Workers’ Compensation: How it Works

Your Complete Guide to Hiring a Personal Injury Lawyer – CHAPTER 4

Being hurt at work is many things: emotionally draining, physically painful, and full of confusing forms and paperwork as you seek workers’ compensation (WC) to cover your medical treatment and other costs—and that’s if things are going well. Naturally, as an injured employee, you have a lot of questions about how the WC process works in Pennsylvania, from getting started with a new claim to what types of injuries even qualify to how you can overcome a denial of benefits.

Who has the answers you need at every step? In short, we do—that is, experienced and compassionate personal injury attorneys like us here at Westmoreland Injury Lawyers.

Today’s post, which is part of our ongoing series to guide you along the way of searching for—and finding—the best personal injury lawyers, highlights the main things you can expect as you work through the WC process. We’ll link together all of our previous blog posts about workers’ comp topics, as well, to give you a comprehensive overview.

Quick Review: What is Workers’ Compensation?

WC laws are designed to ensure that workers who are hurt or disabled on the job are reimbursed for their medical expenses, hospital bills, and lost wages during recovery time. Workers’ compensation covers injuries related to your job, whether you’re hurt in an accident, or through other work-related circumstances.

Even if your employer does not have workers’ compensation insurance, you may still qualify for benefits when you’ve been hurt as an employee on the job. This is because the Pennsylvania Workers’ Compensation Act assures that nearly all workers are covered.

What is the typical process for workers compensation?

As we discussed in our previous post about how to file for workers’ comp in PA, the steps involved in getting the process started after you’ve been hurt and can’t work are similar for most everyone, no matter their industry or occupation.

You must let your employer know you’re hurt or ill and you must get medical attention, (though those steps may occur in the reverse order). Either way, whether your injury is new or related to a pre-existing medical condition, you are responsible for speaking up—within 120 days from when you were first injured or became ill—and for seeking care.

Informing your employer

While you may feel that your pain is too mild or your accidental injury is too embarrassing to explain to human resources, you cannot keep things to yourself. WC exists to ensure that you can pay medical bills and get through periods when you may be unable to work, and you owe it to yourself and your employer to be upfront about injuries and illness as soon as possible.

Getting medical attention

Were you rushed to the hospital in an ambulance from the factory floor or your office? If so, you probably did not have time to let your employer know that you were hurt (though they may already know if it was an emergency). Don’t worry—getting medical attention is your #1 priority in these situations. More often, you’ll have some time to make a regular doctor appointment and be seen in a less urgent manner—however, it is essential not to wait too long.

If you’ve already informed your employer about your pain or sickness, they may have you see a doctor who’s been pre-approved by their WC insurance company within the first 90 days following your notification. Don’t be intimidated by the request, and also know that you’re free to see your preferred doctor in addition to this. These mandated check-ups may not seem fair, but they are a significant part of the claims process in some cases.

Filing your claim

In PA, filing your WC claim technically begins when you inform your employer about being ill or injured. It is then on them to submit what is known as a First Report of Injury with the Pennsylvania Department of Labor & Industry’s Bureau of Workers’ Compensation to open the claims process officially. Note that if your company does not have WC insurance or is a small business without a formal human resources department or employee in an HR role, they may not know about their responsibility in this area. In these situations, it may be up to you to tell them what needs to happen, and if you experience problems, it’s time to contact a personal injury lawyer.

More on how to file your claim:

As we talked about in that earlier post on how to file linked above, your employer will provide you with forms to fill out and/or sign for their WC insurance company and the state Bureau, usually at the time they make your First Report of Injury. It is vital that this paperwork is completed accurately. Have questions, it’s time to prepare for a legal consultation to get help.

Receiving benefits

When your employer files your information with the Bureau of Workers’ Compensation, they and/or their WC insurance company will decide whether to accept or deny your claim. Your employer’s insurer has 21 days from the time the claims process begins to make their decision. If accepted, you will begin receiving benefits very soon after. Then, in an ideal world, all you should need to worry about is getting well enough to get back to work.

Going back to work when you are fully healed

Many workers are eager to “get back to normal” and resume their jobs following a job-related injury, but it’s important to allow for full healing and not rush back. Workers’ compensation benefits will typically stop after your wages revert back to your previous rate. Of course, this is the ideal world scenario again. (Take a look at our previous post about returning to work after WC for more about potential complications.)

Sounds simple, right? If only. Unfortunately, there are lots of things that can go wrong. Most common among this are having your injuries or illness being denied outright when your claim is filed or having your benefits reduced or stopped prematurely while you’re recovering. Note: both situations require an immediate case review by a seasoned personal injury lawyer.

My WC claim was denied and I’m not receiving benefits – what now?

Since we do not live in an ideal world, it is likely that you will receive a Notice of Workers’ Compensation Denial on your claim, as we mentioned. A denial on your initial claim is certainly not the end of the road, and even though you may feel frustrated and discouraged, it’s important to remember that have the right to contest the denial, and you absolutely should.

Workers Compensation is Complex – Don’t Go it Alone

The workers’ compensation process involves so many moving pieces that it’s easy for things to get off track at almost any point—even if your claim was accepted without issue and you have begun receiving benefits, there may still be problems. The most important thing you need to remember is that you don’t have to navigate it all by yourself, nor should you.

Protect your rights and show your employer and the insurance companies that you will demand fair treatment by working with an experienced personal injury attorney. Here in Greensburg, PA, Westmoreland Injury Lawyers is ready to ensure that you have a strong helping hand through this difficult time. Contact us right away for a free WC case review and consultation.