How Do I Get Workers’ Comp Benefits in Pennsylvania?

If you were hurt in an accident at work, you might now be laid up with serious injuries that are going to require medical care and take you away from work for a while.  In the meantime, these medical bills will be costly, and you won’t be working to receive a wage, so Workers’ Compensation might be best for you.  But how do you actually file for these benefits?  What does the process look like?

Most employees who are not independent contractors already have Workers’ Comp benefits as part of their employment; they just need to file when they get injured.  Claims start by notifying your employer of the injury and having them file a claim with their insurance carrier.  This claim will likely be denied by either your employer or the carrier, at which point we have 3 years to file your claim with a Workers’ Comp Judge.  The judge will take on deciding whether your injury is work-related and what benefits you qualify for, but there are medical exams and hearings to attend before that decision is finalized.

For help getting Workers’ Comp, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945.

Step By Step Process to Getting Workers’ Compensation in Pennsylvania

Most employers are required to carry Workers’ Comp benefits for their employees; there is nothing you need to do to purchase benefits or insurance as an employee.  After an injury, these are the steps you take to get paid through those benefits:

Injuries and Evidence Collection

To get Workers’ Comp, you need to have a qualifying injury.  All evidence you can collect or remember about your accident to help show that your injury was indeed “work-related” will ultimately make it easier to prove your claim.

When you get hurt, take notes of what happened if you are able to.  Remembering what you were doing, why you were doing it, who instructed you to do it, who else was involved in the job task, how the injury happened, and who caused it will all help prove your claim later.  Our Pennsylvania Workers’ Compensation lawyers can focus on retrieving other evidence, like accident reports or security camera footage.

Getting Initial Medical Care

After your accident, you should get immediate medical care.  Some employers might refuse to let people leave to go to the hospital, instead requiring you to see a nurse or medical staff at the job site.  In any case, if you need additional care after work, make sure to go to the hospital and get the full medical care you need.

This emergency care should ultimately be billed to your employer as part of your case, but it is vital not to delay care, as delays make it harder to connect the injuries to the accident.  Your medical care will also produce records we can retrieve as evidence for your claim.

Notifying Your Employer

Your claim in proper begins when you notify your employer of the injury, and they file a claim for your coverage with their Workers’ Compensation insurance carrier.  This claim can fail if either the employer or the insurance carrier denies coverage by saying you are not disabled enough or that your injury was not work-related, but the initial notice requirement must be met before any decisions are made.

When reporting your injury to your employer, you should make sure your report is in writing so that you can keep a copy for your records, and you should make sure you are reporting the injury to the correct person.  You can check with your lawyer or union rep if you need help identifying the right department to report to, but generally, reports go to your direct supervisor, HR, or Workers’ Comp liaison.

Employees are supposed to report their injury within 21 days, but injuries absolutely must be reported within 120 days or else you cannot get Workers’ Compensation.

Addressing Your Initial Claim

The insurance carrier and employer will accept or deny your claim – or at least, they are supposed to.  Sometimes insurance carriers simply sit on the notice and do nothing to address the claim, potentially justifying penalties against them later.  Either way, employers/carriers are supposed to respond within 21 days of receiving notice.

When they reply, they can either accept the claim and tell you what benefits they agree to pay, or they can deny your claim.  If the benefits they offer are exactly what you need, your case can be over at this point – but that is rare.  Instead, benefits usually are not enough or the claim is denied.

Employers can also agree to pay benefits for 90 days, during which they will continue investigating and essentially reserve the right to change their mind and end benefits.  You might also be offered a settlement at this point, and you should never accept it without having a lawyer review the terms.

Filing a Claim Petition

If your case is denied, your benefits are inadequate, or the employer fails to respond, we can file a Claim Petition.  This moves the case before a Workers’ Comp Judge (WCJ) and allows them to decide whether the injury was work-related, whether you need disability benefits, and how much to award.  Again, cases can be settled at this stage.

Hearings and Medical Exams

For a judge to make a decision, they need evidence.  This will be presented at a hearing and may include reports from medical exams you need to undergo.  Generally, the employer has to pay for a lot of these exams, but there may be supplemental exams we need you to undergo to get evidence to support your claim if the employer’s medical exams result in evidence that hurts your case.

Regardless, our lawyers should be involved in your case at this point and can continue to guide you through every stage of the case, including hearings, settlement negotiations, and any exams you need.  At the end of these hearings, our goal is to either get you a settlement or ongoing benefits.  Even then, there may be further things we can help you with, such as getting total disability benefits converted to partial disability benefits if you eventually become ready to return to work at partial capacity.

Call Our Workers’ Comp Lawyers in Pennsylvania Today

For help with your case, call Cardamone Law’s Philadelphia Workers’ Compensation attorneys at (267) 651-7945.