Workers’ Compensation Benefits in Pittsburgh, Pennsylvania

Workers’ compensation is a form of non-liability-based insurance that provides financial and medical benefits to employees in Pennsylvania who have been injured on the job or in a way that relates to their occupation. Under Pennsylvania employment law, any employer with at least one employee, including part-time or seasonal workers, is required to carry workers’ compensation insurance that covers their eligible employees. For this reason, if you are employed in Pennsylvania as an employee, then you more than likely should be able to get important workers’ compensation benefits.

Typical benefits available to an employee with workers’ compensation insurance coverage include:

• 100% coverage for all medical treatment costs, past and future, such as hospitalization, prescription drugs, surgery, testing, etc.
• Wage replacement if unable to return to work (usually beginning after one week of missed work but allowing for backpay)
• Disability pay if unable to return to work for an indefinite period
• Vocational rehabilitation services if unable to return to the same role within the company or the same career
• Death benefits for surviving family members in the event of a fatal workplace accident

What Happens If You Caused Your Work Accident?

Workers’ compensation is a no-fault system, meaning that employers cannot be sued in civil court for injuries suffered by their employees unless you can prove that the employer acted with intentional disregard for safety. On the other hand, though, you don’t have to prove that someone else’s mistake caused your work accident to qualify for workers’ compensation benefits. You can even admit that you made a mistake and that it caused your injury. The most important factor to consider is whether the accident or injury occurred in the scope of your employment, not necessarily how it happened. 

In uncommon cases, workers’ compensation benefits can be denied, such as:

• You are injured at work, but during an activity that is not related to your job. For example, injuries suffered during prohibited horseplay might not be covered under workers’ comp.
• The behavior that led to your injury is considered reckless or a blatant violation of company safety policies, such as being under the influence of drugs or alcohol at the time of the accident.

You should never assume that you don’t qualify for workers’ compensation benefits, though. Even if your employer or an insurance company says you can’t get workers’ comp for one reason or another, you should still take the time to at least talk with our Pittsburgh workers’ compensation attorneys. Initial consultations are free, so you can learn more about your options without any upfront costs.

Workplace Injuries Often Covered by Workers’ Comp

Many different types of injuries (and even some illnesses) are covered by workers’ compensation in Pennsylvania. Again, the most important factor is whether the injury occurred during the scope of your employment, regardless of the type of injury. When you first meet with our legal team, we can assess your injury and its cause to determine if it makes you eligible to file for workers’ comp benefits.

We have worked on cases involving all sorts of workplace injuries, such as:

• Slips and falls
• Back injuries
• Occupational illnesses
• Repetitive motion injuries
• Sprains and strains
• Fractures
• Cuts
• Burns
• Electrical injuries
• Struck-by-object injuries
• Caught-in/between-objects injuries

Process of Filing a Workers’ Compensation Claim in Pittsburgh

In addition to most employers being required to carry workers’ compensation insurance for their employees, they must post information about workers' compensation rights and benefits in a “conspicuous” place within the workplace, like the breakroom. Employers are also required to take any injury report filed by an employee seriously and never do anything to impede the workers’ compensation process if the employee wants to file a claim for benefits. To get your claim moving without worrying about the details or potential obstacles, though, you should turn to our Pittsburgh workers’ compensation lawyers from the start.

For a workers’ compensation claim in Pennsylvania, the typical overall process will include:

• Seek medical attention: If you're injured at work, seek medical attention immediately. Inform the healthcare provider that your injury is work-related.
• Notify your employer: Report your injury to your employer as soon as possible. In Pennsylvania, you must notify your employer within 120 days of the injury to be eligible for workers' compensation benefits.
• Complete the First Report of Injury Form: Your employer is responsible for providing you with the necessary forms to file a workers' compensation claim. The First Report of Injury form (LIBC-344) is typically used for this purpose. Complete the form and return it to your employer without delay.
• Employer's responsibilities: Your employer is required to submit the completed First Report of Injury form to their workers' compensation insurance carrier, usually within 24 hours of receiving it. The insurance carrier will then decide whether to accept or deny your claim.
• Claim review: The workers' compensation insurance carrier has 21 days to investigate your claim. During this time, they may approve your claim, deny it, or temporarily accept it while further investigations are conducted. In the meantime, you are still permitted to seek all necessary medical care at no cost to you (even if your claim is denied).
• Claim acceptance: If your claim is accepted, you should start receiving wage replacement and medical benefits. The benefits should cover necessary medical treatment and a portion of your lost wages. You might be eligible for back pay, too.
• Claim denial: If your claim is denied, you have the right to file a petition for a hearing with the Pennsylvania Workers' Compensation Office of Adjudication.
• Appeals process: If necessary, you can appeal a decision through the Workers' Compensation Appeal Board and, subsequently, the Commonwealth Court.
• Return to work: If you're able to return to work in some capacity, your employer may offer you suitable employment. If the offered job pays less than your pre-injury position, you may be entitled to partial disability benefits.

Given the complexities of workers' compensation laws, it is highly recommended that you hire a workers’ compensation attorney at the very start of this process. In fact, if your claim is denied or delayed, don’t be surprised if the notification from the insurance company advises you to speak to an attorney for more information. We can handle or help you through every step. 

Why Was My Workers' Compensation Claim Denied?

Workers' compensation claims can be denied for various reasons, such as:

• Failure to report the injury on time: There is a specific timeframe within which an injured worker must report the injury to their employer. Failure to report the injury within this timeframe may result in a denial of the claim.
• Missed filing deadlines: There are deadlines for filing workers' compensation claims, and missing these deadlines can lead to a denial.
• Dispute over the work-related nature of the injury: If there is a dispute over whether the injury is truly work-related, the claim may be denied. The employer or insurance company might argue that the injury occurred outside the scope of employment.
• Insufficient medical evidence: Inadequate or conflicting medical evidence can lead to a denial. 
• Pre-existing conditions: If the insurance company believes that a pre-existing condition, rather than a work-related incident, is the primary cause of the injury, they may deny the claim. 
• Failure to seek timely medical treatment: If an injured worker delays seeking medical treatment, the insurance company may question the severity of the injury and deny the claim.
• Employer disputes the claim: Employers or their insurance companies may dispute the claim for various reasons, such as challenging the description of the incident, questioning the legitimacy of the injury, or asserting that the injury did not occur at work.
• Failure to follow company procedures: Some employers have specific procedures that injured workers must follow to be eligible for workers' compensation. If these procedures are not followed, the claim could be denied, or at least, delayed pending an investigation.
• Intoxication or substance abuse: If the injured worker was under the influence of alcohol or drugs at the time of the injury, the claim may be denied.
• Fraudulent claims: If the insurance company believes that the claim is fraudulent or that the injury was intentionally self-inflicted, it may deny the claim.
• Employment status disputes: Workers' compensation generally covers employees, not independent contractors. Disputes over employment status can lead to claim denials.

In some cases, workers’ compensation claims are denied wrongfully because the insurance company wants to save money, or the employer wants to avoid increased premiums. For this reason, you should never accept a denial at face value. You should at least let our attorneys know about it during a no-cost consultation. 

Pittsburgh Workers’ Compensation FAQ

• Can I choose my own doctor for a work injury in Pennsylvania?
  In Pennsylvania, if your employer posts a list of designated healthcare providers, you are required to see one of these providers for the first 90 days of treatment. During this 90-day period, treatment should be provided by one of the listed professionals unless a referral to another specialist is necessary. After the initial 90-day timeframe, you have the freedom to choose any healthcare provider for continuing treatment.
• What if I was at fault for my workplace injury?
  Pennsylvania operates a no-fault workers' compensation system, which means that even if your actions contributed to your injury, you are typically still able to receive benefits. The workers' compensation system is designed to provide prompt medical care and financial assistance without delving into fault.
• How long can I receive workers’ compensation benefits in Pennsylvania?
  The duration of workers' compensation benefits in Pennsylvania depends on the nature and extent of your injury. Temporary total disability (TTD) benefits are available while you're unable to work, usually up to 104 weeks, at which point a medical evaluation may determine the permanency of your condition. If you are considered permanently disabled, additional benefits may continue. Partial disability benefits can last up to 500 weeks, supporting workers who return to work at reduced earnings due to their injury.

Let Friday & Cox LLC Work for You

While the legal process of filing for workers’ compensation is not simple, it doesn’t have to feel complicated to you. By hiring our Pittsburgh workers’ compensation attorneys, you can let us take care of everything we can. Our legal team can focus on handling every step, keeping you informed, and dealing with all the paperwork and interactions with employers and insurers. We can even consult with third-party medical professionals to document and understand your injuries, the time you need to heal, and the cost of covering your medical expenses. It is all part of how we go above and beyond your expectations to secure the workers’ compensation benefits or settlement that you deserve after a workplace injury.

If you have recently been hurt on the job in Pittsburgh or the surrounding area, call us at (412) 900-8250 or contact us online to set up a free case evaluation.