Understanding PA Workers’ Compensation Claims
Workers’ compensation is meant to protect you in case you are injured in the workplace. These benefits allow you to have some income as well as a means to pay medical bills, among other benefits. With the Pennsylvania workers’ compensation system, employers pay for the insurance, and in the case of a workplace injury, eligible workers are supposed to get benefits, regardless of fault in the injury.
Many workers who have been injured in Pennsylvania have questions about filing for worker’s compensation. The PA workers’ compensation claims process was created to help workers, but you are more likely to improve your chances of securing benefits if you understand how it works. It can also be useful to speak to a workers’ compensation attorney if you have any concerns and would like personalized legal advice.
When to File a Workers’ Comp Claim
Timing is important. You will start the workers’ compensation process by reporting your injury or work-related illness to your employer. In Pennsylvania, you must do this within 120 days of sustaining your injury or falling ill. If you wait longer, you may lose the right to seek benefits. Although 120 days may seem like plenty of time to file your claim, you will want to inform your employer as soon as you are able. Delays can increase the risk of challenges to your claim, and waiting can hurt your case.
How to File a Workers’ Comp Claim
To start the workers’ compensation claims process in PA, you will need to:
1) Inform your employer of your injury.
Within 120 days of your injury or illness, you will need to tell your employer you have suffered a work-related illness or injury. Ideally, you will want to report your injury sooner than this deadline.
2) Seek immediate medical attention.
As soon as possible, visit a doctor about your illness or injury. When seeking medical attention, be sure to mention that the injury was job-related so the process of documentation can start. Within the first 90 days, you may be required to choose an employer-approved doctor from a list provided by your employer. Outside of these 90 days, you can choose your own physician.
Medical records are an important part of the evidence presented in the workers’ compensation claims process in Pennsylvania, so it is important to seek medical attention. Even if you are not sure you are injured, seeking a medical opinion can ensure you get the treatment you need as well as a professional diagnosis of your condition. Prompt medical attention can also mean you get the appropriate treatment, which can help you avoid medical complications and pain.
3) File your claim with the Pennsylvania Department of Labor and Industry
The third step in the Pennsylvania workers’ compensation claims process is to file a claim with the Pennsylvania Department of Labor and Industry. Your employer must submit a First Report of Injury to the state to start the process. There is a strict deadline of three years from the date of injury to file a claim petition to ensure you do not lose your rights to benefits.
What Happens After a Claim Is Filed?
Once a claim is filed and the workers’ compensation claims process begins, your employer’s insurer has 21 days to deny or accept the claim. If your claim is accepted, you will receive benefits, usually within 21 days of your injury. However, as time goes on, your benefits may change or may be stopped.
There are many ways your benefits may be changed, even if you are approved:
- Your employer may ask you to submit to a labor market survey, which evaluates the employment market and jobs you could do with your injury in the current job market. Your employer or their insurer can use the labor market survey to reduce your benefits after filing the appropriate petition in court.
- You may decide to return to work yourself, which means you may still qualify for benefits for a partial disability. Whether you are eligible for partial disability depends on your wages.
- Your employer may offer you a different type of work duty which takes your injury into account. If they do this, they can take steps in court to reduce your disability benefits.
- Your employer or their insurance company can ask you to submit to an IME (independent medical exam) to determine whether you have recovered. If the physician finds you have recovered, the employer and insurance company can take steps in court to stop your benefits.
It is useful to work with a workers’ compensation attorney if you are facing a labor market survey, IME or any potential changes to your benefits. An attorney can steer you through the process and can vigorously defend your rights to benefits.
What Specialists Do You Need to See?
If you have suffered a work-related injury or illness, there are a number of specialists you may need to see or want to see as part of the claims process:
1) A doctor.
One of the first people you will need to see if you have been injured on the job is a doctor. You must tell this doctor you have been injured at work or think you may have a work-related condition so they can start the process of securing medical information for your case. Your doctor may also recommend treatment options.
In Pennsylvania, you may be required to see your employer’s panel doctors for your treatment during the first 90 days after your injury. If you choose to see your own doctor, workers’ compensation benefits may not cover the costs during the first 90 days after your injury. However, you only need to see your employer’s panel doctors if your employer met all of the requirements under the Pennsylvania Workers’ Compensation Act, including but not limited to:
- You signed paperwork for “acknowledgement of rights and duties” on at least two documents at your time of hire and after your injury, AND
- The employer posted a list of at least six different doctors for you to choose from.
If your employer did not meet these requirements, you may be able to choose your own physician and have your own costs covered right from the first day of injury. It can be beneficial to see your own doctor rather than an employer-approved one. Choosing your own medical provider means you can choose someone you are confident has your best interests in mind.
Unfortunately, there is a lot of confusion about employer-approved physicians. Even your own employer may not understand the rules. If you are concerned, talk to a workers’ compensation attorney to ensure you get quality medical attention. Even if you have to see an employer-approved provider, keep in mind you can switch to doctors of your own choice 90 days after your injury.
2) Medical specialists.
Depending on your work injury, you may be sent to medical specialists. For example, if you have injured your foot you may be sent to an orthopedic professional. If you need surgery, you will be sent to the appropriate surgeon.
3) A workers’ compensation attorney.
Many people only seek out the help of a workers’ compensation attorney if their claim is denied or if they run into delays, but it can be useful to speak to an attorney from the start of your claim. An attorney can ensure you abide by state deadlines so you don’t miss your opportunity to secure benefits. They can explain the workers’ compensation process and guide you through the claim while also securing the evidence you need to get benefits.
If you suspect there may be any problems with your claim, it can be especially important to consult with an attorney. If your claim is rejected or your employer has not secured insurance for you or is delaying submitting a claim, you may want to work with an attorney to ensure your rights are protected.
Anyone who has been injured at work can benefit from speaking to a workers’ compensation attorney. Although the claims process is created to ensure workers get benefits promptly, in reality there may be delays and complications. An attorney can address these issues and answer any questions you have.
4) A financial professional.
Unfortunately, work injuries can cause serious financial distress for workers. While workers’ compensation is meant to address these problems, it can take months or a year to resolve a claim. In the meantime, you may worry about paying the bills.
If you are concerned about your finances after an injury, it can be beneficial to speak to your workers’ compensation attorney. Attorneys understand the pressures of claims and can advise you about short-term disability benefits, unemployment benefits and other options. Before you accept any benefits, sign any paperwork or take on any job to pay the bills, it’s important to speak to your attorney, as any of these options could affect your workers’ compensation claim. If your attorney thinks it appropriate, he or she may refer you to a financial professional so you can organize your finances and ensure you get the support you need.
What Is the Process of a Workers’ Comp Case?
Once your claim is denied, the process of obtaining benefits begins when a Claim Petition is filed with the Pennsylvania Department of Labor and Industry.
The workers’ compensation process in Pennsylvania can take many months. If the insurance company tries to deny the claim, the process of submitting the evidence and waiting for a judge’s decision can take a year or more. Unfortunately, it can be very difficult for an injured worker to pay bills, get medical treatment and pay for everyday expenses. This is one reason why many injured workers seek out legal assistance to get legal advice about their situation.
During litigation, your attorney will present medical evidence in support of your injury, and your doctor may be asked to testify by a deposition. You may be asked to testify, and your attorney can prepare you for this process. The insurance company for your employer may present its own evidence, including its own medical deposition. In some cases, it may claim you are not eligible for benefits because the injury was not work-related. It may also claim you can return to work. Your attorney can then submit legal briefs of 10 to 40 pages to the judge outlining the legal arguments in favor of the case. A workers’ compensation judge will then issue a decision.
Do You Need Help with the Claims Process?
Your attorney will review your claim and answer your questions during your free consultation. If you decide to proceed, your attorney will represent you at an administrative hearing and beyond if necessary. At Frommer, D’Amico and Anderson, workers’ compensation is the only field of law we practice. All of our attorneys are certified as workers’ comp experts by the state of Pennsylvania. If you cannot travel to our office, your attorney will come to you. Personal attention and caring representation set us apart from every other workers’ comp law firm in Pennsylvania.
Whether you are dealing with late checks or have been denied benefits, the attorneys at My Comp Lawyers can take your calls and address your concerns. We will take your case before a judge if that is what is necessary. My Comp Lawyers offers free case management, and we do not ask clients to pay advance costs in litigation.
You’ll also get:
- Convenient access to your attorney. Your attorney can talk to you at night, over the weekend or in your home — wherever it is convenient for you.
- Cost-effective representation. Review our contingency agreement and you’ll find that we provide free case management services. We also don’t charge for depositions, transcripts, medical or doctor records.
- Your questions answered — fast. Avoid frustrating delays and skip leaving unanswered messages with secretaries. You’ll get the detail-oriented representation you deserve.
Pennslyvania Workers Compensation Claims Process and Tips Recap
Workers’ compensation claims in PA are much more complex than many people realize. Once you’ve been injured on the job, there are several things that will be part of the process:
1) The steps you take immediately could affect your workers’ comp claims in PA.
Once you’ve suffered an injury at work, you’ll want to get immediate medical help if you need it. If there’s a chance you’ve suffered a head injury or if you’re seriously injured, get someone to contact emergency services for you. In addition to prompt medical attention, however, you’ll want to start documenting your injuries and report your injuries to your supervisor, manager or the appropriate person at your workplace.
You’ll also want to start documenting any costs you incur as a result of your injuries and medical costs. Keep a careful record of how the injury affects you. At this stage, you may also want to get legal advice from My Comp Lawyers about your Pennsylvania workers comp claim. We can help guide you through what can be a complex process and pursue every avenue so you get the maximum compensation.
2) Stay informed about your Notice of Compensation Payable and your Statement of Wages.
The Notice of Compensation Payable and Statement of Wages are filed with the Pennsylvania Department of Labor and Industry and are filled out by the workers’ compensation insurance carrier. You should get a copy of this paperwork and check it carefully to ensure your wages, the description of your injury, and your type of employment is filled out correctly.
Incorrect information can hurt your Pennsylvania workers’ compensation claim. For example, if a fracture is inaccurately listed as a sprain, you may not get the full benefits you’re entitled to. If your wages are listed as lower than your actual pay, you may get less than you deserve. If you have trouble getting a copy of the Notice of Compensation Payable of if the information is not accurate, contact My Comp Lawyers to get the situation rectified.
3) Act quickly if you receive late checks or checks for less than you expect.
If an insurer sends you late checks, contact My Comp Lawyers after noting when the check arrived and making copies of the check and envelope. Similarly, if you are receiving less than you expect because of offsets or for other reasons, get legal help. My Comp Lawyers can review your benefits to ensure you are getting the maximum that you deserve.
4) Know what to do if your claim is denied.
When you sustain an injury at your job, workers’ compensation insurance is supposed to reimburse you for your wages during the time you cannot work. Unfortunately, denied workers’ comp claims are all too common in Pennsylvania. If you received notice of a claim denial and aren’t sure what to do, My Comp Lawyers can help. Hire us to fight your denied workers’ comp claim and let us help you get the payments you deserve.
There are a variety of reasons why an insurer might deny your claim for workers’ comp benefits. Because the law requires notifying the insurance carrier and the state quickly, failure to act promptly can cause a denial. In other cases, your employer may dispute that the injury or illness happened at work. If your employer disputes the injury, your attorney at My Comp Lawyers will gather evidence that supports your claim. Some insurers look for minor reasons to deny a claim. For example, if the insurer decides your injury is not serious enough to warrant payment, you may need to hire an attorney.
Read your denial notice carefully because it will tell you how to appeal. In some cases, a fast phone call to the insurer can resolve any outstanding issues. In other cases, you’ll need a workers’ comp attorney experienced with Pennsylvania law to get you the payments you deserve.
Hire a PA Workers Compensation Attorney to Help You File Your Workers Compensation Claim
If you have been injured on the job or have been diagnosed with a work-related illness, you may need legal advice. If you need legal representation or advice in Pennsylvania, contact My Comp Lawyers for a consultation. All attorneys at MyCompLawyers.com are certified workers’ compensation experts, and we have chosen to keep our law firm small to ensure each client and case receives personalized attention.
Even if you need to speak to an attorney on the weekend or in the evenings, the legal team at My Comp Lawyers is available. My Comp Lawyers serves Pennsylvania’s injured workers, including workers in Allentown, Altoona and Scranton. If you have been injured at work and are not getting the benefits you deserve, contact our expert team of attorneys today for a free consultation.
Updated: December 13, 2017