Workplace injuries are some of the most common injuries suffered in the U.S. With so many workplace injuries taking place, states, including the Commonwealth of Pennsylvania, have instituted workers' compensation programs to provide wage and health benefits when workers are injured on the job. However, some employers work against employees, denying or fighting against their claims. If you or a family member have been injured on the job and the insurance company or employer denies their claim, you should contact an experienced Philadelphia workers' compensation attorney to make sure they get the benefits they deserve.
Workers' compensation provides a trade-off between benefits and the right to sue. In most cases, if an employee is injured on the job, workers' compensation provides benefits without the need to show the employer was responsible for the injury. In exchange, an employee is generally limited in their right to file a lawsuit against the employer.
Workers' Compensation Background
In Pennsylvania, the Workers' Compensation Act provides for medical expenses and wage-loss compensation benefits in the event an employee is injured on the job and unable to work. If a worker is killed in a work-related accident, death benefits are available to dependent survivors.
Workers' compensation insurance is required by everyone who employs workers in Pennsylvania. It does not matter if the business has been around for decades, or is a start-up just getting off the ground. It is required for seasonal, part-time and full-time workers. Even if the company is staffed by family members, workers' comp insurance is still required.
Employers are responsible for paying the cost of insurance. They may purchase insurance through an insurance broker, agent, directly from a workers' comp insurance provider, or through the State Workers' Insurance Fund. Larger companies who have been around for more than three years and are financially stable may be able to apply for self-insurance status.
What Types of Injuries are Covered?
Almost every worker in Philadelphia is covered by workers' compensation insurance. Some workers, including volunteer workers, employees with a religious exemption, or certain federal employees may be exempted in certain cases. If an employer never provided coverage, the employee may still be eligible for benefits. If an employee is not sure if they are covered by workers' compensation, they should seek further information.
Workers' compensation provides coverage if an employee is injured on the job, or in the course of their employment. This may include situations like construction site accidents, a slip and fall injury in the office, or a delivery driver who gets into a car accident. It may also include injuries due to long-term exposure or repetitive motion.
Workers' comp generally does not apply to injuries that occurred outside the course of employment, such as an accident driving to or from the workplace. It may also not include self-inflicted injuries, or injuries occurring if the employee was under the influence of drugs or alcohol.
After an injury, the employee should promptly report the injury or work-related illness to their employer or supervisor. If the employee does not timely report the injury, they may see a delay in receiving benefits. The employer then reports the injury to the Bureau of Workers' Compensation. After reporting the injury, the employer may accept or deny the workers' compensation claim.
If the claim is accepted, the worker should start receiving benefits, including payment for lost wages, medical care, specific loss benefits, and if applicable, their surviving dependents may be entitled to death benefits. Wage-loss benefits are generally based on a percentage of the employee's pre-injury earnings, adjusted based on whether the employee is partially disabled or totally disabled.
Medical care covers the payment of reasonable surgical and medical services related to the workplace injury. This may also cover medication, hospital treatment, and medical supplies if needed. An employee may be able to choose their own health care provider, unless the employer accepts the claim and has posted a list of at least 6 health care providers. In that case, the employee may be required to visit one of the listed providers for initial treatment and for a period of 90 days. After that, the employee may be able to select a provider of their choice.
When Your Workers' Comp Claim is Denied
A workers' compensation claim can be denied by an employer or their insurance provider for any number of reasons. It may be denied because the employee was not covered, the injury was not work related, or simply due to a clerical error. Unfortunately, some employers deny valid injury claims. An employer may claim the employee caused the injury, they were injured somewhere else, they were on drugs at the time of the accident, or they do not believe the employee was injured.
If your claim is denied, you may file a petition with the state. A workers' compensation judge may then determine if your claim should be approved or denied. In some cases, the judge may submit the case to alternative dispute resolution, to settle the dispute through mediation or a settlement conference. If the judge denies the decision, the case may be appealed to the Workers' Compensation Appeal Board and then on to the Commonwealth Court.
Philadelphia Workers' Compensation Attorneys
If you were injured on the job in Philadelphia, your employer should provide you medical and wage benefits for your injuries. Unfortunately, some employers and insurance companies refuse to compensate their injured employees, leaving injured workers without a source of income. If your compensation claim was denied, you need an advocate to fight for you. Contact the team at Gilman & Bedigian. We offer a free consultation and will fight for you, to make sure you are fully compensated for your injuries.