The Pennsylvania Workers’ Compensation Claims Process

Every year, millions of Americans at hurt at work and need some way to pay the bills while they are out of work. Luckily, most of them can rely on workers’ compensation insurance to cover their medical bills and wage loss. Pennsylvania’s workers’ compensation law requires almost all employers to offer this type of coverage for employees. This does not mean, however, that the workers’ compensation claims process is easy.

If you received a Notice of Denial, have questions, or need help navigating the workers’ compensation process in Bucks County, Cordisco & Saile LLC can help. While the best way to make navigating the Pennsylvania workers’ compensation process easier is having a skilled attorney by your side, understanding how the process works can also reduce stress and let you know what to expect.

The steps in the Pennsylvania workers’ compensation process include: 

1) Reporting the Injury

Unless the injury is severe and requires immediate attention from first responders, the first thing you should do is to notify your employer. Under Pennsylvania Workers’ Compensation Act, you have a maximum of 120 days to notify your employer about a work injury. It is best to do so in writing, although there is no law stipulating this is necessary.

Note: This seems like a long time, but it can actually work against you. The longer amount of time can actually cause you to forget to report it until it is too late. In addition, you will receive no benefits until after you report your injury.

For this reason, you should notify your supervisor or a human resources representative about your injury as soon as it occurs. This is true even if the injury is minor. It is also important to note that a work injury is any injury, illness, or other medical condition caused by your job or suffered at work.

Once you have notified your employer, s/he must file a first report of injury with the Bureau of Workers’ Compensation and notify the insurance company. This launches your workers’ compensation insurance claim.

2) Getting Medical Care

Ensuring you get the necessary medical care should be your top priority after a workplace accident. In the event of a serious injury, call 911 or visit your nearest emergency department. When injuries are not as serious, however, there are some things you need to be aware of.

Pennsylvania Workers’ Compensation Act requires you to see a company-approved doctor for treatment during the first 90 days. Your employer must post a list of at least six approved care providers you can choose from. If your employer fails to provide a list, you can choose your own provider. You can also choose your own doctor after the initial 90-day treatment period.

It is imperative to continue care and document your treatment for as long as it is necessary. This is key in obtaining and keeping your workers’ compensation benefits.

Your employer and the insurance company will likely attempt to deny benefits unless there is medical documentation of your injuries and the restrictions they cause. Without this proof that you are not physically able to return to work, your employer will expect you to return to work.

In addition, if you ignore doctor’s orders and do something that could jeopardize your recovery (e.g., carrying your nephew when the doctor told you that you could not lift anything above 20 pounds), the insurance may deny your claim on the grounds that you are contributing to or fabricating your injuries.

3) Waiting on Approval

Even in the best-case scenario, there are several weeks of waiting between the date you suffer injuries and the time when workers’ compensation benefits begin. The insurance company has 21 days from the day it receives notice of your injury to approve or deny your claim.

While the decision sometimes comes quickly, it often takes the full 21 days. For many, this three-week period can seem like an eternity. You may be eligible for short-term disability or other benefits during this time.

4) Drawing Benefits, or Receiving a Notice of Denial

You should know if the insurance company accepted your workers’ compensation claim within a few weeks of letting your employer know about your injury. If the insurance company accepted your claim, you will likely receive a letter and receive a benefit check “on a regular basis.”

If you received a Notice of Denial, you have options but you will need to call us as soon as possible so we can work on saving your case.

You might also receive a petition from the insurance company notifying you that it will be terminating, modifying, or suspending your benefits. We can help you determine what led to this decision and work to persuade the insurance company to reverse the decision.

5) Appealing a Denial of Benefits

If you receive a Notice of Denial — or if the insurer petitions to reduce or terminate your payments — you can fight for the compensation you deserve by appealing your case. The first step is requesting to have a Bureau of Workers’ Compensation judge hear your case.

If the judge does not overturn the decision, we can continue to the Workers’ Compensation Appeals Board. Lastly, we can take your case to the Commonwealth Court if the Bureau of Workers’ Compensation does not overturn the original decision.

If you are considering filing an appeal in your workers’ compensation case and have not already enlisted the help of a knowledgeable lawyer, now is the time to make that call. Your employer’s workers’ compensation insurance company most likely has a legal team dedicated to these cases, and you will not want to take it on without adequate legal representation. It is almost impossible to win this type of appeal without a lawyer. 

Cordisco & Saile LLC, Bucks County Workers’ Compensation Attorneys

The lawyers at Cordisco & Saile LLC can help you navigate the Pennsylvania workers’ compensation process, including securing the documentation you need to prove your injuries and restrictions and representing you through the appeals process.

Call us today at 215-642-2335 to schedule your free, no-obligation initial consultation.