A concussion can range in severity from mild to moderate to actually being a traumatic brain injury that could result in surprisingly severe lifelong consequences. When you receive a concussion at work, you should consider filing for Workers’ Comp with the help of a lawyer.
First, get medical care to treat your injury. Then talk to a lawyer about filing a claim for coverage through your employer. If your employer denies your claim, you can file a formal claim through the state. Settlements can result in high dollar payouts, but there are only specific benefits covered. Lawsuits may also be available.
For help, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945 right away.
What to Do After a Concussion at Work
Acting quickly is important with a concussion, and it helps properly document your injuries to improve your chances in a Workers’ Comp claim.
Get Medical Care
If you hit your head, get immediate medical care. It is impossible to know if you have “just a concussion” or whether there is bleeding or a worse traumatic brain injury (TBI).
Even “just a concussion” is nothing to joke about; concussions are mild TBIs and can lead to serious ongoing symptoms (confusion, lethargy) as well as acute temporary symptoms (passing out, throwing up). Post-concussion syndrome can also lead to ongoing effects.
Call a Lawyer
Work with our Delaware County, PA Workers’ Comp lawyers as soon as you can after an injury to make sure you are taking the proper steps.
File a Claim
Claims start with notice to your employer, but they often deny claims. You may need to escalate your case to a formal Claim Petition to get the benefits you need.
Consider a Lawsuit
Workers’ Comp only pays for certain areas of damages, so you may need to file a lawsuit for full compensation (e.g., for pain and suffering damages). However, lawsuits cannot be filed against an employer for work-related injuries.
Filing Your Claim
Workers’ Comp begins with a claim through your employer. You can then escalate this to a formal claim through the state if they deny your claim.
Filing Through Your Employer
You can file a claim with your employer by notifying them of the injury within 21 days. They then notify their insurance carrier of the claim, and the two parties decide whether to pay it or reject it.
Acceptance or denial typically must come within 21 days.
Deadline to File
You must file this claim within 21 days of the initial injury, though you can technically still file if you do so within 120 days.
What’s Needed?
You must notify the correct people at your work. This could be HR, a supervisor, or even a third-party claim administrator in the case of some large companies.
Filing a Claim Petition
If your initial claim is denied, you can file a Claim Petition with the Pennsylvania Workers’ Comp Office of Adjudication. They then assign the case to a Workers’ Comp Judge (WCJ) who handles the case instead of a traditional judge.
Deadline to File
This claim must be filed within 3 years of your injury.
What’s Needed
Your Petition explains everything about your case:
- What injuries you suffered
- What your work role was at the time of injury
- Your wages before and after the injury
- The effect your injury has on your ability to work and care for yourself
- What permanent effects you suffered
- And more.
Working with a lawyer is essential to make sure this Petition doesn’t miss anything.
Requirements to File
Workers’ Comp requires three things for your case to succeed, as well as the evidence and legal arguments to prove these elements:
Employee Status
Only employees can file Workers’ Comp claims, not independent contractors. This might cut out certain workers, but your title as a contractor is not necessarily enough. If your work is controlled by your employer and you were serving their interests rather than being “self-employed,” you should qualify as an employee.
Work-Related Injury
If the injury happened while working, it is likely work-related. As long as it stemmed from work conditions or the tasks you do at work, it should be covered.
Injuries while off duty or during your commute usually do not count. However, falls from a ladder, slip and falls, and auto accidents in the course of your job should typically count.
Disability
Medical care can be covered as long as the injury is work-related, but wage-loss benefits are only paid if your injury is disabling for at least 7 days. They do not need to be in a row.
Medical Benefits for Concussions
Medical benefits can cover the full cost of caring for your injuries.
What’s Covered?
All care should be covered, from CT scans and diagnostic testing to ongoing care with a neurologist and physical rehab, if needed.
Do I Need Pre-Approval?
Workers’ Comp does not pre-approve care. Your care team will assess your needs, dictate what reasonable care you need, and send the bill to insurance. In the first 90 days of care, you must typically use a list of providers your employer chose, so they are more likely to trust these providers. However, concussions often need appointments with specialists who would not be listed.
As your care goes on, questions can go to a Utilization Review if the insurance carrier wants to challenge the reasonableness of the care.
How Much Care is Covered?
All care is covered; there is no limit. If you need brain scans and neurosurgery, it should be covered so long as that care is reasonable.
Disability and Wage-Loss Benefits for Concussions
Benefits for lost wages are not always available.
Requirements
If your injury is disabling for at least 7 days, you can get benefits.
When Are They Paid?
Generally, you will not receive benefits until after the 7th day of disability, and back pay for the first 7 days is only available if you are disabled for at least 14 days. However, benefits will not start until your claim is approved, so this could take weeks or months anyway.
Once they start, they are paid either weekly or biweekly; however, you were paid before the injury.
Settlements
You can settle a Workers’ Comp claim at various points:
- After your claim is accepted
- Before a hearing is completed
- After a hearing
- After you have already been receiving benefits.
The goal is to turn ongoing benefits into a lump sum (or a structured settlement) instead of administering the claim as it goes. This means
- Medical care costs are cashed out and paid to you to manage as you go.
- More money cannot be added into the settlement later.
- Lost wages are cashed out for the full period you are expected to suffer lost wages.
- Any specific loss benefits for lost vision, lost hearing, serious facial scarring, amputation, or permanent lost function are also cashed out.
Call Our Workers’ Comp Lawyers in Pennsylvania for Help Today
Call Cardamone Law’s Bensalem, PA Workers’ Comp lawyers at (267) 651-7945.
