Workers' compensation in Pennsylvania provides payments and benefits for workers who are injured on the job. Workers' comp is a type of no-fault insurance where the injured worker can get benefits without having to file a lawsuit or prove the employer was responsible for the injury.
However, some employers or insurance companies wrongly deny workers' comp benefits, leaving an injured worker unable to provide for themselves and their families. An experienced Northwest Pennsylvania workers' compensation lawyer can fight to get a workers' comp claim approved and appeal a denial.
Workers' Compensation in Pennsylvania
Workers' compensation in Pennsylvania is regulated through the Workers' Compensation Act. Workers' comp provides compensation and medical expenses for work-related injuries. Compensation payments provide partial wage-loss for the time a worker is unable to work until he or she is able to go back to work.
Almost all workers in Pennsylvania are covered by workers' comp, (with some exceptions for federal workers, sole proprietors, and other excluded workers). Most employers are also required to provide workers' comp coverage. Benefits are either paid by the employer's workers' comp insurance provider or the State Workers' Insurance Fund.
Workers comp is a type of “no-fault” insurance, which means that the employee is not required to file a lawsuit to get payments for their injuries. It is intended to be the exclusive remedy for workplace injuries, increase workplace safety, and reduce litigation.
Coverage begins on the date an employee is hired. An injury, illness, or disease caused by the job is covered by workers' comp. However, intentionally self-inflicted injuries and injuries caused by an employee's violation of the law (including illegal drug use) is not covered.
Filing a Claim for Workers' Comp
The first step to getting benefits is to report a work-related injury or illness. The injury needs to be reported to an employer and supervisor, that the injury was work-related, and where and when the injury occurred. Workers must generally report an injury to the employer within 21 days. If the injury is not reported within 120 days, the compensation claim may be denied.
For injuries that result in the loss of a day or shift of work, the employer must first file a report of injury to the Bureau of Workers' Compensation within 7 days.
An employer or insurance carrier has 21 days after notice of the injury to either approve or deny the claim. If the carrier or employer denies the claim, the claim is considered closed and the injured worker should consider talking to a workers' comp lawyer to file a claim petition and find out what options are available.
How much will you get for workers' compensation?
The benefits available may depend on the job, income, and type of injury. Compensation includes wage loss payments, specific loss benefits, medical care, and death benefits.
Wage Loss Payments
If you are totally disabled because of the injury and unable to work or partially disabled and receiving less than before the injury, you can receive payments for lost wages.
Lost-wage payments are generally 2/3rds of your average weekly wages. The minimum compensation rate is the lower of 90% of the worker's average weekly wage or 35% of the statewide average weekly wage.
Specific Loss Benefits
If the injury causes permanent loss of all or part of a thumb, finger, hand, leg, foot, toe, sight, hearing, or serious and permanent disfigurement to the head, neck, or face, the injured worker may be entitled to a specific loss award.
The injured worker is generally entitled to all workplace injury related surgical and medical services. Depending on the employer and insurance provider, the employer may require that you visit a provider from a posted list of at least 6 providers for the initial treatment. You may be required to continue treatment with the listed provider for the following 90 days.
If the workplace accident or injury results in death, the surviving dependents may be able to receive death benefits. If you lost a family member because of a workplace accident, talk to an experienced attorney about your rights and legal options.
Was Your Workers' Comp Claim Denied or Cut Off?
An employer or insurance carrier may deny your initial claim, only provide temporary compensation, or cut off benefits. If your workers' comp claim was denied or the employer/carrier stops payment, talk to an experienced Northwest Pennsylvania workers' comp lawyer about your rights.
The insurance company or employer may decide to deny a claim or stop benefits for a number of reasons. This includes believing the injury was not related to the job, the employee is still able to work, or the employee has returned to work. The insurance company may even have an investigator follow the worker around and take photos and video as evidence the worker is not seriously injured.
Appealing a Workers Comp Claim
After the employer/carrier issues a Notice of Workers' Compensation Denial, the employee generally has 3 years from the date of injury to file a Claim Petition. The petition will generally be assigned to a judge in the county where the employee lives.
A workers' compensation hearing involves the employee and employer/carrier presenting evidence to the judge. The judge may schedule the case for mediation. The parties may also request an informal conference or settlement conference with the judge as a form of alternative dispute resolution.
If the judge issues a decision denying the claim, the injured worker has 20 days from the date of the decision to file an appeal with the Workers' Compensation Board.
After the Workers' Compensation Board issues an opinion, the injured worker has 30 days from the opinion publication date to file an appeal with the Commonwealth Court.
After the Commonwealth Court's decision, the injured worker has 30 days to file a Petition for Allowance of an Appeal with the Pennsylvania Supreme Court.
At each stage of the appeals process, it can be more complex and difficult to get your claim approved. An experienced Pennsylvania workers' comp attorney will review your case, injury status, evidence, and claim denial and handle the appeals to get the compensation you deserve.
Benefits of Using a Lawyer for Your Workers' Comp Case
An experienced workers' compensation attorney can help review your claim, file a claim petition, and negotiate with the insurance company to get your workers' comp claim approved. Workers' comp cases can be complex and any mistakes can result in losing your chance to get compensation.
You can be sure the employer and insurance company have lawyers working to deny your claim so it is only fair that you have an advocate on your side who understand workers' comp law in Pennsylvania.
There are a number of benefits to using an attorney for your SSD case. The SSDI application process can be complicated and any mistakes, errors, or accidental problems can be a reason for denial. An experienced attorney will do an in-depth review of your case to identify all the potential problems for why your claim could be denied.
At the Shafer Law Firm, we will never ask you to pay a fee unless we are able to win your case.
Crawford County Workers' Compensation Attorney
For 29 years, Crawford County attorney Jeffrey Millin at the Shafer Law Firm has been representing clients in workers' comp and personal injury cases across Northwest Pennsylvania. Experienced. Proven. Contact Jeffrey Millin in Meadville or Conneaut Lake today for a free consultation.