Attorney Michael L. SaileWorkers’ compensation is designed to provide help to employees who are injured or become ill on the job. This system typically covers damages such as medical bills and lost wages. Having these benefits can significantly reduce financial strain, allowing a worker to focus on recovery.
Understanding workers’ compensation after an injury is vital to protecting your rights as an employee. At Cordisco & Saile, our firm helps guide workers through the process of securing the compensation they deserve. If you have been injured on the job, do not hesitate to get the help you deserve today.
Navigate This Page
- Key Information About Workers’ Compensation Law in Pennsylvania
- Employee Rights Under the PA Workers’ Compensation Act
- Who Is Eligible for Workers’ Compensation in Pennsylvania?
- Injuries and Illnesses That Are Typically Covered Under Workers’ Comp
- What Types of Benefits Are Available?
- Understanding Your Rights to Coverage for Medical Treatments
- How to File a Workers’ Compensation Claim in Pennsylvania
- Common Challenges and Appeals in Workers’ Compensation Claims
- Returning to Work After a Job-Related Injury
- How Cordisco & Saile Can Help With a Workers’ Compensation Claim
Key Information About Workers’ Compensation Law in Pennsylvania
In Pennsylvania, employers are required to carry workers’ compensation insurance for employees. This law protects full-time, part-time, and seasonal workers after a job-related injury or illness. Independent contractors are generally not covered; however, some exceptions may exist.
If you’re unsure how these rules apply to your situation, speak with a lawyer to learn more about the purpose of workers’ compensation and how the system works.
Employee Rights Under the PA Workers’ Compensation Act
Employees have the right to benefits for work-related injuries and illnesses, including medical coverage, wage loss benefits, and protection from retaliation. It is important for workers to familiarize themselves with their rights before signing documents or returning to work.
Similarly, employers must uphold their responsibility to report workplace injuries to their insurance carrier or the relevant state agency, typically within five days of becoming aware of them. Our Pennsylvania workers’ compensation lawyers can ensure your claim is filed on time and protect your rights to compensation.
What if My Employer Doesn’t Have Coverage?
Employers are legally required to carry workers’ comp insurance in Pennsylvania. If you are injured on the job and discover your employer does not have this required coverage, you may be able to file a claim with the state’s Uninsured Employers Guaranty Fund (UEGF) to seek benefits. A successful UEGF claim can provide many of the same types of benefits you would have received if your employer had proper insurance.
Who Is Eligible for Workers’ Compensation in Pennsylvania?
You must meet eligibility requirements to secure compensation through workers’ comp insurance, including the following:
- The injury or illness must be directly connected to your job duties
- It must be reported to your employer within 120 days
- You must file a claim within three years of the injury
It is important to note that while employees who are out of work due to a workplace injury have a significant window of time to file a claim, the first 90 days are critical for initial medical treatment and documentation.
Employers also have obligations to their employees, such as posting workers’ compensation notices in a visible location at their worksite and offering coverage through private insurance carriers, the State Workers’ Insurance Fund, or by being approved to self-insure.
Our seasoned workers’ compensation lawyers can help confirm your eligibility and gather the necessary evidence to support your claim.
Injuries and Illnesses That Are Typically Covered Under Workers’ Comp
Any number of injuries and illnesses could be covered under workers’ comp if they developed in the course of employment, including the following:
- Fractures and broken bones
- Lacerations, cuts, and puncture wounds
- Burns
- Sprains and strains
- Amputations and crush injuries
- Eye injuries
- Spinal cord trauma
- Carpal tunnel syndrome
- Hearing loss from loud work environments
- Joint or muscle damage from long-term repetitive tasks
- Cancer linked to workplace carcinogens
- Traumatic brain injuries
Even gradual or repetitive stress injuries may qualify, such as back injuries from repeated lifting. You can benefit from the knowledge and skillset of an attorney who has experience handling a range of workplace injury claims.
What Types of Benefits Are Available?
The primary benefits covered under workers’ compensation are medical bills and lost wages. You can be compensated for hospital stays, surgeries, doctor’s appointments, and any other medical expenses related to your injury. Lost wages resulting from time off work due to reduced earning capacity may also be provided.
For cases involving permanent disability, employees may be able to collect specific loss benefits. The extent of compensation you are eligible for depends on whether the injury is total or partial. Total disability means you are entirely unable to work. In contrast, partial disability means you are unable to perform some, but not all, of your job duties, or you can only work a limited number of hours.
Calculating Pennsylvania Workers’ Compensation Benefits
In Pennsylvania, wage-loss and disability benefits are generally calculated as a percentage of the injured worker’s average weekly wage (AWW) at the time of injury. However, this is subject to annually adjusted statewide maximum and minimum limits. Our legal team can ensure you receive full and fair benefits for your injuries.
Understanding Your Rights to Coverage for Medical Treatments
An employer has the ability to establish a designated list of health-care providers for workers’ comp injuries. However, for the panel to be valid, the list must include at least six providers, three of which must be physicians, and must show each provider’s name, address, phone number, and medical specialty.
Injured employees can choose their own medical provider if their employer has never posted a valid panel of designated medical providers. Similarly, after 90 days of treatment with a panel provider, they may switch to any licensed provider for continued care. Lastly, if the employer’s panel lacks a necessary specialist, the employee may seek treatment from an appropriate provider of their choice at any time.
The most common dispute between workers and insurers is whether treatment is reasonable and necessary. The insurers may claim that care is excessive or unrelated to the work injury in an attempt to minimize a payout. Our team at Cordisco & Saile advocates for proper access to medical care and will fight back against insurers’ allegations.
How to File a Workers’ Compensation Claim in Pennsylvania
The general process for filing a claim in Pennsylvania is as follows:
- Report your injury to your employer: To preserve your right to wage-loss benefits from the date of injury, you should notify your employer of the work injury as soon as possible, and no later than 21 days. If you wait more than 120 days to report the injury, you may lose the right to workers’ compensation benefits entirely.
- File an incident report or employer accident form: Your employer will typically require you to complete an internal incident report describing how the injury occurred. This creates the official record needed to begin the workers’ compensation process.
- Seek medical treatment: If your employer has a valid list of panel doctors, you must see one of them for the first 90 days; otherwise, you may choose your own doctor.
- Employer files a First Report of Injury with the insurer: After you report the injury, your employer submits a First Report of Injury (FROI) to its workers’ compensation insurance carrier to notify that a claim is being opened.
- Insurer investigates the claim: The insurer reviews medical records, the incident report, and employer statements before deciding whether to accept or deny the claim. They must issue one of three documents: Notice of Compensation Payable (approved), Temporary Notice of Compensation Payable (conditional), or Notice of Denial.
- Receive benefits or file a claim petition: If the claim is accepted, you will begin receiving medical coverage and, if applicable, wage-loss benefits. However, if the insurer denies or disputes your claim, you can file a Claim Petition for a judge to review your case.
Our well-versed attorneys can leverage their knowledge of Pennsylvania’s workers’ compensation laws to guide clients through every stage of the filing process.
Tips for Filing a Claim
You can take proactive steps to avoid mistakes or missed deadlines on your claim, including the following:
- Report your injury immediately to preserve evidence and prevent missing deadlines.
- Document everything from the incident, including reports, medical notes, and paperwork.
- Keep in mind the three-year statute of limitations to file a Claim Petition if your benefits are denied or stopped.
- Seek legal support early on so an experienced workers’ compensation attorney can help you build a strong claim from the start.
Common Challenges and Appeals in Workers’ Compensation Claims
Navigating the workers’ compensation claims process can be challenging, including denials, delayed payments, and employer disputes. If your claim is denied, you can begin the appeals process, which follows the steps below:
- File a Claim Petition – Begin the appeal by submitting a Claim Petition after a denial or dispute.
- Hearing before a workers’ compensation judge – Present evidence, including medical records and witness testimony.
- Appeal to the Workers’ Compensation Appeal Board – Ask the Board to review the judge’s decision for legal or procedural errors.
- Appeal to the Commonwealth Court – Request further review focused on legal issues.
- Appeal to the PA Supreme Court – In rare cases involving significant legal questions, you may petition the state Supreme Court to hear the case.
Persistence and legal guidance are crucial to the success of your claim. Our compassionate legal team has extensive experience overturning denials and handling appeals. Get in touch today to learn more.
Returning to Work After a Job-Related Injury
An injured worker in Pennsylvania has the right to return to work only when medically cleared and cannot be forced to resume full duties before they are physically capable of doing so. When approved for performing modified or light work, the employer must provide tasks that match these.
Disputes can arise when employers pressure employees to return too soon or assign work that does not match the doctor’s directions. Keeping copies of your work restrictions and speaking with a workers’ compensation attorney if you feel pressured can help protect both your health and your benefits.
How Cordisco & Saile Can Help With a Workers’ Compensation Claim
The workers’ compensation process can be highly complex to navigate on your own. Fortunately, partnering with a knowledgeable attorney can simplify the claims process and protect your rights as an employee.
At Cordisco & Saile, we are known for our client advocacy and results-driven approach. Our Pennsylvania team is here to help with paperwork, appeals, and negotiations. Contact our office at 215-642-2335 to schedule an initial consultation.
When someone chooses Cordisco & Saile to represent them, they've made one of the best choices of their life in a terrible time. They're going to get empathy, they're gonna get communication, they're gonna get knowledge, and they're gonna get informed throughout every step of the way. What they're also gonna know and learn is what's hurting them, the impact on their life, and how every day they go through this pain and suffering that we're here fighting for them.".
