Procedures for Filing Workers’ Compensation Claims in Pennsylvania
In Pennsylvania, workers’ compensation is mandated by the Pennsylvania Workers’ Compensation Act. The system was put in place to protect employers, as well as workers. Employers are protected from getting sued by workers who are injured on the job, while injured workers are compensated for medical costs and lost wages. However, workers must follow mandatory procedures to receive benefits. The Pennsylvania Department of Labor and Industry has published a detailed flowchart illustrating this process. The steps in this flowchart can be divided into two main categories:
- Filing an initial claim
- Filing an appeal if you are denied benefits
Even if you are successful in obtaining benefits after filing your initial claim, your employer may attempt to decrease or terminate your benefits later. You may choose to appeal those negative decisions as well.
Procedures for Filing a Claim
Follow these three steps when filing your initial claim to protect your legal rights to workers’ compensation benefits.
Obtain Medical Care
Seek medical attention immediately if you are injured at work or as soon as you become aware that your illness or injury is work-related. If your employer posted a list of approved health care providers, you would need to choose a doctor from that list to obtain coverage.
- Keep records of all medical bills and other expenses, such as medication. All your medical bills are covered but you must be able to document your expenses.
- Follow all treatments Failure to do so could disqualify your right to benefits.
- Keep a diary starting from the time you are injured and continuing until you are fully healed. Make sure you take the time needed to describe in writing all your injuries and how they affect your life. This may prove crucial in securing benefits.
Report Your Injury to Your Employer
Properly reporting your injury is vital to receiving benefits. If you are injured on the job, immediately report the incident to your supervisor, personnel department, and union steward. When doing so, be sure to describe:
- The date of the injury
- Where the accident occurred
- Each body part affected
The sooner you report your injury or illness, the better. If you give notice of the injury within 21 days of the accident, you may be eligible to receive retroactive benefits. Failure to report your injury within 120 days will jeopardize your right to compensation.
Contact a Workers’ Compensation Attorney
Although you are not required to have a lawyer to file a claim in Pennsylvania, many employers will attempt to deny claims, and employers and their insurance companies typically have attorneys arguing their side of the story. It is especially important to seek professional legal counsel if your injury is severe or if it involves pre-existing conditions or other circumstances that your employer may cite to deny or minimize your coverage. If you choose to hire an attorney, you will be able to leverage their knowledge and experience in guiding you through the remaining procedures.
What to Expect After You File Your Claim
After you reported your injury, your employer is required to relay this information immediately to their insurance company. They must also file a First Report of Injury to the Bureau of Workers’ Compensation within seven days, or within 48 hours if the injury resulted in death. If your employer’s insurance company accepts your claim, you can expect to receive the following notices from your employer within 21 days after you notify them of your injury:
- Notice of Compensation Payable
- Agreement for Compensation
- Statement of Wages
After you receive these forms, you can expect to receive payments. You must continue to submit your medical bills and other covered expenses as instructed. Wage loss benefits will continue until you go back to your previous job unless your employer’s insurance company seeks to modify, suspend, or terminate your benefits while you are still off work. If your employer’s insurance company denies your claim, you will receive a Notice of Workers’ Compensation Denial within 21 days after you provide notification of injury.
Instead of initially accepting or denying your claim, your employer’s insurance company may decide that they would like more time to investigate your claim. If that occurs, you will receive a Notice of Temporary Compensation, which gives the insurance company up to 90 days before accepting or denying full liability for your injury. You will receive benefits during the time you are awaiting their final decision.
Procedures for Appealing a Denial of Benefits
If you receive a Notice of Workers’ Compensation Denial, you generally have three years from the date of your injury to file a Claim Petition. If you choose to appeal your claim, it is in your best interest to hire an attorney as the process involves litigation. Steps in the process include the following:
- Notice of Assignment. Your petition will probably be assigned to a workers’ compensation judge in the county where you live. You and/or your attorney will receive a Notice of Assignment stating the judge who will preside over your case, followed by notices regarding the date, time, and place of your hearing.
- Attorneys for both sides will present medical evidence and may call witnesses to testify regarding your condition.
- The judge may choose to schedule the case for mediation. The time frame for reaching an eventual settlement will vary according to individual circumstances of the case.
- Once the judge renders a decision, the case is closed.
- WCAB appeal. Either party has 20 days from the decision date to file an appeal with the Workers’ Compensation Appeal Board (WCAB). The appeal must include a copy of the judge’s decision, the specific grounds for the appeal, and a statement of the alleged findings.
Because written documentation is crucial to the success of an appeal, it is easy to see why it is so important for employees to maintain precise, detailed records of their work injury or work-related illness from the very beginning all the way through their medical visits and treatments.
If you or your employer wish to appeal the judge’s decision, the following steps may occur:
- WCAB appearance. The WCAB will issue a written decision after attorneys representing each side submitted written briefs and present oral arguments
- Appeal to the Pennsylvania Commonwealth Court. Either party may file an appeal within 30 days of the WCAB decision. The court will then publish a decision.
- Final appeal to the Pennsylvania Supreme Court. Either party may file a Petition for Allowance of an Appeal within 30 days from the date of publication of the Commonwealth Court’s decision. The Pennsylvania Supreme Court will either decide to hear the case or uphold the ruling of the Commonwealth Court. Very few cases reach this stage.
Given the potential for protracted litigation, it is wise to seek skilled legal counsel from the start to make sure your claim is accepted in the beginning. However, if you attempted to file an initial workers’ compensation claim on your own without a lawyer and your claim was denied, Larry Pitt & Associates, P.C. is available to vigorously represent you in the appeals process.
Procedures for Appealing a Change in Benefits
Even if your initial claim was successful and you are currently receiving workers’ compensation, your employer may seek to modify, suspend, or terminate your benefits before you make a full recovery. You have three years from the date of your last benefits check to petition the termination of your benefits. Before your employer can suspend, modify, or terminate your benefits, they must be able to prove that you can return to some type of work. It could be your previous position or a different type of occupation that meets your medical restrictions.
The Pennsylvania Workers’ Compensation Act outlines specific procedures for employers seeking to modify or suspend your weekly payments. The procedures may involve:
- An independent medical examination (IME). An IME doctor chosen by your employer may examine you and determine that you are able to return to some type of work.
- A vocational expert. A vocational professional may complete an assessment of your earning capacity.
- Labor market survey. This report lists available jobs within a reasonable commuting distance that you are physically able to perform.
If you receive notification from your employer that you must submit to an IME or a vocational earning power assessment, contact an experienced workers’ compensation attorney as soon as possible to make sure your rights are protected, and your wage benefits are not suspended or reduced. For example, if your employer proves that you can earn wages that are less than your pre-injury wages, then your benefits may be reduced to two-thirds of the difference between your pre- and post-injury wages.
If you were earning $1,200 a week before you were hurt at work, your weekly wage loss benefits would be $800. If a vocation expert finds jobs in your area that pay $700 a week and the IME shows that you are capable of performing those jobs, your employer may attempt to reduce your benefits to two-thirds of the difference between your pre-injury wages and your new earning capacity. Your workers’ compensation benefits would then shrink to $333.33 instead of $800 per week because it is assumed you would earn $700 a week.
Four Essential Principles Successfully File for Workers’ Compensation
In summary, there are many procedures and requirements involved in filing for workers’ compensation. Throughout the entire process, your chances of success will be greater if you follow these four essential principles:
- Get the right medical care
- Document and report all details
- Meet all deadlines
- Know your legal rights
Many workers are unaware of the full scope of their legal rights in the state of Pennsylvania. The skilled attorneys at Larry Pitt & Associates, P.C. have dedicated their careers to understanding and defending those rights.
Philadelphia Workers’ Compensation Lawyers at Larry Pitt & Associates, P.C. Help Injured Workers File for Benefits
If you were injured at work, there is no reason to risk losing the benefits that you earned. To learn how legal representation can help you obtain maximum compensation, reach out to a Philadelphia workers’ compensation lawyer at Larry Pitt & Associates, P.C. today. For a free consultation, call us at 888-PITT-LAW or fill out our contact form.
Located in Philadelphia, Bensalem, Lansdowne, and Reading, we represent injured workers in Berks County, Bucks County, Chester County, Delaware County, Montgomery County, Philadelphia County and throughout Pennsylvania, including those in the communities of Abington, Ambler, Ardmore, Bala Cynwyd, Bensalem, Clifton Heights, Crum Lynne, Darby, Downingtown, Doylestown, Drexel Hill, Essington, Folcroft, Glenolden, Haverford, Havertown, Holmes, Kutztown, Lansdowne, Media, Merion Station, Morton, Narberth, Norristown, Norwood, Philadelphia, Prospect Park, Quakertown, Reading, Roxborough, Sharon Hill, Upper Darby, West Chester, and Wynnewood.