Navigating a Workers Comp Claim
If you have been injured at work, you’re not only dealing with your physical injuries. You’re also dealing with the financial insecurity that being out of work brings. You have household bills to pay, and now, on top of that, you have medical bills to worry about, too. Fortunately, most employees in Pennsylvania are covered by their employer’s workers’ compensation insurance. But that can come with its hurdles. When you are trying to navigate a workers’ compensation claim, having the assistance of our experienced Philadelphia work injury lawyers can ensure that you get the benefits you need so you can rest, heal, and get back to work.
What Does Workers’ Compensation Cover?
Workers’ compensation is a state-administered program under Pennsylvania’s Workers’ Compensation Act that benefits workers who sustain job-related injuries or illnesses.
Workers’ compensation benefits are designed to provide medical and wage-loss benefits for employees regardless of fault. When you are injured or sustain a job-related illness, workers’ compensation – or workers’ comp – can help relieve some of the financial burdens you face while you cannot work.
“Compensable” workers comp injuries in Philadelphia include:
- An injury that results from a specific work-related accident or incident
- An injury or condition caused by repetitive activities performed at work
- A pre-existing condition that was aggravated by work-related activities – The pre-existing condition does not have to be work-related
- A disease that has been recognized as an occupational disease
Workers comp medical benefits include “reasonable and necessary” medical expenses related to the injury, illness, or condition, including:
- Doctors’ or other healthcare providers’ fees
- Surgery or other necessary medical interventions
- Hospitalization and related services
- Prescription costs
- Other necessary medical equipment
- Specific loss benefits if you have suffered permanent disfigurement or the loss of a body part, hearing, or sight
- Death benefits to family members if the injury or incident results in a fatality
If you can’t work temporarily or permanently due to your condition or injury, wage-loss benefits are available depending on your level of disability.
The Difficulties in Navigating Workers’ Comp without a Philadelphia Work Injury Lawyer
Although workers’ compensation is a crucial safety net for injured workers, it does have significant drawbacks.
While workers comp has state oversight, workers’ comp claims are administered through individual insurance companies that are large, profitable businesses. Like most large public companies, insurance companies don’t like to pay for things if they don’t have to. This can make workers’ comp claims complicated to navigate, and many workers who have valid claims get denied the benefits they need and deserve.
Other disadvantages of workers’ comp include:
- Despite being covered for all reasonable medical costs, wage-loss benefits only cover a portion of the injured worker’s actual wages.
- Specific rules and timelines must be followed in a workers comp claim.
- Employers and their insurance companies can initially force you to choose from their own list of providers to get the care you need instead of using your trusted doctor.
- Insurers can deny benefits if the worker can’t prove the injury or illness was work-related.
- Workers cannot recover compensation for non-economic damages such as physical and emotional pain and suffering.
- A worker signs away their ability to hold their employer legally accountable through a personal injury lawsuit if they accept workers comp benefits.
What are Your Responsibilities After a Workplace Accident in Pennsylvania?
To be successful in a workers’ comp claim, you have specific responsibilities and timelines that must be adhered to:
- You should seek medical attention as soon as possible, document and record everything that happens, and strictly follow the treatment plan.
- Within the first 90 days, you may be required to see your employer-approved provider. After 90 days, you can see a provider of your choosing.
- You must notify your employer of your injury immediately, or within 21 days of the incident, to begin receiving benefits.
- Clearly report precisely how, when, and where the accident happened so there is no room for misinterpretation.
- After 120 days, you may lose the right to seek workers’ compensation benefits.
- Your employer should file a First Report of Occupational Injury form with their insurance company and the Bureau of Workers’ Compensation.
- The insurance company then has 21 days to accept or deny the claim.
- If you are denied coverage, you must file a claim petition. You must then appear before a judge with the Workers’ Compensation Appeal Board, who will review your records and evidence and determine whether you are entitled to benefits.
- If your appeal is denied, you may be able to take your appeal to the Pennsylvania Commonwealth Court or further on to the Pennsylvania Supreme Court.
Unfortunately, an appeal can be long, complicated, and exhausting after being denied benefits. In the meantime, you are not receiving needed benefits, and bills are piling up. At the hearing, you may be facing your employer, their insurance company, and their attorneys, all working against you. It’s to your advantage to have your own legal counsel to ensure you submit a complete and well-supported claim in the beginning or advocate for your rights during the appeal process.
Getting the Professional Assistance of an Experienced Work Injury Lawyer
Getting workers’ compensation benefits is not always easy and overturning a denial can be particularly difficult. After a workplace injury, getting the help of an experienced Pennsylvania work injury lawyer can help ensure that your claim is complete, concise, and supported adequately. Hence, you are more likely to be approved for benefits. You may also be able to file a third-party lawsuit if your injury resulted from someone’s negligence.
At Saffren & Weinberg, our skilled workers’ comp lawyers in Philadelphia are here to help. We have dedicated our practice to getting the crucial benefits that injured workers need and deserve. When you’ve suffered a work-related injury or illness, call us at (215) 576-0100 or contact us online to schedule a free consultation. Don’t take the chance of navigating a claim on your own.
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 available 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.