Filing a workers’ comp claim is a time-sensitive process, and any missteps by the injured worker or their employer could mean delayed or denied benefits. In some cases, the claim process might be delayed because of negligence or deliberate inaction on the part of the employer.
How can you tell if your employer is doing the right thing if you are injured at work? It’s important to understand the basics of workers’ compensation and how the claims process works to make sure your employer is following the mandated law and guidelines in Pennsylvania.
What Is Workers’ Compensation?
In all but one state in the U.S., companies are required to provide workers’ compensation benefits for their employees. The program is designed to protect both the injured worker and the employer. The injured employee receives medical treatment for bodily injuries or occupational illnesses and is compensated for lost wages at the expense of the employer. Employers, in turn, are protected from a direct lawsuit by the injured employee.
For more than 100 years, Pennsylvania has required businesses to carry workers’ compensation insurance under the Pennsylvania Workers’ Compensation Act. Workers’ compensation insurance can be secured through a licensed insurance carrier or the State Workers’ Insurance Fund (SWIF). SWIF was established to help provide a quality workers’ comp program for businesses to meet their required obligation under the Workers’ Compensation Act.
There are several exceptions to the mandatory coverage requirements. Exemptions include workers covered under other workers’ compensation acts (for example railroad workers, longshoremen and federal employees); domestic servants (coverage is optional); some agricultural workers; and employees who have requested, and been granted, exemption due to religious beliefs or their executive status in certain corporations.
Workers’ Compensation Claims Process
If you are injured at work, it’s important to follow the specific workers’ compensation claims process to receive benefits in Pennsylvania. There is a finite window of opportunity to start the process, so it’s critical to take quick action after an injury.
After an injury, you should report it to your supervisor immediately (preferably, in writing), seek medical attention, and start the paperwork to begin the claims process.
Reporting the Injury: After an injury, you should report it to your employer as soon as possible, even if you feel it is minor and does not require medical attention. Notify both your supervisor and the human resources department. Documentation is key, so you should proactively request to complete an accident or injury report and ask for a copy for your records.
To receive full benefits in Pennsylvania, you have 21 days to report your injury. After day 22, benefits may be reduced, and, after day 120, compensation benefits may not be available at all. It’s best to report the injury immediately to start the process.
Your employer is required to immediately notify their insurance carrier of your injury and within 7 days file a First Report of Injury with the state Bureau of Workers’ Compensation. If you have not heard from the insurance carrier within a week of reporting your injury to your employer, it could be a warning sign that your company may be trying to avoid paying workers’ compensation benefits.
If you haven’t heard from the employers’ workers’ comp insurance carrier, contact the carrier directly to ask if the injury was reported.
Seek Medical Attention: Unless the injury requires immediate emergency medical treatment, employees should seek medical attention from the employer-provided list of doctors or health care offices for treatment. Under state law, injured workers will have to receive care from a “panel” medical provider for the first 90-days of treatment.
After 90-days, the employee can continue care with another provider. If the employer does not have an approved list of providers, you can seek medical attention from a doctor of your choice, so long as the treatment is reasonable, necessary, and directly-related to your work injury.
Additionally, if the type of provider you need is not part of the panel list—for instance, if you need a neurologist, but there is no such healthcare provider on the list—you may treat with a neurologist of your choice (again, so long as the treatment is reasonable, necessary, and directly-related to your work injury). Ask for detailed copies of your office visits and keep those for your records.
Start and Complete the Paperwork: After you’ve reported your injury to your employer, they are required to provide you with the proper forms and paperwork to file your claim. Typically, this includes forms from their insurance company, a form to report your injury to the state, information on your rights and workers’ comp benefits, and information about returning to work.
If your employer does not provide you with any paperwork or information after your injury, this is another sign your employer may be trying to avoid reporting your claim. Don’t wait for your employer to provide the forms – be proactive and request the forms directly.
If you do not complete the paperwork provided and return it to your employer, your claim may not move forward. Remember – if you’re hurt on the job, you are your own best advocate (unless, of course, you have a seasoned workers’ comp attorney representing you). Employers may delay the process to avoid paying you for lost wages or medical expenses.
Consult with an Experienced and Proven Workers’ Compensation Attorney: The workers’ compensation process is complex, especially when a claim is denied or if your employer is not following the claims process set forth by Pennsylvania’s Workers’ Compensation Act. If you are injured on the job, you should seek advice from an experienced workers’ comp lawyer to ensure your employer is following all state laws for your claim and to make sure you receive all of the compensation you are entitled to in a timely manner.
The insurance carrier has a team of experienced attorneys that may try to reduce your benefits or deny them altogether, so having the right attorney on your side gives you the best chance of receiving full benefits.
Workers’ Comp Claim Statistics in Pennsylvania
Every year, thousands of workers are hurt on the job in Pennsylvania. Injuries documented through the PA Department of Labor & Industry, Bureau of Workers’ Compensation range from minor injuries such as sprains and strains to more serious injuries like amputation and severe burns.
In 2019, there were 172,756 work injury and illness cases reported to the Bureau of Workers’ Compensation, 511 fewer than 2018. Fatalities, however, increased from 66 to 71. More than half of the injuries occurred in two industries – Education & Health Services and Trade and Transportation & Utilities. Other notable PA workers’ compensation statistics include:
- The most common injury resulting in a workers’ comp claim was a sprain or strain (36.8% of total claims), followed by a contusion, crushing, or bruise (19.7%). The least common injury was an amputation or loss of use of a limb (.2%).
- Workers ages 25-29 represented the largest number of workers’ comp claims (12.3% of total cases), followed by workers ages 55-59 (10.7%).
- Lancaster county ranked 7th in the state in the total number of workers’ compensation claims in 2019 with 4,479 cases.
Your Workers’ Comp Partner
We know the Pennsylvania workers’ compensation system is complex and navigating the system alone can be a challenge. Employers and their workers’ compensation insurance companies know this too, and unfortunately, many times take advantage of injured workers to avoid paying out valid workers’ comp claims or not paying claimants as much in wage loss, medical or lump sum settlement benefits as they should.
If you feel frustrated with the process and the piles of paperwork, Georgelis, Larsen & Sabatino Injury Law Firm, P.C. is here to help. Our skilled, aggressive, and experienced attorneys have worked on thousands of workers’ comp cases and know how to check the status of a workers’ comp claim. Our consultations are always free, and we will be your unrelenting advocate during the workers’ comp claim process.
We have recovered more than $85,000,000 for our clients and we have won 99% of our cases. We are available 24/7 to answer your questions—we can come to you if you can’t come to us, or we can schedule a virtual consultation!
Our goal is to ease the burden of a worker’s comp claim and make it easy on you. Contact us today at 1-800-HURT-NOW!