What to Expect After a Filing a Workers' Compensation Claim

The Workers' Compensation system was established to protect injured workers by providing for benefits (and to their families) in the event there is an on-the-job injury or an injury sustained due to the type of work performed. Some Workers' Compensation claims are for accidents on the job such as loss of limb in a machine or a back injury due to heavy lifting. Other Workers' Compensation claims are due to medical problems due to repetitive motion, such as carpal tunnel syndrome. Still other Workers' Comp claims are for the inhalation of dangerous chemicals such as asbestos, which often results in a form of lung cancer called mesothelioma. Regardless of the type of injury you have suffered at your job, you should seek the legal advice of an experienced Workers' Compensation lawyer today to ensure that you and your family get the benefits to which you are entitled.

Filing a Workers' Compensation claim is no easy task. The language can be difficult and confusing, and often times, the first filing is quickly denied. Workers' Comp will deny claims for reasons such as a deadline was missed or a form was filled out incorrectly. Workers' Compensation attorneys have a great deal of experience filling out these forms and dealing with the difficult aspects of Workers' Compensation law.

The Claims Process

Before making a workers' compensation claim, the injured worker or their representative must tell the employer that an injury has occurred and provide medical information. In certain cases, a an injured worker will need to submit a written claim form:

o If the insurer requests one
o If the worker needs weekly payments for more than 12 weeks or medical expenses of more than $7,500
o If the insurer decides to not start provisional liability payments, or stops making provisional liability payments, and the worker disagrees.

After this step, the insurer will decide whether or not to accept the claim. Before payments begin, the insurer will need certain facts and will investigate the matter by questioning the employer and the injured employee. Information will also be sought from the medical doctor who examined the injured employee. Within seven of being informed of the accident/injury, the insurer must begin provisional liability payments to the injured worker unless there is a compelling reason to not begin payments.

A claim for workers' compensation benefits must be made within six months of the date of the injury in most states. This may be extended to three years in some cases. A worker is not entitled to compensation unless notice of the injury was given to the employer as soon as possible after the injury occurred.

Workers Compensation in Pennsylvania - Claims and Benefits

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.