Workers' Compensation Claims in Pennsylvania

workers' compensation claim form

If you have been injured on the job in Pennsylvania, you are eligible to receive workers’ compensation benefits.

Under the Pennsylvania Workers’ Compensation Act, all companies or individuals who employ one or more workers are required to take part in the state’s workers’ comp program. All workers are covered, whether they are full-time, part-time or seasonal. There are some exceptions for workers who are normally covered by other programs – railroad workers, government employees and dock workers to name a few. In a few cases, like consultants, workers’ comp does not cover them at all.

Workers’ compensation benefits will provide compensation for:

  • Lost-wages, in most cases two-thirds of your average weekly wage but there are maximum limits.
  • All medical expenses connected to your work-related accident.
  • Specific loss benefits, which are paid to a worker who has lost total or partial use of a functioning body part. The benefits are paid out according to a schedule that determines how many months of compensation a worker will receive for a specific injury.
  • Death benefits to your survivors if you die in a work-related accident.

About Pennsylvania Workers’ Compensation Claims

The government does not pay for workers’ compensation. Your employer pays all workers’ compensation costs. It does this through a workers’ comp insurance company, or if the employer is large enough, it can pay for the costs on its own. Many large hospital chains and corporations are self-insured.

Workers’ compensation is a no-fault insurance program. This means it does not matter if your work-related accident was your fault or your employer’s — you are still eligible for workers’ comp benefits either way.

You are covered by workers’ compensation benefits if your injury or illness “occurs in the course and scope” of your job, which includes:

  • If you are injured at your place of work during work hours.
  • If you are traveling for work, such as on a business trip, running an errand for your boss or on your way to meet a client.
  • If your job requires you to work from home.
  • If your job requires that you do not work in a specific location, such as if you do repairs or installations at client locations.
  • If you are injured on company property. For example, if you are going to your car in the company parking lot at the end of the day and slip and fall on ice, you will be covered. The moment you drive off the lot, you are not covered.

Your injuries will also not be covered by workers’ compensation if:

  • They occur when you are not working.
  • They occur when you are under the influence of drugs or alcohol while at work.
  • You are driving to work or home from work.
  • You are engaged in horseplay or a fight at work.
  • They happen during an offsite lunch break.

If you have been injured in a work-related accident in Pennsylvania, you may have some questions about the correct way to file a claim for workers’ compensation. It is important that you understand the filing process and its timeframe. Talking to an experienced workers’ compensation attorney is also a good idea to give you a broader understanding of the workers’ compensation process in the state.

If you are one of the fortunate workers whose employer agrees that you have been injured on the job, deserve compensation and should be fairly compensated while you are injured, you may never have to file a claim. While this is a nice idea, however, the reality is that most workers in Pennsylvania will not be treated this way and will need to know how to file a claim to receive the compensation to which they are entitled.

When to File a Work-Related Injury Claim

One of the keys to making a successful Pennsylvania workers’ compensation claim is timing.

The first thing you should do if you have suffered a work-related injury or have been diagnosed with a work-related illness is to report your injury or your illness to your supervisor or to your employer as soon as possible. If you just tell a friend that you were hurt at work or are sick, this does not satisfy the reporting requirement. While you have 120 days from the date you sustained your injury or realized you had an illness to tell your employer, you should not wait that long.

Three months may seem like a long time, but the longer you wait, the greater the chance that your injury or illness will be challenged by your employer and their insurance company. They may use the delay to argue that you were not really hurt that badly or that the diagnosis was wrong.

If your injury is severe enough that it requires immediate medical attention, you should notify your employer as soon as you can.

Once you have notified your employer of your injury, and you miss a shift or a full day of work, your employer is required to notify the Bureau of Workers’ Compensation. It does this by filing what is known as a First Report of Injury (FROI). Your employer needs to do this within three days of you missing your first shift or day on the job. If an accident results in a death, your employer is required to send notification within 48 hours.

If you notify your employer that you have suffered a work-related injury or illness within the first 21 days of either suffering the injury or of your doctor notifying you that you have an occupational illness, you will receive workers’ compensation benefits from the date you suffer the injury or when you were made aware of your illness. However, if you report the injury or the illness after the first 21 days but within the 120-day window, your benefits begin from the date you reported the illness or injury.

When your employer sends the FROI to the Bureau of Workers’ Compensation, the Bureau is not required to act. It is merely a notification of the day that you were injured or diagnosed with an illness. This provides the Bureau with a start date in case you decide to file a claim against your employer and their insurance company.

Your employer is also required to report your injury to its insurance company. The insurance company has 21 days from the date it was notified to deny or accept your request for workers’ compensation benefits.

If the insurance company accepts your injury or illness is valid, you will receive a Notice of Compensation Payable and start to receive workers’ compensation benefits. Sometimes the insurance company will send you Notice of Temporary Compensation Payable. This means that the insurance company has not yet ruled your claim as valid but is willing to pay some benefits until a final decision is made. The insurance company can change its mind within 90 days and stop paying you all benefits.

If the insurance company decides that your injury is not valid, they will send you a Notice of Workers’ Compensation Denial.

If your request for benefits is denied, you have three years from the date of your injury to file a workers’ compensation claim.

How to File a Claim

After you have told your employer about your work-related injury, you have three years from the date you suffered your injury or when your doctor diagnosed your illness to file a workers’ compensation claim petition with the Bureau. Remember, the three-year statute of limitations begins when you first suffered an injury or were diagnosed with an illness.

Sometimes the start date of an injury is not in question. If you break a leg or injure your hand on the job, you know the date it happened and that’s the date you report to your employer. Some other work-related injuries, however, can take a while to manifest themselves — days, weeks and sometimes even years.

A great example of this is a stress-related injury like carpal tunnel syndrome or impingement syndrome — injuries caused by repetitive stress on your wrist. Administrative assistants and data clerks frequently suffer from carpal tunnel syndrome. You can also get a repetitive stress injury from doing the same thing day in and day out for a long time. Anyone who is consistently required to lift heavy objects may suffer from a repetitive stress injury in their back or legs.

This is why it is important to notify your employer as soon as your doctor diagnoses you with a repetitive stress injury. If you do not notify them within the 120-day period, you may lose your right to collect any workers’ compensation benefits. And if you fail to file a claim within three years after you first suffered or learned of the injury, you do lose your eligibility for benefits.

There are some exceptions to the three-year statute of limitations that are important to know:

  • If you have been exposed to loud noise over a long period and suffered a hearing loss, you need to file a workers’ compensation claim within three years of the last time you were exposed to the noise.
  • If your job required exposure to any toxin or a dangerous chemical and you developed a work-related occupational illness, you need to notify your employer of your illness within 300 weeks of the last time you were exposed to the toxin or chemical. At this point, the 120-day notice and three-year window for making a claim begin.
  • If your employer has already paid you some compensation – for instance, they sent you a Notice of Temporary Compensation Payable – and they paid you for 90 days but then stopped, you have three years from the date of receiving the last payment to file a claim.
  • If your employer lied to you about accepting your claim and you never received workers’ compensation benefits, your time window for making a claim may be extended. It’s important to talk to an experienced workers’ compensation attorney if this ever happens to you.

If you want to file a successful workers’ compensation claim, there are two critical things to do:

  • See a doctor immediately. Even if you think your injury might only be minor or your first thought is you don’t want to be a nuisance, it’s important to see a doctor as soon as possible and tell them that your injury is work-related. Don’t wait until the week after your injury or longer to see a doctor. If you do, your employer and their insurance company will argue that you are not seriously hurt as is proved by the fact you waited to seek medical assistance.
  • The other reason to see a doctor as soon as possible is to begin the process of establishing documentation. The more documentation you have about your illness or injury, the better. Keep a copy of every medical bill and every medical report. Record the name and location of every specialist you see about your injury or illness and the date you saw them. Keep notes about what they told you. Make sure you tell every doctor you see, whether in an emergency room immediately after your injury or during a visit to a specialist, that your injury is work-related.

In Pennsylvania, you are required to see a doctor from a panel of doctors selected by your employer for the first 90 days of your injury. After 90 days, you can see your own physician. You can use your own physician before the 90 days is up, but you will be responsible for paying that medical bill.

As we noted above, a denial by your employer and their insurance company is far more likely to happen when you suffer a work-related injury than an acceptance. Some of the reasons that they may cite for their denial include:

1. You Did Not Notify Them of Your Injury Within the 120-Day Window.

This excuse is frequently used for repetitive stress injuries or occupational illnesses.

2. Your Injury Is Your Fault.

Your employer will argue that your injury was a result of horseplay or a fight or that the injury took place outside of your regularly scheduled workday.

3. Your Injury Is Not All that Bad.

This is where they will use your tardiness in reporting your illness or injury or in seeking medical attention to argue that you are not as sick or as hurt as you say you are.

4. You Were Drunk or High on the Job.

This excuse is frequently used by employers and their insurance companies to deny initial requests for benefits from workers.

5. Your Accident Was Not Related to Your Job.

You were hurt on a lunch break while you are offsite, or you were doing something that was not job-related when you were injured.

If your employer and their insurance company do not accept liability for your injury and denied your workers’ compensation coverage, you have three years from the date you originally suffer the injury or were diagnosed by your doctor to file a workers’ compensation claim.

If your employer and their insurance company deny your workers’ compensation benefits, you should immediately contact an experienced workers’ compensation claim lawyer. Do not wait until the last second to talk to an attorney about your claim. The claims process can last a long time. You must file your claim within three years, but that doesn’t mean it will be settled within three years. If you wait too long to speak to an attorney, the result may be that you and your family find yourselves in a bad financial situation, without medical attention for your injuries and without compensation to cover lost wages.

To Learn More About Filing a Workers’ Compensation Claim in Pennsylvania, Contact Calhoon and Kaminsky P.C.

An experienced workers’ compensation attorney from Calhoon and Kaminsky P.C., can help you prepare your claim. We will assist you in gathering all the important medical documentation you need to support your claim. We can help you find witnesses who will support your version of how your injury occurred and the effect it has had on you and your family’s lives. We will find the medical experts who can testify on your behalf during your workers’ comp appeal hearing.

Working with an experienced workers’ compensation attorney from Calhoon and Kaminsky P.C., can make the difference between success and failure for your claim. Our firm has won millions of dollars in benefits and awards for injured workers. Our practice is all about workers’ compensation. We know all of the tricks that insurance company lawyers will try to play in an attempt to deny you the benefits to which you are entitled.

Contact us for a free consultation. You can call us at 717-695-4722, or you can visit our contact us page where you can leave us your information and tell us something about your work-related injury or illness. We will be in touch as soon as possible.