Our team of personal injury and workers’ compensation lawyers can assist you with getting the benefits that you deserve from both your employer and third parties whose negligence may have contributed to your injury in a workplace accident.
Here are a few answers to frequently asked questions which employees in Pennsylvania have about the workers’ compensation system.
Frequently Asked Questions
What is workers’ compensation?
Workers’ compensation pays the medical expenses and lost wages of employees suffering an on the job injury or work-related illness. In cases of a work-related death, it pays a benefit to the employee’s dependent survivors.
The workers’ compensation system is an exception to the normal litigation process created by the Pennsylvania legislature nearly a century ago. It removes these disputes between employees and employers from the court system. You are not eligible to bring a lawsuit in court against your employer for a work injury even if they are negligent.
Like “no fault” car insurance, your employer’s insurance pays eligible claims regardless of whether the company was negligent. If your employer has not purchased insurance or followed the appropriate procedures to self-insure, then the state of Pennsylvania will pay for your claim through the Uninsured Employers Guaranty Fund.
The terms and conditions of the whole system are specified in the Pennsylvania Workers’ Compensation Act as well as the accompanying rules and regulations.
Am I covered by Workers’ Compensation?
Nearly every Pennsylvania worker is covered by the workers’ compensation system. Employers must cover all eligible employees, including part-time and seasonal workers. Unlike some laws which exclude employers below a certain number of employees, the workers’ compensation system covers nonprofits, unincorporated businesses and even employers with only one employee,
The law excludes certain workers who are covered by other systems when they are injured, such as railroad workers, longshoremen and federal workers. The law also excludes a handful of other categories, including certain real estate licensed salespersons, domestic workers, and agricultural laborers. However, the vast majority of people working in Pennsylvania on a day to day basis are covered by workers compensation.
If you are automatically eligible (almost everyone), then you are protected from your first day of employment and do not have to select coverage, pay a fee or wait for your coverage to begin like health insurance.
What types of injuries are covered?
The workers’ compensation system protects employees who suffer a wide variety of injuries, from minimal injuries that require medical treatment to the severest accidents causing the death of an employee. Even a minor incident that aggravates or substantially contributes to an existing injury is covered.
Covered injuries can include injuries caused by a specific incident, such as a forklift accident, broken arm due to a slip and fall, or back injury from carrying a heavy box. It can also cover medical treatment and lost wages due to repetitive injuries, such as carpal tunnel syndrome from typing, or illnesses caused by work, such as mesothelioma from asbestos exposure.
You do not need to be at your workplace to receive compensation for your injuries. If you are in the course and scope of your employment, then you may be protected. For example, if you are traveling for work (other than your daily commute), your injuries may be covered.
No compensation is paid when an injury is intentionally self-inflicted or the injured employee is violating the law, such as by using drugs.
I’ve been injured. What do I need to do?
If you have a work-related injury or illness, you should notify your employer or supervisor as soon as possible. Indeed, some employers require their workers to report injuries immediately.
Written notice works well as it creates a record of the substance of your notification that can be used later. However, oral notification is sufficient under the law. Your notification should make clear to your employer or supervisor that you have been injured in a work-related accident. It is not enough for a co-worker to witness the accident as this does not put your employer on notice that they should tell their insurance carrier and start the workers compensation process.
It is important to provide accurate information to your employer concerning the accident and your injuries. If you have questions, please call (866) 357-8614 to speak to an attorney at McEldrew Purtell.
If you do not notify your employer, your benefits may be delayed or denied. Your employer has 21 days from your notification to decide whether to accept the claim, deny the claim or make temporary compensation payments. In any event, notice must be given no later than 120 days after the injury for compensation to be allowed.
Other time limits apply in some cases. In certain cases, you may not immediately realize that you have been injured. When you discover that you have been injured, report it to your employer or former employer and consult with an attorney concerning these deadlines.
How do I get medical treatment?
The workers compensation system covers reasonable surgical and medical services rendered by a health care provider. It includes hospital treatment, medicine, supplies and medical devices as long as they are needed. Your care is covered even if you do not lose any time at work.
If your employer has properly posted a list of designated providers for the treatment of a work injury or illness, you must seek non-emergency care from them for the first 90 days of medical treatment. The address, phone number and specialty of the provider will be on the list. You are entitled to choose freely from the list and may switch providers on the list if you choose. In a medical emergency, you may seek treatment from any physician but subsequent care must be rendered by a designated physician.
If your employer has posted a list and you seek non-emergency treatment elsewhere during the 90-day period, your employer or their insurance carrier may refuse payment for treatment. After the 90 day period has expired or where there is no posted list, you are free to choose your own health care provider. If you seek medical treatment outside of Pennsylvania, you may also lose some or all of the benefits of the workers compensation system.
What happens if I can’t work?
The workers’ compensation system in Pennsylvania pays injured workers two-thirds of their weekly wage up to a maximum of the average weekly wage in the state as calculated by the Department of Labor and Industry. The average weekly wage in Pennsylvania in 2015, for example, was $951 per week.
There is a 7 day waiting period before the state begins to pay for lost wages. If you are out of work for more than 14 calendar days, you will be reimbursed for lost wages during the waiting week. Some employers encourage employees to use their sick time for the first 5 working days if they are not sure they will be out of work long enough to receive coverage for their lost wages during the first week.
Do I need a lawyer?
Your employer or their insurance carrier will have a lawyer represent them throughout the process to ensure that they do not pay you if they do not have to do so. It is important to have an attorney on your side to make sure that your rights are protected, deadlines are met,
Without your own representation you put yourself at an immediate disadvantage. Additionally, an opposing attorney will seek to stop or reduce benefits paid. That is why it is critical to obtain skilled legal representation for every step of the workers’ compensation process.
An experienced attorney will give critical advice when calculating benefits, but also advice when dealing with signing documents, and various filing requirements. The law offices of McEldrew Purtell can also help connect you with the right health care providers along the way, and we don’t get paid unless we help you receive benefits, keep your benefits, or reach a settlement.
How much does an attorney cost?
Our attorneys handle workers’ compensation and personal injury cases on a contingency fee basis. There is no attorney fee for our services unless you recover. Our rates for these cases are competitive with what is typically charged by other attorneys in these practice areas.
My spouse or family member was killed at work. Help!
We are very sorry to hear that your family has suffered this enormous tragedy. You have our heart-felt condolences for your loss.
Workers’ compensation benefits are available to dependents of the employee if the death was work-related. Dependents typically include the surviving spouse and children but parents and even siblings of the employee can in some circumstances be dependents. The payments are a specific percentage of the average weekly wage as well as an initial payment for burial expenses.
The children are eligible while they are under 18 years of age (or 23 in the case of a child enrolled in college or graduate school). The spouse is eligible until he or she remarries, enters into a similar relationship, or passes away.
Many claims for death benefits are settled with lump sum payments. The insurance company does not want to risk that the surviving spouse will be receiving payments for the rest of a long life. The surviving spouse wants their family to be compensated even if he or she passes away unexpectedly or meets another person.
When will my benefits start?
Your employer’s insurance company has 21 days from your notification of injury to decide whether to cover it, deny your claim or extend the investigation for 90 days with a Notice of Temporary Compensation Payable. If your injury is accepted and you have missed more than seven days of work, you will receive your check for wage loss shortly thereafter. If they issue a Notice of Temporary Compensation Payable, your wage-loss benefits will be paid on a temporary basis for a 90-day period while they further investigate your claim.
What if my benefits are denied?
If your claim is denied by your employer or their insurance company either initially or after temporary payments, then the filing of a Claim Petition with the Pennsylvania Bureau of Workers Compensation is necessary. This is typically handled by your legal counsel due to the complexity of the form and process. The Judge assigned to your petition will hold a series of hearings to listen to testimony by doctors concerning your injuries. Unfortunately, this process can take a year or more.
This process is complex and the Department of Labor & Industry advises that individuals consider hiring an attorney in order to navigate the process as your employer or their insurance carrier will be represented by counsel in opposition to your claim.
The denial of your initial application for workers’ compensation does not mean that you will not ultimately prove meritorious. Your employer may have denied it on the basis of incorrect information, faulty medical information or on the basis of other objections which could be challenged through the litigation process.
When do my benefits end?
Once benefits start, your employer and their insurance carrier generally can’t unilaterally stop paying. In some instances, you may receive payments for the rest of your life. However, the length of time that you will receive benefits depends on a number of factors and there are several reasons your workers’ compensation benefits can end. Some of these reasons include:
- If you return to work or are able to return to work, your benefits may be reduced or stopped.
- If you refuse or fail to comply with various procedures such as submitting to a medical exam or returning an employee verification form.
- If you are put in jail after being convicted of a crime
- If you are partially disabled and exhaust the 500-week period of benefits
- If you are collecting specific loss payments for an amputation or other loss of the use of a body part, and the time period for payment ends
- You take a lump sum payment of money to settle your workers’ compensation claim.
- If your death is caused by an event unrelated to your work injury.
Workers’ compensation is designed to compensate you for medical treatment and lost wages related to work injuries. If you get better, your benefits end.
Get in Touch
Our team of attorneys with experience in both employment and personal injury matters provides the right combination to get your questions answered. If you need additional assistance, please call us at (215) 545-8800.