PA Workers' Compensation: A System for Fair Compensation
In Pennsylvania there is a specific system and set of law for injured employees and workers. This system is called workers’ compensation. It is in place to ensure you obtin fairand just benefits in a timely manner. Under this system, you give up the right to file a lawsuit, but you do not have to prove who is at fault, and are guaranteed medical care and quick payment for lost wages and other related damages.
I am Pottstown Workers’ Compensation Attorney James V. Monaghan and I work diligently to help Montgomery County residents file their claims against their employers to obtain the compensation they are entitled to. If you have suffered a work-related injury or illness, contact us for a free case consultation. I can help you obtain the best settlement for your particular situation.
How Does the Pennsylvania Workers’ Compensation System Work?
Generally, Pennsylvania employers must provide workers’ compensation insurance coverage for their employees, including part-time and seasonal workers. There are a few exceptions: for example, some volunteers, agricultural laborers, casual employees, and domestics are not covered. Further, certain categories of workers receive benefits under separate compensation benefit laws. These include federal civilian employees, railroad workers, longshoremen, and shipyard and harbor workers.
If you incur a work-related injury (or death), illness, or disease, you may be entitled to workers’ compensation benefits (such coverage begins the date you were hired). However, if the injury or death is intentionally self-inflicted, or is caused by your violation of law (for example, drug use or intoxication), there will be no relief available.
What Do I Do When I am Injured at Work?
As soon as you’re injured or discover a work-related illness, you must contact your supervisor immediately and provide him/her with full details of the incident, including the date and place of the injury. Make sure you provide your employer with a descriptive illustration as to what occurred in addition to requesting any witnesses (example - coworkers who saw the accident occur) to provide a statement on your behalf. Once you have lost a day, shift, or turn of work, your employer must report your injury or illness to the Bureau of Workers' Compensation.
Note, if you fail to properly inform your employer about your work-related injury within 120 days from the date in which it occurred, then you will be barred from filing a claim against them. This is why it is so important to act with haste in providing them with the required notification. You will not receive compensation for your injuries until you file a claim.
Your employer may choose to either accept or deny the claim. If denied, you have the right to file a claim with the bureau for a hearing before a workers’ compensation judge. Further, if your employer does not have workers’ compensation insurance to cover your damages, you may be eligible for benefits from the Uninsured Employer Guaranty Fund.
What Types of Benefits Can Be Claimed?
Depending on the specific circumstances of the work-related injury, there are a variety of types of workers’ compensation benefits.
- 1. Medical Care
Of course, the most important and immediate need is for you to have medical care. Your employer is responsible for advising you in writing of your rights under the workers’ compensation law. This notice is required at the time of injury or as soon afterward as is practicable.
Generally, you are entitled to payment of reasonable medical and surgical services provided in Pennsylvania. That includes medicine, supplies, orthopedic appliances and prostheses as well as hospital treatment and services. All of this is without cost to you: if there is a difference between the health care provider’s charge and the amount your employer pays, you are not billed for the balance.
Depending on whether your employer provides proper notice of providers, you may be free to choose your own health care provider or you may have to initially seek treatment from a list of providers selected by your employer. Once you begin receiving benefits, your employer or the workers’ compensation insurer has the right to ask you to see a doctor of their choice for an examination every six months.
For more information about your employer’s medical care requirements pertaining to your work-related injury, see Section 306(f.1) (1) (i) of the Act.
- 2. Lost Wages
If you are totally disabled and cannot work, or if you are partially disabled and are receiving wages less than your pre-injury earnings, you may be entitled to wage-loss benefits. Generally, these benefits are equal to approximately two-thirds of your average weekly wage, up to a weekly maximum. Certain time limits, though, may apply.
- 3. Death Benefits
If the injury or illness results in death, surviving dependents may be entitled to benefits.
- 4. Specific Loss Benefits
If you have lost the permanent use of all or part of your thumb, finger, hand, arm, leg, foot, toe, sight, and hearing -- or otherwise have a serious and permanent disfigurement on your head, face or neck -- you may be entitled to a specific amount of compensation.
- 5. Occupational Diseases
There are special rules for occupational diseases. They are covered if caused, or aggravated, by your employment, so long as the disability occurs within 300 weeks of your last employment in a job where you were exposed to the hazard.
Continuing Reporting Requirements
There are certain, periodic reporting requirements if you are seeking or are receiving benefits. You must be truthful: workers’ compensation insurance fraud is a crime. In addition, failure to complete the required forms may result in the suspension of your benefits.
Circumstances That May Affect Your Continuing Benefits
There are a number of reasons why your benefits may be reduced or stopped.
For example, if -- after you begin to receive benefits -- your employer has evidence to prove that employment is available to you, within your medical restrictions and in your local area, you may receive an offer of employment. If you decline, your employer may petition a workers’ compensation judge to either reduce or stop your wage-loss payments.
You must cooperate with the workers’ compensation insurance carrier in any investigation, including inquiries about your employment, self-employment, wages, or your physical condition.
Do I Need a Workers Compensation Lawyer?
Pennsylvania’s workers’ compensation program is a great benefit to workers and employers. It streamlines the process of getting you the medical treatment and money you deserve, and saves your employer from costly litigation; however, it is not always smooth-sailing. The law is complex, and your employer and the insurance carrier will be represented by experienced attorneys. You may need someone on your side to protect your rights.
What Is Alternative Dispute Resolution?
It may be in your best interest to attend mediation with your employer (and your self-obtained counsel) to come to a resolution. You or your employer can file a petition with the Office of Adjudication to begin the mediation process.
Though you are not required to obtain counsel for representation in worker’s compensation proceeding, we strongly recommend you work with an experienced King of Prussia attorney to make sure you file the proper claim forms in a timely manner and to combat opposing counsel’s arguments. If you hire an attorney, the fee agreement must be approved by the workers’ compensation judge or the Workers' Compensation Appeal Board.
If you incur a severe disability as a result of the work-related injury, you may be able to apply for Social Security and obtain disability benefits. For additional information, visit the Social Security Administration's website.
Our workers’ compensation attorneys are ready to assist you with filing your claim against your employer to obtain compensation for your injuries. Contact us today at (610) 275-5800 for a free case consultation. I am here to help you with your workers’ compensation benefits claim and needs.