Getting injured on the job can be a stressful and confusing experience. Between dealing with pain, medical appointments, and lost income, the last thing you want is to navigate a complicated legal process. The good news is that Pennsylvania’s workers’ compensation system is designed to provide benefits to injured workers regardless of who was at fault for the accident. Here is what you need to know about filing a claim and protecting your rights.
What Is Workers’ Compensation?
Workers’ compensation is a form of insurance that provides wage replacement and medical benefits to employees who are injured in the course of their employment. In Pennsylvania, nearly all employers are required to carry workers’ compensation insurance. This system operates on a no-fault basis, meaning you do not need to prove that your employer was negligent to receive benefits.
Benefits typically include coverage for all reasonable and necessary medical treatment related to your injury, partial wage replacement while you are unable to work, and compensation for permanent impairment if applicable. Our workers’ compensation attorneys help injured workers throughout the Altoona area understand and access these benefits.
Step 1: Report Your Injury to Your Employer
The first and most critical step is to report your injury to your employer as soon as possible. Under Pennsylvania law, you must notify your employer within 120 days of the injury to be eligible for workers’ compensation benefits. However, waiting even a few days can create problems. Insurance companies may question why you delayed, suggesting your injury is not as serious as you claim or that it did not happen at work.
Report the injury in writing whenever possible. Include the date, time, location, and a description of how the injury occurred. Keep a copy of your written report for your records. If your employer has an incident report form, fill it out completely and accurately.
Step 2: Seek Medical Treatment
Get medical attention as soon as possible after your workplace injury. Pennsylvania has a specific rule about medical providers for the first 90 days of treatment. If your employer has posted a list of at least six designated healthcare providers, you must choose from that list for the first 90 days. After that period, you are free to see any doctor you choose.
Be completely honest with your doctor about how your injury occurred and the symptoms you are experiencing. Your medical records will be a key piece of evidence in your workers’ compensation claim. Any inconsistencies between what you tell your doctor and what you reported to your employer can be used against you.
Step 3: Your Employer Files the Claim
Once you report your injury, your employer is legally required to notify their workers’ compensation insurance carrier. The employer must file a First Report of Injury with the Bureau of Workers’ Compensation within their insurer’s reporting requirements. If your employer fails to file the claim, you have the right to file a Claim Petition directly with the Bureau.
After the claim is filed, the insurance company has 21 days to accept or deny it. If they accept the claim, you will begin receiving benefits. If they issue a Notice of Denial, you have the right to challenge that decision by filing a Claim Petition.
Step 4: Understand Your Benefits
Medical Benefits
Workers’ compensation covers all medical expenses that are reasonable, necessary, and related to your work injury. This includes doctor visits, hospital stays, surgery, prescription medications, physical therapy, and medical equipment. You should not have to pay any out-of-pocket costs for treatment related to your workplace injury.
Wage Loss Benefits
If your injury prevents you from working, you are entitled to wage loss benefits. In Pennsylvania, the rate is approximately two-thirds of your pre-injury average weekly wage, subject to a statewide maximum. These benefits are categorized as total disability (you cannot work at all), partial disability (you can work in a limited capacity but earn less), or specific loss (you suffered a permanent loss of a body part or function).
What to Do If Your Claim Is Denied
Claim denials are more common than many people realize. Insurance companies may deny your claim for various reasons, including disputes about whether the injury is work-related, arguments that you did not report the injury in time, or claims that your condition is a pre-existing issue. If your claim is denied, do not give up. You have the right to file a Claim Petition with the Bureau of Workers’ Compensation and present your case before a Workers’ Compensation Judge. An experienced attorney can significantly improve your chances of a successful outcome. Social media posts can also impact your claim, so be cautious about what you share online during this process.
Common Mistakes That Can Hurt Your Claim
Several common mistakes can jeopardize your workers’ compensation claim. Failing to report your injury promptly is the most frequent. Other mistakes include not following your doctor’s treatment plan, returning to work too soon, giving recorded statements to the insurance company without legal advice, and failing to document your symptoms and limitations.
Another critical error is not understanding the full scope of benefits available to you. Some injured workers may also qualify for Social Security Disability benefits if their injury prevents them from working for an extended period. Learning about the signs of approval for Social Security Disability can help you determine if you should pursue that avenue as well.
Third-Party Liability Claims
In some cases, a third party other than your employer may be partially or fully responsible for your workplace injury. For example, if defective equipment caused your injury, the manufacturer might be liable. If a negligent driver caused your injury while you were working, you could have a personal injury claim in addition to your workers’ compensation benefits. Our attorneys evaluate every workers’ compensation case to determine whether a viable third-party claim exists, because any settlement from a third-party case would be in addition to your workers’ compensation benefits.
Get the Help You Need
Filing a workers’ compensation claim in Pennsylvania does not have to be overwhelming. Knowing your rights and following the proper steps can make the process smoother and help you get the benefits you deserve. If you have been injured at work and need guidance, contact Gieg and Jancula for a free consultation. We are here to fight for your rights and help you focus on your recovery.