Some Injuries May Not Be Covered, Even if They Occurred on the Job
In Pennsylvania, most workplace injuries are covered by workers’ comp. The system is “no-fault”, meaning that injured workers are entitled to compensation regardless of who was at fault for the accident. However, many work injury claims are denied. Often, a denial of benefits can be reversed on appeal with the assistance of an experienced Philadelphia workers’ compensation lawyer. Some injuries though are simply not compensable under the Pennsylvania Workers’ Compensation Act.
Types of Injuries Not Covered by Workers’ Compensation
Full-time employees, temporary workers, and paid interns are all generally eligible for benefits as long as their injuries were incurred at work or while they were acting in the scope of their employment. Nearly all Pennsylvania employers must carry workers’ compensation insurance, either through a state-run insurance program, private insurance company, or self-insured policy. The system was created in part to ease the burden of workers who would have otherwise had to prove their employer was negligent in order to recover compensation. In exchange, workers may not sue their employers in personal injury lawsuits; workers’ compensation is considered to be their “exclusive remedy”.
Although the system is no-fault, there are certain types of injuries that may not be covered by workers’ compensation insurance, including:
- Certain psychological injuries – Workers may be able to claim benefits for mental stress injuries, however the mental injury must have either been caused by a work-related physical or psychological stimulus. Claims based on the mental/mental standard are typically more difficult to prove because the psychological injury must have been caused by either an extraordinary event or an abnormal working condition.
- Disfigurement or scars below the neck – The Pennsylvania Workers’ Compensation Act only grants benefits for scarring or disfigurement to the face and neck. Other parts of the body are currently not compensable.
- Injuries intentionally caused by employees – Generally, workers are entitled to compensation for their injuries regardless of who was at fault for the incident. However, workers who engage in willful misconduct or horseplay, as well as those who were under the influence of drugs or alcohol at the time of their injury and those who intentionally inflict injuries upon themselves, may not be eligible for coverage.
- Injuries suffered by certain types of employees – Federal employees, longshoremen, railroad employees, independent contractors, volunteers, and certain other types of workers are not covered by the Act. However, they may be entitled to compensation under other federal laws such as the Federal Employers’ Liability Act.
- Injuries sustained while commuting to or from work – The coming and going rule prohibits employees from collecting workers’ comp for injuries they sustain on their way to or from work. However, workers acting in furtherance of the business of their employers may be eligible for benefits even if their accident did not occur at a fixed workplace location.
- Non-economic damages – Pain and suffering, emotional distress, loss of consortium, decrease in quality of life, and other non-economic damages are not covered by workers’ compensation. However, these damages may be available in other types of lawsuits, such as third-party personal injury claims.
- Non-work-related injuries – Work injuries that occur outside of work are not covered by workers’ compensation. However, non-work-related pre-existing injuries may be covered under the Act if they were aggravated or worsened by the employee’s work activities or environment.
Injured workers may be able to claim additional forms of compensation such as non-economic damages in a third-party claim. Although employees may not personally sue their employers for their work-related injuries, they may bring a personal injury claim against responsible third parties. The Philadelphia workers’ compensation lawyers at Larry Pitt & Associates, P.C. help workers obtain the maximum compensation to which they are entitled, including damages from third parties.
In Pennsylvania, third-party claims may be filed simultaneously with workers’ compensation claims. One of the main advantages of pursuing compensation from a third party is that a worker may be able to obtain non-economic damages such as pain and suffering in addition to workers’ compensation benefits.
To prevail, a worker must prove that the third party either negligently or intentionally caused their injury. Some examples of third-party defendants include:
- Equipment manufacturers
- Government entities
- Property owners
Let an Experienced Philadelphia Workers’ Compensation Lawyer at Larry Pitt & Associates, P.C. Evaluate Your Claim
If you have any questions regarding your work injury, contact the Philadelphia workers’ compensation lawyers at Larry Pitt & Associates, P.C. Our attorneys have more than 35 years of experience representing workers in Philadelphia and throughout the state. For a free consultation, please complete our online contact form or call us at 888-PITT-LAW today.
We are proud to assist clients in 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, Pennsylvania.