Getting the forms correct is one of the first big hurdles in getting your Workers’ Comp claim granted. It is important to never try to fill out or turn in these forms without having a lawyer review your case first, but it is important to understand how the forms are filled out and what is required.
The Claim Petition form seems straightforward, but it has complex questions you should review with a lawyer. Most of the form is simple: your info, your employer’s info, and any relevant insurance info. The rest of the info includes details about your injury, how it happened, why it’s work-related, when your last employment was, and other details.
For help, please do not try to fill out your forms on your own; call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945 today.
What Form Do I Fill Out?
There are many forms related to Workers’ Comp claims, most of which can be found on the Department of Labor and Industry’s website for the Workers’ Comp Office of Adjudication (WCOA).
The most important form for filing your claim is a Claim Petition.
Party Information
The form starts simply enough with the information for all parties involved.
Your Info
The firm needs your name, date of birth, address, and phone number. If you’re filing for a deceased worker, you need the worker’s info and your info.
Employer Info
This simply includes the name, address, and phone number, plus their FEIN (Federal Employer Identification Number) if you know it (e.g., from your W-2).
Insurance Info
If you know the employer’s insurance info, you should fill that in, including their NAIC code (a unique code for each insurance company). If your employer is self-insured and uses a third-party administrator, you put that info here instead.
Injury Questions
Questions 1-5 deal with the injury, how it happened, and where it happened.
Note that question 1 has a short line but requires a full explanation of the injury and illness. It might not fit here, meaning you would attach the explanations and answers on a separate page and reference them here.
The rest deal with the date, how it happened, etc. This needs to show the injury was work-related for you to get benefits.
Notice Question
Question 6 asks you when you gave notice of the injury and how.
You need to notify your employer of your injury and give them time to accept or reject your claim before you turn to a Claim Petition. Notice must be delivered within 120 days or else your claim is automatically rejected, but notice is usually given within 21 days of the injury.
You also have to wait 21 days from your notice date for your employer to decide your case.
Employment and Disability Questions
Question 7 deals with what your job title was at the time of injury.
Question 8 asks whether you were working for other employers and who they were.
Question 9 is the big question for wage-loss benefits: did the injury stop you from working and when? If you are out of work for over 7 days, you can get wage-loss benefits.
Earnings Questions
Questions 10-11 deal with whether you’ve returned to work, whether it is with the same employer, and where you are working now. This includes questions about your current job title.
Questions 12-13 deal with what your wages were when you were injured and how they have been affected since. This is vital for calculating your lost wages. If you faced no drop in income because of your injury, then you cannot get wage-loss benefits.
Benefits Questions
Question 14 requires you to explain all of the benefits you are demanding. This is incredibly complex because it requires you to break down partial vs. full disability, medical benefits, lawyer’s fees, disfigurement, and other benefits.
Typically, injured workers seek three areas of benefits:
- Medical benefits to cover all ongoing treatment, now and into the future
- Wage-loss benefits covering 2/3 of lost earnings or 2/3 of the difference in wages before and after the injury
- Payments for amputation, lost function, serious disfigurement, lost hearing, and lost vision.
Your Pennsylvania Workers’ Comp Lawyer should help you calculate all of these amounts and place them in the correct boxes based on what category of benefits they fall into.
Other Pending Litigation
If you are filing a lawsuit in the case, you need to explain that in Question 15. You can seek benefits through Workers’ Comp and sue an outside party for their responsibility, but you cannot sue your employer for a work-related injury.
Attorney Questions
The rest of the info is for your attorney to fill out and sign.
Date
The date of the petition is awkwardly to the side; don’t miss it!
FAQs for Filling Out Workers’ Comp Claim Petitions in Pennsylvania
What is the First Form I Fill Out?
Before you even get to a Claim Petition to file with the government, you have to notify your employer of the injury and let them file an insurance claim with their Workers’ Comp insurance carrier. If they deny your claim, then you can turn to a Claim Petition.
Notice must be given within 120 days of the injury, or else you lose eligibility. However, notice within 21 days is expected.
Can I Fill Out a Claim Without a Lawyer?
Technically, you can fill out the Claim Petition without a lawyer, omitting the section on attorneys. However, you should not.
First, you might be too injured to even handle the paperwork, so let us do it for you. Second, you likely do not have the experience and understanding of the legal standards to get things right on the first try, and you should never waste an opportunity for success.
Lastly, once the case goes to a judge, they might reject the form and tell you to get a lawyer if the form seems like it’s missing info, so why waste time filing and losing before getting an attorney?
What if There Isn’t Enough Room?
Some areas of the form are too small to contain the full information needed in a proper Claim Petition, so we typically submit claims with additional documentation.
What Do I Do After Filling Out the Form?
After it is properly filled out and reviewed by your lawyer, copies need to be submitted to the WCOA and served on the defendants and their attorneys according to proper rules of service.
How Can I Afford a Lawyer
Workers’ Comp lawyers are typically paid out of the winnings in your case, and some bad actions by your employer might even mean they pay for your legal fees as a penalty. Always call a lawyer; never seek to handle your petition on your own just because you think it is too expensive to get a lawyer.
Once the case goes before a Workers’ Comp Judge, it is very unlikely you can progress through stages like paying for witness depositions and medical reports without help from a lawyer.
Call Our Workers’ Compensation Lawyers in Pennsylvania
Never handle your claim on your own. Call Cardamone Law’s Warminster, PA Workers’ Comp lawyers at (267) 651-7945 for a free case review.
