Eligibility
Employers are required by law to provide workers compensation coverage to their employees. Most workers are covered by the Pennsylvania Workers Compensation Act. Even if an employer only has one employee, that employee is covered. Those who are self-employed may be rare exceptions to this law.
If an employee is hurt on the job, his or her eligibility for work comp benefits will depend upon the circumstances of the injury. In general, you may be eligible for workers compensation payments if you are hurt on the job, make a pre-existing injury worse, or develop a work-related illness. In addition, you can request work comp payments even if you are at fault for your injury. However, accidents that happen while traveling to or from work or during breaks generally do not qualify for workers compensation, unless you are driving for your job.
Most injuries and illness caused by a work-related accident or condition are covered under the PA Workers Compensation Act. The only ones that may not be covered are:
Injuries that are intentionally self-inflicted, including suicide
Injuries that are caused by your own intoxication or illegal drug use
Injuries that are caused by breaking the law
Injuries that result when a co-worker attacks you for personal reasons
Injuries that result when a third person attacks you for a reason not related to your job
Filing a Claim
You should report any work-related injury or illness to your employer or supervisor right away and make sure that your employer or supervisor files an accident report. In Pennsylvania, you have 120 days to let your employer know that you sustained an injury at work. If you don't tell your employer that you were injured within 120 days, you can not receive work comp benefits. You have three years from the day you were injured to file a claim petition for an injury.
It is important to note that in PA, the Workers Compensation Bureau prints all of its forms on the same color paper. Therefore, you have to read all of the documents carefully. If you sign a document, the Courts believe that you have understood it and will enforce what you have signed, even if you made a mistake.
Payments
In Pennsylvania, you may be eligible to receive work comp payments if a doctor places you on medical leave from work for more than seven days. In order to be paid for your first seven days of missed work, you have to be off of work and under a doctor's care for at least 14 consecutive work days.
If your work comp claim is approved, the following payments may be available to you:
Medical Benefits
Total Disability Benefits (lost wages)
Partial Disability Benefits (lost wages)
Death Benefits
Specific Loss Benefits
Scarring
In Pennsylvania, payments for lost wages are approximately 2/3 of your average weekly wage, up to a pre-set maximum. Benefits can be reduced if you are receiving other payments like social security, pensions, severance pay, unemployment comp, etc.
Denied Benefits
If your work comp claim is wrongfully denied, there are steps you can take to fight the decision.
If you are going to appeal the denial of your workers comp claim, you will most likely need an attorney to help file your claim petition, handle your paperwork, and represent you at a workers comp hearing. In fact, in many cases a judge won't "hear" your case unless you have legal representation.
In Pennsylvania, there is normally more than one hearing for a workers comp case. After the documents and testimony are submitted and the case is closed, the judge will issue a written decision. If anyone involved in your case does not agree with the decision issued by the judge, an appeal is filed by an attorney. The appeals process can go all the way to the Pennsylvania Supreme Court.
Hiring an Attorney
Hiring an attorney is particularly important if your benefits are denied, if you lose your benefits, if you are in danger of losing your benefits, or if you want to pursue a lump sum settlement.
An attorney who knows the ins and outs of the work comp system can help you receive or keep your benefits. If you decide to appeal the decision to deny your workers comp claim, an attorney will help you file your claim petition, complete your paperwork, and represent you at hearings. If you receive letters threatening to reduce or end your benefits, an attorney can help you maintain them.
Finally, if you've been collecting workers compensation for at least four months, you may be eligible to receive a lump sum settlement. While this option has its conveniences, it is important to make sure that the settlement you receive is fair. An attorney can help you decide if a lump sum settlement is the best option for you, how much you should receive, and how to handle medical issues after your settlement.
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