Many people think of lawsuits as the only way of getting paid after an injury. In the context of a work injury, a lawsuit might not even be available. Employees typically cannot sue their employer, and your accident might have been a true “freak accident” where no one was at fault.
Even so, Workers’ Compensation might pay full benefits for your injury. These can cover medical expenses, 2/3 of your lost earnings (in most cases), and additional benefits for amputations, permanent lost function, lost hearing, lost vision, and serious facial scars.
For help getting your benefits, call the Certified Pennsylvania Workers’ Compensation Lawyers at Cardamone Law today at (267) 651-7945.
What is Workers’ Compensation?
You may have heard the term Workman’s Comp or Workers’ Compensation before, but never had to know much about it until your injury. Workers’ Comp is a system put in place to get workers payment for injuries they sustain on the job.
In a traditional lawsuit, you would have to prove who was at fault for the accident and then win a case in court against them to get compensation. This is difficult for many workers since laws often make it hard to sue an employer, and many accidents are the worker’s own fault.
Workers’ Compensation was originally instituted as an alternative. Under this setup, employers pay for injured workers regardless of who caused the accident. This pays for medical bills, lost earnings, and certain serious injuries, all without having to prove fault.
The benefits you get are perhaps lower than a lawsuit, and there is no compensation for pain and suffering, but you can get a wider range of injuries covered.
Do I Have Workers’ Comp?
Employers are required to carry Workers’ Comp insurance for most employees across Pennsylvania. Some jobs – such as realtor – are excluded, and federal employees have a different system. Otherwise, if you meet the definition of “employee,” your employer should cover you.
There is nothing to do to be covered under an employer’s policy. You do not have to sign up for an insurance policy or pay into the policy; it is entirely your employer’s responsibility to provide coverage. When you get injured, you file your claim with the employer and later with a Workers’ Comp Judge (WCJ).
The core issue that might prevent you from being covered is if you are an independent contractor. These workers are essentially self-employed and do not have coverage under their bosses’ policies. However, employers must classify workers correctly, and mistakes or errors in classification might make you eligible even if you thought you were not.
What is the Deadline to File for Workers’ Comp?
Claims typically need to be filed by reporting your injury to your employer within 21 days of your injury. If you were disabled and out of work for at least 7 days, you can file a claim for lost wages as well as medical care. Once you reach 14 days of missed work, you can get paid back for the first 7 days, too.
If you do not report your injury within 120 days, your claim is barred entirely, so it is important to report your accident through the proper channels within 21 days to avoid any delays or issues. Our Workers’ Comp attorneys can help you determine the right person or department to report your injury to.
Your employer is likely to deny your claim under any excuse they can. Once they do, you have to file your claim with a WCJ within 3 years of the injury.
Who Decides Workers’ Comp Claims?
Your employer initially decides whether to accept or reject your claim. They can also accept claims on a temporary basis and get additional time to investigate. This might mean you benefits get accepted at first, but then switched off within 90 days.
Going to Court
Once your employer rejects your claim, you can go before a WCJ for a neutral decision. These judges do not sit in county or municipal courts like other judges but instead work for the Pennsylvania Department of Labor & Industry’s Workers’ Compensation Office of Adjudication.
These WCJs are the initial “referees” to make the decision of whether to grant benefits and how much they are, following specific Workers’ Compensation rules. If they deny your claim, it can be appealed to the Workers’ Compensation Appeal Board (WCAB), and then again to the Commonwealth Court if needed.
You can finally appeal your claim to the Pennsylvania Supreme Court if every stage has ruled against you, but they can reject the appeal if they believe the case was rightly decided below.
Is there a Jury?
Workers’ Compensation claims do not use a jury. Technically, there is no “trial,” but instead, decisions are made after a hearing or multiple hearings the WCJ holds without a jury to gather evidence about your disability and income.
Why Was My Workers’ Comp Claim Denied?
Employers often deny Workers’ Compensation claims at first. They may have good grounds to do so, or they may simply hope that you accept the denial and stop the case there.
Employers can face penalties – such as paying for your attorney’s fees – if they deny your claim unreasonably. That means they typically deny based on one of these common grounds:
- Denying that your injury was work-related by claiming it happened outside of work, during your commute, or while you were doing things outside of company policy
- Denying your injury is disabling (they still have to pay for medical benefits, but they deny wage-loss benefits)
- Claiming you caused the injury intentionally, through drug use, through alcohol use, or through illegal activities
- Claiming you are an ineligible independent contractor.
Can You Appeal a Denial?
When your employer initially declines your case, this functions as the start of your case before the WCJ. After that, there are plenty of opportunities to get the WCJ to grant your benefits or to even negotiate a settlement with the employer.
If the WCJ denied your claim, you can also appeal to the different boards and courts discussed above.
Call Our Workers’ Compensation Lawyers in Wyndmoor Today
For your free case evaluation, call Cardamone Law’s Workers’ Compensation lawyers at (267) 651-7945.
