Pittsburgh Workers’ Compensation Lawyers

What Is Workers’ Compensation? 

Workers’ compensation is a form of insurance that provides financial and medical benefits to employees who have been injured on the job. These benefits may include medical care, disability pay, and vocational rehabilitation services. Workers’ compensation also provides death benefits to surviving family members in the event of a fatal workplace accident.

Workers’ compensation can cover the necessary medical treatment, including hospital visits, prescription drugs, rehabilitation services, surgery, testing, and related expenses when an employee suffers a work-related injury or illness. In addition to covering medical costs, workers’ compensation may also provide disability payments for lost wages if the employee cannot return to work due to their injury or illness. In some cases, workers’ compensation may even pay for retraining or education programs to help injured employees find alternative employment. This compensation is typically capped at either 2/3 of the employee’s salary or the statewide limit, which is adjusted yearly.

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.

Generally speaking, sustaining an injury at work entitles you to collect workers’ compensation; however, there are some contexts in which you would not be eligible, such as: 

• You are injured during an activity that is not related to your job. For example, injuries sustained during horseplay would not be covered under worker’s comp.
• The behavior that led to your injury is considered reckless, such as failing to use proper safety equipment or being under the influence of drugs or alcohol

Examples of Injuries that Are Eligible for Workers’ Compensation

Some common injuries that may be eligible for workers’ compensation include: 

• Slip and Falls: If your employer is not properly maintaining floors, stairs, and walkways, you could slip and suffer an injury. 
• Back Injuries: Common in roles involving manual labor and movement, back injuries like herniated discs, strains, or spinal cord injuries are often very serious. 
• Occupational Illnesses: If you work with chemicals, fumes, or other hazardous substances, you could develop a disease or illness. Common among these illnesses are things like rashes, debilitating allergic reactions, lung disease, or even cancer. 
• Repetitive Motion Injuries: Job responsibilities that require consistent, repetitive movements like typing or using heavy machinery could leave you with carpal tunnel, tendonitis, or bursitis.
• Sprains and Strains: Injuries to muscles, ligaments, and tendons are common and can result from lifting heavy objects, repetitive motions, or awkward postures.
• Fractures: Broken bones can occur due to falls, collisions, or accidents involving heavy machinery.
• Cuts and Lacerations: Sharp objects, tools, or machinery can cause cuts and lacerations in various workplace settings.
  Contusions and Bruises: Impact with hard surfaces, objects, or machinery can lead to contusions and bruises.
• Burns: Burns may result from exposure to hot surfaces, flames, chemicals, or electrical hazards.
  Electrical Injuries: Electrical shocks or burns can occur when working with faulty equipment or in environments with exposed wiring.
• Struck by Objects: Workers may be injured when struck by falling or flying objects, such as tools or equipment.
  Caught in or Between Objects: Injuries can occur when a worker is caught in or between objects, such as machinery or vehicles.

The above list is by no means exhaustive. You very well could suffer a unique injury due to the nature of your work. That is why it is crucial to get in touch with us as soon as possible—so we can evaluate your case and tell you where you stand.

The Process of Filing a Workers’ Compensation Claim in Pennsylvania

Most employers in Pennsylvania are required to provide workers' compensation coverage for their employees. Employers must also post information about workers' compensation rights and benefits in a conspicuous place within the workplace.

Here is a general guide to filing a workers' compensation claim in Pennsylvania:

• 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.
• Employer's Responsibilities: Your employer is required to submit the completed First Report of Injury form to their workers' compensation insurance carrier. 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.
• Claim Acceptance: If your claim is accepted, you should start receiving wage-loss and medical benefits. The benefits should cover necessary medical treatment and a portion of your lost wages.
• 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. It's advisable to seek legal representation at this stage.
• Appeals Process: If necessary, you can appeal a decision through the Workers' Compensation Appeal Board and, subsequently, the Commonwealth Court. Legal representation is highly recommended during the appeals process.
• 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's often beneficial to consult with an experienced workers' compensation attorney. They can guide you through the process, ensure your rights are protected, and represent you in hearings or appeals if necessary.

Why Was My Claim Denied?

Workers' compensation claims can be denied for various reasons. Here are some common reasons why a workers' compensation claim might be denied:

• 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. It's essential to be aware of and adhere to these deadlines.
• 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. It's crucial to provide detailed and consistent medical documentation to support the claim.
• 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.
• 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, they may deny the claim.Employment Status Disputes: Workers' compensation generally covers employees, not independent contractors. Disputes over employment status can lead to claim denials.

If your workers' compensation claim is denied, it's crucial to understand the specific reasons for the denial and consult with an attorney specializing in workers' compensation. Appeals processes are available in many jurisdictions, allowing injured workers to challenge denials and seek the benefits they are entitled to receive.