Workers’ Compensation is sometimes a lengthy, complex process. Getting your injuries paid for means showing that they were work-related – which typically means that they happened on the clock. If your employer denies that, how can you get your benefits paid?
Employers do not get the final say on whether your claim is valid or not, and they often deny claims at the beginning, hoping you will just give up. Our lawyers can file a Claim Petition with the Workers’ Comp Office of Adjudication to have a Workers’ Comp Judge review the case, and they can decide, based on your evidence, whether the injury was work-related or not. In some cases, the fact that the injury was outside of regular work hours isn’t even enough to disqualify you for benefits.
Call (267) 651-7945 for a free case evaluation with Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers.
Does an Injury Have to Happen On the Clock for Workers’ Compensation?
First and foremost, an injury does not necessarily have to happen “on the clock” or during business hours to be “work-related.” This is a bit complicated and comes up in a minority of cases, but the standard is whether the injury was “work-related,” not whether it happened “on the clock.”
Work-Related Definition
An injury is “work-related” if it meets either of these criteria:
- It was caused by work tasks
- It was caused by work conditions.
This means that an injury at the office might be “work-related” even if it happened after hours, before you left the building. Injuries can also be “work-related” if you are performing them outside of your regular work hours on a special assignment of some kind.
Conferences, Meetings, and Office Parties
There are a few accepted areas of “off the clock” times that still typically qualify as part of your work tasks. That means that injuries during these events can still qualify as “work-related.”
Any time you have to do something as part of your job, whether you are getting paid an hourly wage for it or not, is still work-related. This can include
- Conferences
- Work travel
- Retreats
- Off-site meetings
- Networking events
- Team-building events
- Lunch meetings
- Client meetings
- Office parties.
If the event was optional, this may call into question whether it was work-related. But as long as you are with coworkers and employers, doing things to benefit your employer, the time will often count as “work-related.”
Exception: Commutes
The “coming and going rule” says that commuting to and from work means you are not “at work” for purposes of Workers’ Compensation. This means that an injury after hours on your way home from work typically would not qualify.
However, you may have an agreement with your employer that overrides this, such as an agreement that your drive into work in a company-owned vehicle makes you “at work,” even before you officially “clock in” for the day. Commuting between work sites is also typically considered “at work,” as long as it is not your morning/evening commute to/from work.
Appealing an Employer’s Workers’ Comp Denial
When your employer or their Workers’ Compensation insurance carrier makes a determination about your Workers’ Comp eligibility, that isn’t the end of your case. Instead, it’s really just the beginning.
Filing Formal Claims
Your claim starts with your employer deciding (in consultation with their insurance carrier) whether to grant benefits or not. If they deny you benefits, then that opens your ability to file a formal claim.
Within 3 years of the initial injury, you can file a formal Claim Petition with the Workers’ Comp Office of Adjudication to get your case assigned to a Workers’ Comp Judge.
Evidence Collection
After the case is assigned to a WCJ, both sides will get time to collect evidence. This includes seeking doctors’ exams and reports, where the doctor can link the injury back to work tasks. This is especially helpful with injuries that occur over time – like repetitive stress injuries – to link them to work tasks instead of outside activities.
We can also get evidence and statements from coworkers to prove that your accident happened at work, during work hours, to counter an employer’s incorrect assertions about timing.
Seeking Penalties for Unreasonable Denials
Sometimes the employer’s claim is just wrong. Other times, they are intentionally lying and have no reasonable basis to deny your claim.
If they deny your claim unreasonably, we can seek penalties, potentially including legal fees.
Workers’ Comp Hearing
The final determination by the WCJ is made after a hearing, where all evidence is submitted. Hearings may be multiple days or one event. The WCJ may want you to testify in person or may rely on your depositions.
Appeals
If the WCJ gets the case wrong, we can appeal to the Workers’ Compensation Appeals Board. If the case has truly unique facts and is carving out unprecedented legal rules, the WCAB may uphold the decision so we can bring it before the Commonwealth Court or even the Pennsylvania Supreme Court for further appeals.
FAQs for Workers’ Comp Claims Denied as Outside of Work
What Proof Does an Employer Need to Deny Your Injury Happened at Work?
Technically, the worker needs to prove the injury was work-related, not the other way around. However, employers cannot just deny a claim because they want to; they need some reasonable basis to say the injury happened outside of work, such as
- Late reporting
- The fact that you got treatment after work instead of leaving work to seek treatment
- The phrasing of your injury report
- Things you said during medical treatment
- Lack of eyewitnesses.
Because of this, it is vital to always work with an attorney on your claim so your words are not taken out of context or misused against you.
Can You Convince an Employer to Change Their Mind?
Often, through negotiations with your Workers’ Comp lawyer, employers can be convinced to change their mind and settle the case. This means they can grant benefits, and potentially pay them in one lump sum, instead of making us take them to a hearing over the case.
Call Our Workers’ Compensation Lawyers in Pennsylvania Today
Call (267) 651-7945 for a free case assessment with the Philadelphia Workers’ Compensation lawyers at Cardamone Law.
