Hernias are quite common lifting and carrying injuries. Even a somewhat mild hernia can set you back a few weeks or months, with the risk of reinjury, the time it takes for surgery, and the time it takes before you are able to work again after surgery.
When filing a Workers’ Comp claim for a hernia, it is important to understand the timeline of your case, what you need to do to file and get your claim approved, how to pick a surgeon, and what your settlement could be worth.
For help with your case, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers today at (267) 651-7945.
Timeline of a Workers’ Compensation Claim
Discovering your hernia in the first place could be difficult, especially if it has been growing and becoming aggravated for a while before you realize something is really wrong. Take the following steps to get immediate treatment and file your claim.
Get Medical Care
If you suffer an acute hernia – the kind where you lift something and immediately feel serious pain – go to the hospital right away. If you think you might have a hernia and the injury has been lingering and worsening, get it checked out as soon as you can.
If you have the foresight to check with your employer about what doctors they will require you to use, you may be able to get your initial treatment with their listed doctors. If it is urgent, just go to the hospital and worry about coverage later.
File Notice
You must notify your employer of your injuries within 21 days to start the Workers’ Comp process. They then get 21 days to accept or deny your claim.
Hernia injury cases are somewhat limited in time and are somewhat routine, so it is possible your claim will be accepted. If there are any issues, our Pennsylvania Workers’ Comp lawyers can help.
Call a Lawyer
Even if you think you are handling the case fine on your own, talk to a lawyer. We offer free case reviews and can help you understand what to do next. If your claim is denied, you will certainly need a lawyer’s help to take the next steps.
File a Claim Petition
If you are denied, you can take your case to a formal claim petition with the Workers’ Comp Office of Adjudication. However, most hernia injuries are repaired and healed long before the time it would take to take a contested Workers’ Comp claim to a Workers’ Comp hearing.
It can take upwards of 6 months for a contested claim to get to the point of settlement, and over a year to get all the way to a hearing if it is not settled first.
Getting Medical Care for a Hernia
Hernias often need surgery, which means it is vital to understand how medical care is covered under Workers’ Comp.
No Pre-Approval
Workers’ Comp does not require pre-approval. When you get treated, your doctor will prescribe the care you need, and unless the insurance company finds it unreasonable and challenges it through a Utilization Review, it will be covered.
Coverage for Surgery
Hernias often need to be surgically repaired. Any surgery is serious surgery, but hernia repairs are somewhat routine procedures that can usually be handled quickly and come with a short recovery time.
Treating Doctors
The doctors and other care providers you use must come from your employer’s list of approved care providers for treatment for care within the first 90 days. Most hernia injuries are going to be examined and maybe even operated on within those first 90 days, so you have to pay close attention to that list.
Second Opinions on Surgery
Although you may need to use your employer’s chosen surgeons if your surgery is scheduled within the first 90 days, you can get a second opinion from a doctor you choose about whether or not you need surgery.
Wage-Loss Benefits for Hernias at Work
If you suffer a hernia at work, it will likely keep you from working long enough to qualify for Workers’ Comp.
Timeline for Eligibility
Workers’ Comp only pays benefits if your injury keeps you from working for at least 7 days. You may be able to perform some light-duty work, but hernias will typically cause you to miss at least 7 days of work, between surgery and recovery times.
This typically qualifies you for benefits.
Amount Paid
Workers’ Comp typically pays 2/3 of your pre-injury average wage while you cannot work at all. If you can work to some extent, perhaps doing light-duty work, then you can receive 2/3 of the difference in pre- and post-injury wages.
These wage-loss benefits are capped at the statewide average and have a floor at half that value or 90% of your average weekly wage, whichever is lower.
Requirements for a Workers’ Comp Claim
Note these three basic requirements for coverage under Workers’ Comp for a hernia or any other on-the-job injury:
- You are an employee, not an independent contractor.
- You were injured within the scope of your job duties or because of dangerous job conditions.
- Your injury disabled you for at least 7 days.
Settling Workers’ Comp Claims for a Hernia in Pennsylvania
The goal of a settlement is to get the injured worker all of their benefits now (or over time) instead of having the Workers’ Comp insurance carrier continue to administer the claims over time.
Pros and Cons
The main benefit is that you typically get all the money in a lump sum, and you can stop any requirements for check-ins or oversight with the insurance carrier. This also takes the burden off the insurance carrier.
One downside is that your medical care coverage is all paid out. If you need further medical care beyond what they paid for already, it would come out of pocket.
Options
You have two major sets of options with settlements:
- Lump Sum vs. Structured Settlement – Money can be paid at once or over time, depending on what’s best for you.
- Global Settlement vs. All But Medical Settlements – Because lost wages are somewhat easier to expect and calculate in some cases, it may be better to settle just the wage-loss benefits. That way, if surprise medical expenses cost more money, they can still be covered through the open medical benefits claim.
In Hernia Cases
With hernia cases, the claim is often administered for only a short period, but that can either be settled or administered on an ongoing basis, and it can be hard to know which is best without help from a lawyer.
The risk of defective surgical mesh or other complications might be included in your case, too, so always talk to a lawyer about these potential issues.
Call Our Workers’ Comp Lawyers in Pennsylvania
For your free case evaluation, call Cardamone Law’s Philadelphia Workers’ Comp lawyers at (267) 651-7945.
