Injured workers may not be able to sue their employer for their injuries. However, Workers’ Comp is still there to cover injuries, whether you caused them, your employer caused them, or an outside party caused them. Benefits from Workers’ Comp are often paid much faster than a lawsuit, helping you and your family move forward during this difficult time.
Our attorneys can review your case and help you file your claim. From there, we can negotiate with insurance companies and seek to get you full benefits for your work injury. If there are complications or denials, we can go in front of a judge to argue your case.
For help, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Specialists at (267) 651-7945 today.
What is Workers’ Comp?
Workers’ Compensation is an insurance system designed to cover employees’ work-related injuries without the need to prove fault first. As a trade-off, injured employees cannot sue their employers for injuries sustained in the course of their work, but Workers’ Comp also covers injuries where a lawsuit might never have been allowed.
The core requirements for a successful claim are showing that…
- Your injury was work-related
- It left you with disabilities that lower your earning capacity.
This can cover accidents even if you caused them or an outside party caused them; it is a type of no-fault coverage.
All employers who have even one employee who could be injured in Pennsylvania need to carry Workers’ Comp insurance.
Who Decides Workers’ Comp Cases?
When you file your initial case, you do so with your employer within 21 days of injury (though you technically can file within 120 days of the injury and still get benefits). They will pass the claim to the insurance carrier, and they usually make the first decision about benefits.
Insurance Carrier
Even when employers want to pay claims, it might be their insurance carrier getting in the way. Although your employer’s name might be on the case, this is often truly a fight between you and the insurance carrier.
Workers’ Comp Judges
If they investigate the claim and deny your benefits, we can file a document called a Claim Petition with the Workers’ Comp Office of Adjudication. They will assign the case to a Workers’ Comp Judge (WCJ), who will act as the referee in your case. They made the determination about whether or not the injury was work-related and disabling, and they decide benefits.
WCAB and Appellate Judges
There is no jury in a Workers’ Comp claim. The WCJ makes the decisions on their own, but if you need to appeal the case, it can go to the Workers’ Comp Appeal Board (WCAB). From there, cases can be further appealed to the Commonwealth Court and then the Pennsylvania Supreme Court.
Settlement
If your employer’s insurance carrier relents, they can settle the case at any time. Our Workers’ Comp attorneys can often negotiate with the insurance carrier and potentially get your claim accepted or settled if they want to avoid going to a hearing
Calculating Benefits for Injured Workers in Whitehall
If you were hurt at work, you typically claim three areas of benefits under Workers’ Comp:
Medical Benefits
Medical benefits pay for your medical care directly. Unless there is something you need reimbursed, these costs are usually paid directly to the care provider. They will simply bill the insurance carrier, and they generally pay without pre-approval.
In the first 90 days of treatment, treatment is only covered if you use approved doctors. Your employer will have a list of at least six providers, and least two of which need to be physicians. The rest might be chiropractors or specialists.
You can go off the list if you need a specialist that is not listed or if you want a second opinion on surgery. However, surgical care still needs to be performed by a listed doctor if it happens in the first 90 days.
Wage-Loss Benefits
Wage-loss benefits cover your lost earning capacity. They last for as long as you are disabled and pay at the same rate unless you take on employment.
As long as you are unable to work, you receive 2/3 of the “average weekly wage” (AWW) you made before the accident. This is subject to a cap at the statewide AWW, which is set by law each year. If you are a low earner, your benefit cannot drop below whichever of these values is lower:
- 1/2 the statewide AWW
- 90% of your lost wages.
If you are working to some extent, your benefits are instead 2/3 of the difference in what you made before the accident and what you make now.
If, after 2 years on benefits, you undergo an impairment rating evaluation (IRE) that finds your whole-body impairment under 35%, you are converted to partial disability benefits. The pay rate does not change unless you go back to work, but you cannot get more than 500 more weeks of benefits under this status.
Specific Loss
Permanent injuries pay additional benefits. These include…
- Amputation
- Total lost function
- Lost hearing
- Lost vision
- Significant facial scarring/disfigurement.
Each injury has a number of weeks in the law to set how long these benefits last. The amount is 2/3 of your AWW, capped at the statewide AWW. The floor, however, is 1/2 the statewide AWW only (not 90% of your AWW).
Can You Sue if You Get Workers’ Comp?
You cannot sue for an injury if you caused it yourself or if your employer caused it. However, you can still get Workers’ Comp. Workers’ Comp can also come in all kinds of other cases, even when someone outside the workplace was responsible for your injuries.
If an outside third party was ultimately responsible, you can still sue them. These third-party claims can cover the rest of your lost earnings and even pay pain and suffering, making them incredibly important in some cases.
You can file both claims, you just cannot get paid for the same damages twice. This usually means having to pay back your employer/their insurance carrier when you get paid again from the lawsuit, but you get to keep the rest of the damages, minus legal fees.
Call Our Workers’ Compensation Attorneys in Whitehall Today
No matter what industry you were injured working in, call our Workers’ Comp lawyers at Cardamone Law at (267) 651-7945 today.
