Workers’ Compensation and How to File a Claim in Pennsylvania

Workers’ Compensation is a big topic in not just Lancaster, but in all of Pennsylvania. Our area is home to companies and industries of all types and sizes… and while employers are doing more than ever to keep their workplaces safe, injuries on the job are an unfortunate reality of most vocations, particularly those involving physical labor.  Attorney Anthony J. Sabatino stopped by the set of FOX43 Morning News to talk about issues that can arise during the course of a workers’ compensation claim, and what an injured worker needs to do to make sure that they and their families are protected.

Here’s The Interview on Workers’ Compensation in Pennsylvania:

Q:  Let’s start at the beginning: when someone gets hurt on the job, what types of benefits are available to them?

A:  Good morning, and thanks for having me. In Pennsylvania, the workers’ compensation system provides employees with wage loss, medical, specific loss, scarring and disfigurement and death benefits. Typically, an injured worker will receive two-thirds of their average weekly wage as compensation for any loss of income they experience. Additionally, any medical expenses they incur, which are reasonable, necessary and related to the work injury, will be covered.

Scarring and disfigurement benefits apply to injuries that permanently alter the head, face or neck areas, and include surgical scars. Specific loss benefits are payable as a result of a traumatic or surgical amputation of a body part or the loss of use of a body part for all practical intents and purposes. And, death benefits are available to the spouse and children of an employee who is killed in the course and scope of their employment.

Q:  I would imagine that getting hurt on the job is daunting enough.  But, beyond that, an injured worker has to worry about supporting their family with a decreased income, getting the medical treatment they need to recover and making sure that they fulfill their obligations under the laws of the workers’ compensation system—all while wondering whether their job will still be there for them when they are ready to return. How can they manage to juggle all of these things successfully?

A:  It’s no secret that, despite safeguards built into our workers’ compensation system to treat both employers and employees fairly and equally, the playing field can feel uneven at times to either side. As someone who exclusively represents injured workers, i know that employees often consider this experience as harrowing and overwhelming, even if their claim has been accepted and they are getting benefits.

Q:  If an injured worker is receiving their wage loss benefits and the medical treatment they need to get healthy and return to their job, shouldn’t their stress-level be significantly lower than it would be if their claim was denied outright?  In other words, what does an employee have to worry about if it appears to them that the employer is doing all the right things under the law?

A:  Without trying to sound like an alarmist, there are a litany of issues that are virtually certain to arise in the context of any claim, even if the injured worker believes that things are copasetic and the employer and its insurance company are doing everything they should be.

Some of these include: determining which medical providers an employee is permitted to treat with; whether or not an employer’s insurance company is entitled to send an injured worker for an independent medical examination, or ime; what happens if the insurance company does not issue income loss benefits to the employee in a consistent and timely manner; and whether the insurance company refuses to pay for the employee’s medical treatment. And that’s only scratching the surface—there are plenty of nooks and crannies that exist in the system.

Q: There are a lot things to consider and that could come into play. Can you elaborate on each of them a little bit for any of our viewers who might be in the midst of a workers’ compensation claim?

A:  Absolutely. Pennsylvania’s workers’ compensation law compels an injured employee to treat with what is called a “panel” medical provider for the first 90 days following a work injury, but there are several exceptions to this. For instance, if the injured worker needs an orthopedist, but there is no orthopedic surgeon on the employer’s panel list, the employee can treat with an orthopedist of their choice. Additionally, if a panel medical provider refers the injured worker to a non-panel provider, the insurance company must cover this treatment for the employee, even if the 90-day post-injury period has not expired.

Independent medical examinations, or IMEs, are occasions when the employer and its insurance company send the injured worker to a physician of their own choosing for an evaluation. There are a number of things employees hurt on the job should know about IMEs, including their potential underlying purpose, the circumstances under which they are allowed and how often they can occur.

In terms of wage loss checks, an insurance company must issue them on a schedule consistent with the timeframe under which the employee was or is paid their regular wages. Thus, if an employee was paid on a weekly basis, they must be issued their workers’ compensation checks on a weekly basis. If the insurance company fails to do so, or otherwise makes erratic payment of income loss benefits to the injured worker, there are mechanisms by which the insurance company can be held accountable, both short- and long-term.

Last, our workers’ compensation law states that an employer and its insurance company are only responsible for paying an injured worker’s medical expenses that are related to the accepted description of the employee’s work injury. This means that, for example, if the accepted work injury is a low back strain or sprain, and the employee needs a lumbar spine operation, the insurance company is within its legal rights to deny payment for the surgery; because, obviously, surgery is not appropriate treatment for a typical strain/sprain injury.

To complicate things further, Pennsylvania law does not require insurance companies to pre-authorize recommended or prescribed medical services. Therefore, i have seen countless occasions where an employee undergoes a surgical procedure, only to find out, after the fact, that the insurance company is not going to cover it or pay them disability benefits for the time they miss from work. Again, there are mechanisms by which the description of an employee’s work injury can be addressed and modified, proactively, before it is too late, rather than reactively.

Q:  With all of these nuances in and shifts in the workers’ compensation system, how is an injured worker to know what to do and what not do, without jeopardizing their benefits? I mean, what’s the moral of the story here, or the takeaway from all of this?

A:  well, consulting with a good and trustworthy attorney is an excellent first step. Speaking for my firm, we never charge a fee to review and evaluate a workers’ compensation claim. So, we’ll answer any questions and address any concerns for injured workers, as well as give them our thoughts and recommendations, absolutely free and with no obligation.

Even when we do get involved on behalf of an employee hurt at work—so that we can make sure that their injury is described accurately, that they are getting paid the right amount on regular intervals and that the insurance company is not inappropriately taking advantage of them—there is never a fee unless we must actively defend their benefits in court or we are able to resolve their claim for a lump sum settlement.

Here’s the Full Interview on FOX43 Morning News

If you or someone you know is injured on the job, Call Georgelis First at 1-800-HURT-NOW! We’ve helped recover more than $90,000,000.oo for our clients and won more than 99% of our cases –and we can help you too! Give us a call today.