How to File a Workers’ Compensation Claim in Pennsylvania
Disclaimer: This article serves as a brief general guide for injured workers in York, PA, as well as other Pennsylvania counties. This is general information only and does not represent legal advice that may apply in specific workers’ compensation cases. Injured workers are strongly encouraged to discuss questions and concerns regarding Pennsylvania workers’ compensation law with a well-qualified workers’ compensation attorney in Pennsylvania.
Workers’ Compensation in Pennsylvania is a no-fault system that provides benefits for injured workers. You don’t have to show that the injury was somebody’s fault, just that the injury was work-related.
Let’s assume that you suffer a work-related injury in the course and scope of your employment with a company. What should you do? Some of the questions running through your mind could include:
- Will my employer ensure I get all of the benefits to which I may be entitled?
- Do I need to do anything to protect my rights to recover wage loss benefits or medical benefits as a result of a work injury?
- Do I need to do anything at all?
Yes, you need to act promptly and if your injury is serious, you should immediately seek the assistance of an experienced Workers’ Compensation attorney.
Coverage Under the PA Work Comp Act:
Pennsylvania employees are covered for the entire period of employment. Coverage begins the first day on the job. Injuries or diseases caused or aggravated by employment are covered under workers’ compensation, regardless of the employee’s previous physical condition.
However, injured workers must take affirmative steps to protect their right to recover benefits under the Pennsylvania Workers’ Compensation Act.
Benefits are available for:
- Acute injuries
- Repetitive use injuries
- Wage loss
- Medical benefits
- Loss of certain body parts and disfiguring scars
Key Stages of Filing a Workers’ Compensation Claim
Here is how an average workers’ compensation claim goes from start to finish.
Providing the Notice of Injury
Perhaps the most important first step is to provide notice of your injury to your employer. Section 311 of the PA Workers’ Compensation Act provides that notice of injury must be provided within 120 days of injury.
Where the employee is exposed to continuing, multiple traumas, the injury does not take place until the last exposure or trauma occurs, which is usually the last day of work.
However, the date of diagnosis, not the last date of work, can also be determined to be the date of injury for beginning notice, even where the employee continues to work.
It’s critical to remember that your notice must go to the employer — telling a fellow employee you got injured at work does constitute an official notice under the Act. Notice should be given to the employee’s supervisor or other management personnel.
The employee has the burden to prove that proper notice was given, so it’s always best to send notice by email and print out the notice so that it can later be proven that adequate notice was given.
Make sure that the notice states that the injury is work-related. Merely stating that your back began to hurt while at work does not provide sufficient notice to your employer that you’re claiming a work-related injury. You should generally describe when the injury occurred, how it happened, and what body parts were injured.
Whether the employee gave adequate notice of an injury is frequently disputed and is based on the totality of the circumstances. You don’t need to provide your employer with an exact diagnosis. However, a reasonably precise description of the injury is required.
An experienced workers’ compensation attorney, in York, PA, can guide you through this process.
Seeking Immediate Medical Help
You should seek prompt medical treatment for your injuries. For the first 90 days, you must be treated by doctors on your employer’s designated list of medical providers if proper notice was provided to you at the time of hire and following injury.
You may be treated by the doctors of your choice following the expiration of 90 days.
As always, keep all billing and medical records sorted and saved in case your claim gets disputed or denied.
Receiving Notices from the Employer’s Insurer
After the employer receives notice of a work-related injury, the employer must report all employee injuries to its workers’ compensation insurer. Within 21 days, the insurance adjuster must issue a Notice of Compensation Payable, accepting the injury, or a Notice of Denial, denying that the employee has suffered a work-related injury.
Employers may also choose to issue a Medical Only Notice of Compensation Payable if the employer has chosen to pay related medical bills, but not wage loss.
An employer may also decide to issue a Notice of Temporary Compensation Payable for a period not exceeding 90 days, without admitting liability, where there is uncertainty regarding compensability. A notice of temporary compensation payable may convert to a notice of compensation payable if an employer does not subsequently issue a Notice Stopping Compensation Payable.
These options can be rather confusing and obtaining the assistance of a well-qualified workers’ compensation attorney in York, PA can be invaluable to make sure you are getting all of the benefits to which you are entitled.
Dealing with a Notice of Denial
Your employer’s insurance company may send you a Notice of Denial stating that your injury was not work-related. In that case, should you accept this as a final decision and find other means to pay your medical bills and to have some other source of income while you’re unable to work?
The answer is a resounding NO!
Insurance companies are in business to make money, not to pay out money if they can avoid it. If you receive a Notice of Denial, it’s extremely important to consult a Pennsylvania Workers’ Compensation Lawyer to determine whether you have grounds to file a Claim Petition with the Bureau of Workers’ Compensation.
Hiring an Attorney
During this complex process, you may start to wonder if you could do it yourself. Will it be possible to file your own claim petition and handle your case?
The answer is yes, but it would be a huge mistake! Workers’ compensation litigation is complex and your employer or your employer’s insurance carrier will be represented by an experienced attorney.
During workers’ compensation litigation, you will usually need to retain a medical expert, take a formal deposition of your medical expert (which usually costs several thousands of dollars), cross-examine the insurance company’s medical expert, and write various motions and briefs.
It takes many years of experience as a workers’ compensation attorney to acquire and sharpen these skills, and the workers’ compensation judge will normally advise an unrepresented Claimant to obtain an experienced workers’ compensation attorney to handle the complexities of litigation.
Generally, workers’ compensation claim petitions must be filed within three years of the date of injury or the claim will be barred.
Aren’t lawyers expensive? How can I afford an attorney if I’m not working? Pennsylvania Workers’ Compensation Attorneys generally work on a contingency basis—we don’t get paid until we get you benefits! Generally, we get 20% of any indemnity benefits that we can recover on your behalf.
Understanding Wage Loss Benefits
If you suffer a work-related injury and are unable to work, you can expect to recover between 2/3 and 90% of your pre-injury average weekly wage.
If you suffer reduced wages because of your work injury, you generally can recover 2/3 of the difference between your weekly wages and the reduced wages if you’re able to perform part-time or light-duty work.
All benefits are non-taxable!
Filing a Claim Petition After a Claim is Denied
If a case is denied and not settled during litigation, it generally will take about one year before the parties will get a Decision from a Workers’ Compensation Judge.
After a Claim Petition is filed, the Bureau generally assigns the petition to a Judge within several days. The insurance carrier then has 20 days to file an Answer to the Claim Petition. A pre-trial hearing is generally held about a month after the assignment of the Petition. The Judge will then give the parties a scheduling order that directs the parties to take the Claimant’s factual deposition within 30 days.
Within 45 days thereafter, the insurance company is allowed to have the Claimant examined by a doctor of their choice. Claimants must generally take the deposition of their medical witness within 90 days of the first hearing.
Employers then have 90 days thereafter to take their medical deposition. The parties then have about 60 days thereafter to submit Proposed Findings and Briefs to the Judge and the Judge will then usually file a Decision within a month or two later.
Mediation for a Workers’ Comp Case
A workers’ compensation judge will usually require the parties to agree to mediation of the case with another workers’ compensation judge to see whether the parties can come to terms with a settlement unless it is determined that mediation would be futile.
This is usually done after the insurance company has had a chance to obtain a medical report after the defense medical exam. Neither party is obligated to accept the recommendations of the Mediating Judge, but many cases settle once the parties sit down with a neutral judge who can point out the strengths and weaknesses of the claim and the benefits of settlement to avoid the uncertainties of litigation.
After the Judge writes a Decision, either side may file an appeal to the Workers’ Compensation Appeal Board. However, the Board may not reweigh the evidence or the Judge’s credibility determinations, and therefore, most Decisions are affirmed by the Board.
Cardamone Law Can Help You Fight This Uphill Battle
Work injuries can have a very serious impact on a worker’s life as well as the lives of the worker’s family. You may be suffering painful physical injuries as well as emotional injuries that often accompany physical injuries. We know that our clients are also suffering financially, especially when a claim is denied and the worker no longer has an income.
We have many decades of experience working to get our clients all of the benefits that they deserve. You need to concentrate on getting better, while we concentrate on getting you the medical benefits and wage loss benefits you need and deserve. We want to help ease your pain. You need York, PA lawyers you can trust on your side, fighting for you!
