Pennsylvania Workers’ Compensation Claim FAQ

Q: What is Workers’ Compensation?

Pennsylvania’s Workers’ Compensation Act requires nearly all employers to provide Workers’ Compensation insurance for their employees. The insurance provides full medical, total and partial disability, permanent disfigurement and physical rehabilitation benefits to injured employees, provided their Workers’ Compensation claims are approved. In the event that a worker is killed on the job, death benefits are payable to the worker’s surviving spouse and dependents. Workers’ Compensation is also known as workers’ comp, workman’s compensation, workman’s or workmen’s comp, and workmen’s compensation.

Q. Who is covered under the Workers’ Compensation Act?

Almost all Pennsylvania workers, including those who work seasonally or part-time, are covered by the Act. Even non-profits and employers with only one employee must have Workers’ Compensation insurance, or provide it themselves. However, other compensation laws cover federal employees, railroad workers, longshoremen, shipyard workers and certain other employees. Those who may not be covered at all include certain volunteers, some agricultural laborers, domestics and certain agricultural workers.

Q. When must my employer start providing coverage for me?

Your coverage begins on the day you are hired. You do not need to be at your job for a certain period of time in order to receive benefits.

Q. Are all on-the-job injuries covered?

Workers’ Compensation covers most workplace injuries and illnesses. This is true even if an employer or other employee’s carelessness caused the injury. There are limits, however. Coverage is not provided in the event that an injury is caused by intoxication or illegal drug use. Coverage may also be denied if an injury is self-inflicted, suffered while the worker was committing a crime, or if the worker violated company policy. You should know that your injury need not be caused by an accident to be covered. Often, workers receive compensation for injuries that accumulate over a long period of time, such as carpal tunnel syndrome or back pain. Diseases that develop gradually as a result of work conditions also fall within the Act. These might include heart or lung conditions or stress-related illnesses. You might also be entitled to benefits if your work aggravates a pre-existing condition.

Q. If I am entitled to benefits by law, why do I need an attorney?

Even though the law requires your employer to provide Workers’ Compensation insurance for your protection, your employer or your employer’s insurer may not automatically start paying benefits to you if you are injured or become ill as a result of your job. Under the Workers’ Compensation Act, you must take certain steps to begin the claims process and follow particular procedures and prove particular facts along the way. If you do not meet the Act’s requirements, you could forfeit some or all of the benefits to which you are entitled. A skilled Workers’ Compensation attorney, such as the partners at Schmidt, Kirifides & Rassias, can help ensure that you secure the maximum benefits available without delay. Keep in mind, too, that your employer and the employer’s insurance company will have experienced lawyers working for them. You should, too. Because time is of the essence in these matters, do not delay in contacting an attorney if you think you have a claim. Waiting to do so could result in delayed or forfeited benefits.

Q. What makes Schmidt, Kirifides & Rassias a good choice to handle Workers’ Compensation claim?

The lawyers at Schmidt, Kirifides & Rassias are experienced attorneys who have spent more than a decade handling Workers’ Compensation matters for claimants like you. Workers’ Compensation is all we do. We care about you and your family and strive to help you obtain all that is owed to you under the law. And we pride ourselves on superior service to our clients. When you choose Schmidt, Kirifides & Rassias, you do so knowing that you will receive personalized, courteous attention from your lawyer. And you will deal only with your attorney because our lawyers attend to each matter themselves. We are passionate about our work and set out not to meet, but to exceed, our clients’ expectations. We will help you decide whether you have a valid claim and, if so, determine what steps you must take to obtain benefits. In addition, it is common for insurers or employers to initially deny a Workers’ Compensation claim. In the event your claim is denied, we can handle the appeals it will take to get you the benefits that you are owed. Finally, one of our competent Workers’ Compensation lawyers can determine whether you may bring suit against any third parties that contributed to your injury or illness.

Q. How do I make a claim for Workers’ Compensation benefits?

Your first call should be to your Workers’ Compensation attorney, who can help you take the correct steps to increase the likelihood that you will receive benefits. These steps include: (1) Promptly reporting any injury or work-related illness to your employer or supervisor. Telling a co-worker is not sufficient. When you tell your employer or supervisor about your injury or illness, you must be sure to specify the date and place of injury. If possible, the notice you provide should be in writing. (2) Filing a claim petition if your employer or the employer’s insurance carrier denies coverage for your injury or illness. Your petition will then be assigned to a Workers’ Compensation judge. (3) If, after hearing evidence and testimony, the judge denies your claim, there are multiple levels of appeal that your lawyer can help you navigate. It is important not to give up if your claim is initially denied. This is a common occurrence and you are not without recourse. A skilled attorney can help you pursue your claim with the goal of securing all of the benefits to which you are entitled.

Q. How can my employer respond to my claim for benefits?

Within 21 days of receiving notice of your claim, your employer (or your employer’s insurance company) must respond with a Temporary Notice of Compensation Payable, Notice of Compensation Payable or Notice of Compensation Denial. A letter from the insurance company or employer, or the filing of only an incident report, is not a legally recognized response. (1) A Notice of Compensation Payable means your claim has been accepted and wage loss and medical benefits will begin. You might still need a lawyer to ensure the description of injury and benefit rate are correct. (2) A Notice of Compensation Denial means your claim has been denied. Immediately contact an attorney to discuss your options. (3) A Temporary Notice of Compensation Payablesometimes results in a false sense of security. Your employer can file this notice if the employer is unsure about accepting your claim. Under this notice, your employer can provide benefits for up to 90 days without legally accepting your claim. If your employer issues a Temporary Notice, you should consult with an attorney.

Q. Are there time limits that apply to Workers’ Compensation claims?

Yes. You must inform your employer within 120 days of your injury or disability. While this seems like plenty of time, in reality it is crucial to report any injury or work-related illness to your employer or supervisor right away. You must tell your employer that you were injured while working, giving them the date, location and nature of the injury. If your employer or insurer denies your request for Workers’ Compensation benefits, you have three years from the date of injury to file a Claim Petition. In the case of occupational illness or disease, the injury or disability must occur within 300 weeks from the date of your last employment in an occupation in which you were exposed to a hazard. A petition must be filed within three years of the date of injury or disability. If your benefits were suspended and your condition changes or worsens and you again become disabled, you can file a petition to have benefits reinstated. The petition can be filed up to 500 weeks after the suspension. If you do not take action within these time frames, you could forfeit your right to benefits.

Q. What kinds of benefits are available and how are they calculated?

The Workers’ Compensation Act provides for several kinds of benefits. Depending on your individual situation, you may qualify for lost wages, specific loss benefits, medical care and/or death benefits. (1) Lost Wages: Payments for lost wages are available to employees who are unable to work due to a “total” or “partial” disability. They are also payable to workers who, due to a temporary disability, are earning or are capable of earning less than they were making pre-injury. Wage loss benefits typically total two-thirds of your average weekly wage, subject to a weekly maximum. (2) Specific Loss Benefits: These are payable to workers who permanently lose the use of a limb or appendage; their sight or hearing; or who have suffered a serious and permanent disfigurement of the head, face or neck. (3) Medical Benefits: Covered claims will include payment for reasonable and necessary surgical and medical treatments that are provided by a physician or other healthcare provider. If they are deemed necessary, medical supplies, hospital treatment and services, orthopedic appliances and prostheses will also be covered. Employees may not be charged the difference between a healthcare provider’s fee and the amount paid by the employer or insurance carrier.

Q. How do I know how much my case is worth?

Each case is different because each depends on the facts and circumstances of a worker’s injury or illness. It is possible to have 10 people who have suffered the same injury, and yet have each case be worth a different amount. Some of the factors that will affect your case are: the way your injury occurred, the insurance company involved, your age, whether you have been offered other jobs and other medical conditions unrelated to your work injury. The variable nature of Workers’ Compensation claims is just one of the reasons why it is important to secure the services of a knowledgeable, experienced firm like Schmidt, Kirifides & Rassias. Our lawyers know how to evaluate cases. If your attorney feels you have a valid claim, he can explain how the various factors might affect it and what its worth might be.

Q. How long will it take to resolve my case?

Typically, it takes about a year for a Workers’ Compensation claim to go through the court system, although there are instances when a settlement or agreement is reached before the case ends, and other times when the litigation takes longer. Each case is different.

Q. Can I get money for pain and suffering?

No. Workers’ Compensation benefits are not available for pain and suffering. The Workers’ Compensation system is very different from the civil court system that handles personal injury cases and the like, which is where damages for pain and suffering are recoverable. There are, however, instances in which someone other than your employer or co-worker is responsible for causing your injuries. In such cases, you can pursue monetary damages including those for pain and suffering. An experienced Workers’ Compensation attorney can help you determine whether you have such a case.

Q. Can I settle my claim instead of going to court?

Yes. You can resolve your Workers’ Compensation claim by settlement – called a Compromise and Release – but only if both sides agree to the terms. If both sides do not agree on the amount or other terms there is no settlement. Your employer’s insurer cannot force you to take less than you are willing to take; and you cannot force the insurance company to give more than it is willing to give. Even if all sides agree, a Workers’ Compensation judge must still approve the settlement after making sure that you understand the legal significance of it.

Q. Can I ever sue my employer if I am injured at work?

Typically, you cannot sue your employer for a work-related injury or illness. The Workers’ Compensation system is meant to provide employees who are disabled by work-related injury or disease with fixed monetary awards. It is intended to protect employees by guaranteeing benefits for accepted claims, and also to safeguard employers from lawsuits. However, there are some limited situations when you may sue the employer in court. If you think you have such a case, it is important to contact an attorney for assistance with your dispute.

Q. Can I apply for benefits in addition to those provided by the Workers’ Compensation Act?

Yes. You are permitted to apply for other sources of income such as Social Security, unemployment or public assistance while your case is proceeding. However, you must remember that Workers’ Compensation is a “wage loss” system. You may not “double dip.” That is, you cannot receive benefits from two different sources. This means that at the conclusion of your claim, the insurance company might be able to deduct what you received in other benefits from your Workers’ Compensation claim. Or you might have to return money to the agency from which you received those benefits.

Q. Can I get another job?

You are permitted to return to work if you are physically capable of doing so. Even though your injury may leave you unable to perform your regular job, you may be capable of performing a lighter-duty job. If that is the case, the insurance company might offer jobs it thinks you can handle. Or you might learn of job openings or opportunities on your own. Bear in mind, though, that the Workers’ Compensation system will pay benefits based only on the wages you lose. If you return to work at the same salary you were earning at the time of your injury, you will not be losing any wages and you will therefore receive only medical benefits. If you return to work at a lower salary, Workers’ Compensation may pay you a reduced benefit depending on the amount of your current earnings, and will continue to pay the medical bills related to your work injury.

Q. Can I see my own doctor about my injury or illness?

Whether you can see your own physician depends on your employer. If your employer has posted a list of six or more physicians, and you have signed an acknowledgement form indicating that you are aware of the list, then you must choose one of those physicians for your initial treatment. For 90 days thereafter, you must continue to treat with one of the healthcare providers on the employer’s list. You are entitled to a second opinion in the event that invasive surgery is recommended, however. After 90 days, or in the case of workplaces with no list, or where you have not signed an acknowledgement form, you may see your own physician for treatment. You will have to notify your employer of the provider you choose. After you begin receiving benefits, your employer or the employer’s insurer is entitled to ask you to see their doctor for an examination. If you refuse, a Workers’ Compensation judge may order you to comply with the request. Failure to comply with the order could result in suspended benefits.

Q. What if my doctor and the insurance company’s doctor disagree?

If the insurance company doctor feels that you have fully or partially recovered from your work injury, but your own doctor believes that you are still disabled and unable to return to work, the insurance company may file a petition to challenge your benefits. A Workers’ Compensation judge will hear each doctor’s medical opinion and render a decision based on their testimony.

Q. What does it cost to hire a Workers’ Compensation attorney?

At Schmidt, Kirifides & Rassias, your lawyer’s fee will be based on the benefits we obtain or maintain for you. If we do not secure or maintain benefits for you, we will not get paid.

Q. How will my attorney be paid?

How and when your lawyer gets paid depends on what type of case you have. If the insurer has denied your claim, we will fight your entire case. If we do not obtain benefits for you, there is no fee for our service. If an award is made in your favor, the judge will order the attorney’s fee. In exact compliance with the judge’s order, the insurance company will pay your benefits to you in one check, and issue a separate check to us for our attorney’s fee. We may receive counsel fees for as long as you receive benefits. If, on the other hand, the insurance company has paid you benefits, and the insurer then files a petition to reduce or eliminate those benefits, we will appear on your behalf and submit relevant documents to the judge. The judge will then make a preliminary decision on whether you are to continue receiving benefits while the case proceeds. The judge may also issue an award of attorney’s fees at that time. If so, the insurance company will issue the appropriate benefits to you in one check, and the attorney’s fee to us in a separate check. Finally, if there is a settlement, the insurance company will also issue two separate checks. One check will be issued to you for your share of the settlement. The other will be issued to us for attorney’s fees. In most cases, the attorney’s fee is deducted from the client’s benefits. In some cases, the attorney’s fee may be paid by the insurance company directly and will not be taken out of the client’s benefits. This is what we request in all cases, but you should be aware that such an award is extremely rare.

Q. Can my employer fire me for making a Workers’ Compensation claim?

Maybe. It is unlawful for your employer to fire you just for seeking Workers’ Compensation benefits. In addition, it is unlawful for your employer to harass or otherwise discriminate against you for doing so. However, an employer is permitted to fill a vacant position and may not have an opening when you recover from your injury. The rights and duties of the employee and employer may be covered by a written company policy, contract, collective bargaining agreement or even by Labor Laws separate from the Pennsylvania Workers’ Compensation Act.

Q. What is the timing for an appeal of  a Workers’ Compensation Court decision?

A party to a Workers’ Compensation claim who receives an unfavorable decision from the Judge must file an Appeal within 20 days of that decision, or the appeal will be dismissed. Where an appeal is filed by mail, the envelope must have a US Postal Service mark (not a private postage meter stamp) OR a Certificate of Mailing to prove the date the appeal was filed. Otherwise, the appeal is deemed filed on the date it is “received” by the Bureau of Workers’ Compensation,  rather than the date mailed.

Q. Where can I go for further information about Workers’ Compensation?

Pennsylvania’s Department of Labor and Industry provides online information for individuals. Click here. The Workers’ Compensation Appeal Board also maintains a Web site. Click here. You may also ask your supervisor, union or your employer’s Workers’ Compensation insurance carrier for additional information. Finally, Pennsylvania offers a Workers’ Compensation helpline. The e-mail address is ra-li-bwc-helpline@state.pa.us. Or, call toll-free inside Pennsylvania: 800.482.2383 (800.362.4228 for hearing impaired callers). Local calls and those made outside of Pennsylvania should dial 717.772.4447 (717.772.4991 for hearing impaired callers).

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