Compensation for a work injury can be paid through a lawsuit, but you usually cannot sue your employer or yourself. This leaves many injured workers with Workers’ Compensation as their main route to recovery. While this system is robust and can pay for high-dollar injury cases, getting benefits can require a fight.
Our lawyers are ready to take that fight for you. We stand up to employers and insurance companies whose bottom line is more important to them than your health and safety. We fight to get benefits approved, covering your medical care costs, your lost wages, and certain permanent injuries.
For a free analysis of your potential claim, call our Certified Pennsylvania Workers’ Compensation Lawyers today at Cardamone Law by dialing (267) 651-7945.
How Are Workers’ Compensation Claims Decided?
Workers’ Comp is decided in the beginning by making a claim with your employer. You provide them with notice, and they make a claim with their Workers’ Comp insurance carrier.
You might have already noticed the issue with this: the party who would have to pay is the same party who decides the claim. This means they will deny as many claims as they can, and they will typically only pay if it would be cheaper and easier to just accept the claim and pay up.
In most other cases, they will rely on any excuse they can to deny the claim, such as arguing that your accident occurred outside work or that you are not disabled. To resolve that question, the case goes before a Workers’ Compensation Judge (WCJ).
WCJs are empowered to decide Workers’ Comp cases, and their decisions are appealable to the Workers’ Comp Appeal Board. All of these are part of the Department of Labor and Industry.
You can have the Commonwealth Court and potentially the Pennsylvania Supreme Court review cases upon appeal.
What Workers Can Get Workers’ Comp?
Workers’ Compensation is supposed to be available to nearly every employee. This means anyone who works for someone else under an employer-employee relationship should be eligible. Benefits are not required for self-employed workers or independent contractors.
However, many industries notoriously call people independent contractors when they are not legally supposed to. This can lead to many workers who might think they are ineligible for benefits not even filing in the first place. Talk to a Workers’ Comp lawyer about your status and coverage if you have any doubts.
You also usually will not qualify under the Pennsylvania system if you are a realtor or you work for a federal employer. Realtors are simply carved out in the statute, while postal workers and other federal employees usually use a different system specifically for federal employees.
What Makes an Injury Work-Related?
An injury should be covered as long as it was work-related. There is an exclusion for injuries the worker intentionally caused or caused through drug use, alcohol use, or legal violations. Otherwise, any injury that happens during your work tasks or within the scope of your employment should be covered as a “work-related” injury.
Injuries are not work-related if they happen at home on the weekend, during your off hours, while you are out on lunch, or during your regular morning/evening commute. Unless there is an agreement to the contrary or you are running a work errand on your way, commutes are not usually considered part of your work.
This “work-related” requirement does not mean you need to be actively performing core work tasks to get coverage. Even so, most injuries do occur from the most common, most repeated work tasks.
Employers often try to seek carveouts for injuries while violating company policy, but victims might get paid anyway. For example, it is against company policy for a transportation worker to crash, but truckers get Workers’ Comp for crashes all the time.
How Long Does it Take to Get Benefits from Workers’ Comp?
Benefits can be paid quite quickly if your employer accepts your claim. They usually have up to 21 days to grant or deny benefits, meaning they should start soon after that (i.e., around the following payday). However, if they deny your claim, it takes longer.
Filing before a WCJ and getting your benefits decided after a hearing can take 2-3 months on average. More complex cases can take longer, especially if there are multiple doctor’s appointments required to gather evidence or a lot of witnesses to get depositions from.
Do I Have to Get Medical Exams for a Workers’ Comp Claim?
Usually, medical exams are a required part of your claim. Your employer can require you to undergo independent medical examinations (IMEs) at various points in your case to determine your disability status.
During these evaluations, you go to a doctor of their choice. They pay for the doctor – and they usually have to reimburse you for missing work and pay for transportation to these appointments. But at the end of the day, if you skip the appointment or refuse to go, you might be denied benefits.
If they are allowed a doctor of their choice, so are you. You can usually pay for a competing evaluation from a doctor you choose. Our lawyers can front this cost and recover it when we win your case, supplying us with evidence to contradict their biased doctor’s evaluation.
What Medical Care is Covered Under Workers’ Comp?
When you are first injured, you should get any emergency medical care you need. Your employer should cover this for any injury at work.
After that you may need additional care. Your employer is supposed to cover all care needed for your work-related injury, including the following:
- Surgeries
- Hospital stays
- Specialist appointments
- Follow-up appointments
- Physical therapy and rehabilitation
- Mental health therapy
- Medication
- Medical devices (crutches, etc.)
- And more.
For the first 90 days, care usually must come from a provider on your employer’s list of approved providers. You can still seek second opinions about surgeries and seek off-list specialists if they do not have a comparable specialist listed.
After that, you can get care from providers of your choice.
Call the Drexel Hill Workers’ Compensation Lawyers at Cardamone Law Today
Contact our Workers’ Compensation attorneys for a free case evaluation by calling Cardamone Law at (267) 651-7945.
