When you are injured at work, your employer is supposed to pay for your injuries. They also must have insurance that should cover those costs for them. When things go wrong and payments aren’t made, lawsuits might seem like the best way to correct the issue, but they are not always possible.
Generally, injured workers cannot sue their employers for work injuries. On top of that, the insurance policy is between your employer and the Workers’ Comp insurance company, so workers really don’t have grounds to sue the insurance company either. Instead of suing the Workers’ Comp insurance company when they deny your claim, you usually handle the case by filing a Claim Petition with the Department of Labor and Industry’s Workers’ Compensation Office of Adjudication (WCOA), where the case goes before a Workers’ Comp Judge (WCJ).
For help, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers today at (267) 651-7945.
Can You Sue Workers’ Comp Insurance Companies for Denying Your Claim or Failing to Pay?
Generally speaking, if you are an injured worker, the Workers’ Comp insurance carrier does not work for you. You do not have a policy with them, and they have no obligations to you under that policy.
Instead, their policy/contract is with your employer. Your employer has a legal obligation to pay you Workers’ Comp, but they are the one who has a contract with the insurance carrier to cover those costs.
If you have trouble getting your benefits, it can be tough to tell if it’s your employer or the insurance carrier holding you up. But in either case, the remedy isn’t usually a lawsuit.
Who is Responsible for Paying Workers’ Comp?
The Pennsylvania Workers’ Comp Act requires your employer to cover your Workers’ Comp benefits, including medical care, lost earnings, and specific loss benefits. They should have an insurance policy, where the insurance carrier agrees to provide payment for them, but the obligation rests with the employer.
That means that if you have trouble getting your benefits or your claim has been denied, your case is against your employer. But this case also isn’t a typical lawsuit.
Can I File a Lawsuit for Workers’ Comp Benefits?
Workers’ Compensation is a separate system from lawsuits. When you get hurt at work, you may be able to sue third parties, but you cannot sue your employer. This means that even if they deny your claim, your case doesn’t turn into a lawsuit; it proceeds through the Workers’ Comp system.
Filing an Initial Claim
When you make your initial claim for Workers’ Comp, you notify your employer of the injury within 120 days of the accident (though within 21 is preferred). Then they report the claim to their insurance carrier, and the carrier decides whether to pay.
If either the employer or the carrier denies the claim, you can move on to the next step. If they pay up, then there is no reason to file a claim.
Claim Petition
Once the claim is denied or they fail to respond within the required times, you should get a Pennsylvania Workers’ Comp lawyer to file a Claim Petition.
Claim Petitions are not lawsuits. Instead, they are filed with the Department of Labor and Industry’s WCOA. The claim is assigned to a Workers’ Comp Judge who hears the case, accepts evidence, sets hearing dates, and makes a determination.
If they rule in your favor, your benefits start. If they deny your claim, you can appeal.
Settlement or Award
Most cases are ultimately settled, with the insurance company and employer agreeing to pay you. Let our attorneys negotiate benefits; do not accept the insurance carrier’s or employer’s offer without letting us review it first.
If the case cannot be settled, but the WCJ rules in your favor, you get ongoing benefits. These can be settled later, depending on your known medical care needs and other factors.
FAQs for Suing in a Workers’ Comp Case
Can You Sue for Work Injuries?
Workers’ Comp is called the “exclusive remedy” for work injuries, but this only applies to
- Employees
- Suing their employer
- For work-related injuries.
If you are a contractor, this might not apply. Any workers can also sue other outside parties, even if they are already applying for or receiving Workers’ Comp from their employer.
Can I Sue for Bad Faith in Workers’ Comp?
Insurance bad faith is a claim you can make against an insurance company that fails to pay under the terms of their policy for inappropriate reasons. For this to apply, the insurance company must act in bad faith – which is a pretty high standard.
You can typically only sue your own insurance carrier for bad faith. Because the insurance carrier works for your employer, not for you directly, insurance bad faith lawsuits are not typically an option.
What if My Claim is Denied?
If your initial claim is denied, we file a Claim Petition with the WCOA and get your case before a Workers’ Comp Judge. If they deny your case, we can appeal it to the Workers’ Comp Adjudication Board, then to the Commonwealth Court, then possibly to the Pennsylvania Supreme Court.
What if My Employer Doesn’t Have Workers’ Comp Insurance?
The fact that your employer doesn’t have insurance does not necessarily allow you to sue them directly. Instead, you may still be able to file a Workers’ Comp claim, but it has two potential issues your lawyer can help with:
- UEGF: Employers are required to carry insurance, but if they don’t, their workers can still get paid through the Uninsured Employers Guaranty Fund.
- Statutory Employers: If your direct employer is uninsured, but it handles a portion of another company’s business, that business might be responsible for your Workers’ Comp benefits as your “statutory employer.”
Call Our Workers’ Comp Attorneys in Pennsylvania Today
Call (267) 651-7945 for a free case evaluation with Cardamone Law’s Philadelphia Workers’ Comp lawyers today.
