a Claim Petition and get your case into court quickly so we can start working on a settlement or on taking your case to a hearing.
There are also dozens of confusing outcomes and complications that can arise in your case, and our lawyers have the training and experience to tackle them for you.
Who Pays for Work Injuries in Hellertown?
Your employer is required to carry insurance to pay for work injuries. This Workers’ Comp insurance is supposed to pay regardless of fault, meaning that it should not matter who caused the accident.
You do not need to prove your employer was at fault to get them to pay for your injuries. In fact, Workers’ Comp is specifically designed to still cover your injuries when you are the one responsible for the accident, as long as it is an accident. There is no coverage when you cause your injuries on purpose, through drunken or drugged activities, or by criminal acts.
If other parties cause your injuries, you may be able to sue them, but your employer still has to pay your benefits through Workers’ Comp. You can’t get paid for the same damages twice and may need to pay back the insurance carrier, but pursuing both claims can help supplement your Workers’ Comp payments with damages that wouldn’t otherwise be covered outside of a lawsuit, such as pain and suffering.
Common Reasons for Workers’ Comp Claims
Workers’ Compensation can be filed for any work injury. Medical coverage can be paid regardless of how bad the injury is, and wage-loss benefits can be paid if the injury keeps you out of work for more than 7 days and reduces your earning capacity.
This includes coverage for all of these issues:
- Acute accidental injuries, such as torn ligaments, broken bones, amputation, back injuries, head injuries, electrocution, and more.
- Repetitive stress injuries and other injuries that develop over time, like carpal tunnel and tendonitis.
- Cancer and other health conditions that come from exposure to substances or conditions at work, such as silicosis or asbestosis.
In most cases, you have to file notice of your injury with your employer within 21 days of injury, or up to 120 days if you cannot file right away. In some cases, like with cancer, this deadline may be extended, but do not delay; talk to a lawyer about your condition right away.
What Medical Care is Covered Under Workers’ Compensation?
Workers’ Compensation is supposed to cover all medical care needed to treat your injury or condition. Typically, these recommendations come from a licensed care provider in Pennsylvania, and the insurance carrier must pay for them without pre-approval.
There are some situations where the insurance carrier might not agree that a certain course of treatment is appropriate or helpful. In these cases, they can challenge the findings with a “utilization review” (UR). During a UR, an outside physician examines the case and determines whether the treatment is reasonable, and the judge orders it covered or not.
Another complication with medical care is that the doctor you use is limited in the initial 90 days of treatment. The employer must post a list of approved care providers – at least 2 of which have to be physicians – and you can only choose from these listed doctors. However, you can go off the list for an unlisted specialist or when you want a second opinion about surgery, though a listed doctor still has to perform the surgery.
After the 90 days goes by, you are free to choose a doctor you want to use, and they bill the insurance carrier directly for most treatments and procedures.
Wage-Loss Benefits Under Workers’ Comp
If you are out of work for at least 7 days and your earning capacity is reduced, you can get wage-loss benefits. These pay 2/3 your average weekly wage (AWW) prior to the injury for as long as your injury keeps you totally away from work. If you return to work, your benefit is 2/3 of your pre-injury AWW minus your current AWW.
Benefits also see a cap at the set statewide AWW – determined yearly by law – and a floor at the lesser of 1/2 of the statewide AWW or 90% of your AWW.
If you eventually undergo an impairment rating evaluation (IRE) after receiving benefits for 2 years, they might find your whole-body impairment rating is under 35%, at which point they will switch you to “partial disability” instead. This lasts up to 500 more weeks if you stay under 35% impairment.
IREs happen at 2 years and every 6 months after that, meaning you need to continue to be approved as totally disabled to keep getting benefits. However, benefits do not go up as inflation goes up, so you may want to get off benefits and get back to work – where you can potentially make more money – whenever you are able to.
Specific-Loss Benefits
In cases of amputation, lost sight, lost hearing, permanent loss of function, or significant facial scars, you can also get additional payments. They last for a number of weeks according to the statute, decided for each injury. They usually equal 2/3 your lost wage, subject to a cap at the statewide AWW and a minimum of 1/2 that amount.
Call Our Workers’ Compensation Lawyers in Hellertown Today
Call (267) 651-7945 for a free case evaluation with the Workers’ Comp attorneys at Cardamone Law.
