What Does Workers’ Compensation Cover?

If you’ve suffered a work-related injury or illness in Pennsylvania, workers’ compensation can be a crucial safety net that will pay for your medical expenses or provide wage-loss benefits until you can get back to work. While workers’ comp works well for most injured workers, it isn’t right for everyone. That’s why our Media workers’ comp attorneys at Saffren & Weinberg believe you should know all the pros and cons of workers’ compensation before filing a claim or accepting a settlement. 

How Does Workers’ Compensation Work?

Workers’ compensation protection is required by law under the Pennsylvania Workers’ Compensation Act. The Act requires employers to provide their employees with medical and wage loss benefits if they become ill or injured on the job or because of work-related tasks. The State Workers’ Insurance Fund, private insurance companies, or self-insuring employers pay these workers’ compensation benefits.

When you’ve sustained a work-related illness or injury, you will report it to your employer, who must then notify the Bureau of Workers’ Compensation by filing a report of your injury. Depending on your illness or injury, PA workers’ compensation will pay:

• The costs of your medical care
• Wage-loss benefits until you’re able to work
• Specific loss benefits if you have permanently lost the ability to use a part of your body
• Death benefits to your family if an illness or injury results in your death

But it’s important to understand the nuances of Pennsylvania workers’ compensation insurance to fully understand its limits and disadvantages to decide if it is the right path forward for you.

Who Decides if You Are Eligible for Benefits?

Who decides if you can collect workers’ comp after an injury? Basically, your employer has the right to deny benefits. If your employer believes that your illness or injury was pre-existing, happened outside of work, or happened when you weren’t engaged with work duties, they can deny your benefits. 

What Are Some Reasons You Could Be Denied Workers’ Comp?

While workers’ compensation in PA is generally considered no-fault insurance coverage, there are some circumstances where you could be denied benefits. These include:

• You waited too long to report your injury or illness.
• Your injury or illness didn’t happen at your place of work or while you were doing your job. 
• Your injury or illness isn’t covered.
• Your injury or illness doesn’t prevent you from doing your job.
• Your injury or illness was a pre-existing condition. 
• You gave incorrect information in your report.
• There were no witnesses who could corroborate the incident.
• Your report was inconsistent with the doctor’s findings.
• You never received medical treatment.
• You haven’t cooperated with your employer’s or insurance company’s requests for additional information. 
• You were at fault for your injuries or illness because of intoxication, illegal activity such as drug use, fighting, recklessness, or not complying with safety protocols. 

What Are Your Options if You Have Been Denied Workers’ Comp in PA?

If you have been denied benefits, you have the right to a hearing before a Workers’ Compensation Judge who will listen to evidence on both sides and decide. If your benefits are still denied, you have the right to go through a formal appeal process.

However, this process is time-consuming and complicated, and there is no guarantee that your denial will be overturned. Litigating a workers’ comp denial can be challenging, and it’s important to get the help of an experienced workers’ comp lawyer in Media to represent your interests. 

What Are the Limitations of Workers’ Comp in PA?

While workers’ compensation in PA offers essential benefits for injured workers and their families, it’s not perfect. Unfortunately, most injured workers don’t understand the disadvantages of workers’ compensation until it’s too late. 

When you accept a worker compensation settlement, you essentially give up your right to hold your employer legally liable for your injuries. This is only one way the Pennsylvania Workers’ Compensation Act limits your ability to seek compensation for a work-related injury or illness, including:

• An insufficient settlement – Unfortunately, insurance companies are in business to make money and often pay settlements based on their own bottom lines, not necessarily in the injured party’s best interest.
• Pain and suffering – If the pain from your injury or illness prevents you from working, you can receive benefits for your inability to work from workers’ comp, but not for the pain and suffering itself. If your injury is serious, pain and suffering often represent a significant source of compensation in a lawsuit.
• How your injury or illness has affected your quality of life – Work-related injuries or illnesses can also affect the overall quality of your life, making it impossible to enjoy things you once did. No compensation for quality-of-life issues is available to you if you can no longer seek a legal remedy. 
• Disfigurement from an injury below the head and neck – Currently, the Act only provides benefits for disfigurement of the face, head, or neck. Current legislation is being considered to change these benefits, but it has only passed the Pennsylvania House of Representatives.
• Most psychological issues – The Act limits your ability to collect benefits for work-related psychological issues. You must prove that your psychological issues were a direct result of abnormal work conditions, and this can be extremely difficult to prove. 
• Consequential damages – If you cannot work, you are also probably unable to do things around your home, meaning you will have to hire people to do all those tasks for you. These costs are not recoverable through workers’ comp. 

While Pennsylvania workers’ comp provides many critical benefits to injured workers, it is imperfect. In some cases, injured workers may be better off considering other options. This is when it’s important to consult with an experienced PA workers’ comp attorney.

Getting Guidance on Workers’ Compensation in PA

If you’ve sustained a work-related injury or illness or have been denied workers’ compensation benefits in Pennsylvania, don’t try to navigate this alone. It’s to your advantage to get the guidance of a PA workers’ compensation lawyer to understand how the Pennsylvania Workers’ Compensation Act works and what your rights and responsibilities are as an injured employee. Let us help you get the compensation you deserve through workers’ compensation benefits or other legal means. 

At Saffren & Weinberg, our experienced Media workers’ comp lawyers are dedicated to representing the rights of injured workers. We offer a free consultation to help you understand your options after a work-related injury. Contact us at (215) 576-0100 or through our website contact form to schedule a free consultation to discuss your workers’ compensation rights.

 

Disclosure:

This website is designed to provide only general information. The information presented on this website is not formal legal advice. You should not rely on any general information from any source for making legal decisions. Each legal matter is unique and requires specific attention from a qualified and experienced attorney. Unless a representation agreement has been signed with Saffren & Weinberg, we are not your legal representatives.