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Questions Most Frequently Asked By Injured Workers

Is my injury or illness covered by Workers’ Compensation?

Pennsylvania’s Workers’ Compensation Act is a no fault insurance system, which provides coverage for any injury, illness or disease, arising in the course of employment and related to the employment. Coverage is provided regardless of an employee’s previous physical condition. Injuries can involve specific acute instances of, for example, back injuries, neck injuries, fractures, etc., or can develop over a period of time with repeated work activities (such as heavy lifting, or repetitive motion work), which ultimately leads to a disabling condition.

Workers’ Compensation also recognizes various illnesses and diseases, which arise in the course and scope of employment and are related to employment as being compensable. These can include, but are not limited to, lung diseases, heart conditions and systemic poisoning. The Act also has special provisions regarding hearing loss caused by employment.

How long do I have to file a claim?

It is very important that you have your employer fill out a Report of Injury when you report the injury to them. If you report an injury and your employer and/or insurance company denies coverage, i.e., denies benefits, then you must file a claim for workers’ compensation benefits within three years of the date of your injury. If your claim is denied, you will need to file a Claim Petition for compensation. Your employer and/or insurance company will aggressively defend against the Claim Petition and you should retain an experienced workers’ compensation lawyer to help you with the claim.

What do I have to tell my employer about my injury, illness or disease?

If you have suffered a work related injury, you must tell your employer that you were hurt or injured and that the injury was caused by your job. If you believe that you are suffering from a work related illness or disease, you must tell your employer about that condition and why you think the condition was caused by your employment.

The Workers’ Compensation law states that you must advise your employer of your injury and report the injury, as work related, within 120 days of the date you were injured. If you are suffering from a work related disease or illness, then you must advise your employer of that within 120 days of the date that you discover that you have a work related disease or illness. If you do not report the injury, illness or disease within the 120-day period, you will lose your right to receive workers’ compensation benefits.

If you give notice within 21 days of your injury, your benefits are payable from the first day of your disability. However, if you do not give notice to your employer before the 21st day after the injury, compensation is only payable beginning on the date that you gave notice.

Can I treat with my own doctor?

If you suffer a work related injury, your employer may be able to control your medical treatment for the first ninety days after you commence treatment. The employer is allowed to control the treatment if they have posted a list with at least six health care providers for you to choose from. You are free to choose which medical provider you want to see from the list. Your employer cannot force you to go to a particular doctor or health care provider. If you are not satisfied with the first doctor you choose, you can choose another doctor from the list within the ninety-day period. If you decide to treat with a provider not on your employer’s list, the employer/insurance company will not be responsible for those medical bills during the first ninety-day period.

Most importantly, in order for the employer to insist on you treating with one of the listed health care providers within the first ninety days, the employer must have given you a written document providing you with the names of the health care providers and setting forth your rights and duties with respect to medical treatment. If your employer does not have a list, and/or has not provided you with the written paper to read and sign, you can treat with any doctor or health care provider of your choice. If you treat with a doctor or health care provider of your own choosing, you must notify your employer of your selection within five days of your first visit in order to have your bills paid.

After the ninety-day period has expired, you are free to treat with any doctor or health care provider you choose.

How do I know the insurance company has accepted my case?

The insurance company and/or employer is required to file certain documents with the workers’ compensation authorities and send them to you regarding whether they are accepting your case or denying it. If you receive a document entitled a Notice of Compensation Payable, that means the insurance company has accepted your case and will begin paying benefits. Review this document carefully, as it describes the injury that the company is accepting and what compensation benefits will be paid to you.

Insurance companies also frequently issue a document known as a Notice of Temporary Compensation Payable. You should be extremely wary of this document.

While the insurance company will begin paying your benefits pursuant to this document, this document can be revoked by the company within a ninety-day period and it is not an admission by the insurance company and/or employer that they are responsible for a work related injury. If the insurance company/employer revokes the Temporary Notice of Compensation Payable, they have denied your claim and your benefits will immediately stop. You should immediately seek legal advice if this occurs.

If the insurance company and/or employer issues a document entitled Notice of Denial, they have denied liability for your claim and you should immediately seek legal advice from an experienced workers’ compensation attorney.

What are my benefits?

For total disability caused by a compensable injury, an injured worker should receive two thirds of his or her wages after the seventh day of total disability. For partial disability caused by a compensable injury, an injured worker should receive two thirds of the difference between the wages of the injured worker and his or her earning power. Partial disability is payable for up to 500 weeks. The Workers’ Compensation Act also establishes a payment schedule for hearing loss, neck and facial scarring, as well as loss of limb.

The workers’ compensation insurance carrier is required to pay for reasonable and necessary medical services and treatment related to the compensable work injury.

Can my employer retaliate against me for pursuing a Workers’ Compensation claim?

No. An employer may not directly retaliate against an injured worker for exercising his or her rights under the Workers’ Compensation Act.

My employer has scheduled me to see an “independent doctor”, do I have to go?

The Workers’ Compensation Act provides that any time after an injury, an injured worker, if requested by his or her employer, must submit at a reasonable time and place for a physical examination by a doctor selected and paid for by the employer. If the employee refuses, he can be ordered to attend by a Workers’ Compensation Judge. The refusal, without reasonable cause or excuse, to submit to such an examination ordered by a Workers’ Compensation Judge may deprive the injured worker of his or her right to workers’ compensation benefits during the continuance of the refusal.

I received documents from the Workers’ Compensation insurance company and the Bureau of Workers’ Compensation. Are they important?

An injured worker may receive a wide variety of documents from the workers’ compensation insurance company. They include a Termination Petition, Modification Petition, Suspension Petition, Notification of Suspension, Final Receipt, Suspension Agreement, Notice of Compensation Denial, Notice of Compensation Payable, Notice of Temporary Compensation Payable, Employee Report of Wages, Employee Verification of Employment and Employee Report of Benefits.

Although the above list is not exhaustive, receipt of any of these documents by an injured worker and failure to respond appropriately could have a dramatic and costly effect on an injured worker’s rights under the Workers’ Compensation Act.

Upon receipt of any document from the workers’ compensation insurance company or the Bureau of Workers’ Compensation you should consult an experienced workers’ compensation lawyer.

How can I afford a lawyer?

Most workers’ compensation lawyers handle cases on a contingent fee basis. In other words, a fee is not paid until an award of compensation is made. Further, the Workers’ Compensation Act provides that all lawyer fees must be approved by a Workers’ Compensation Judge or the Workers’ Compensation Appeal Board and may not exceed twenty percent (20%) of the amount awarded the injured worker.

Can I settle my case?

The Workers’ Compensation Act allows an injured worker to “settle ” or “compromise and release” all liability claimed under the Workers’ Compensation Act. Settlement of a workers’ compensation claim is a permanent and drastic step, which should not be undertaken lightly. Your workers’ compensation insurance company has a great deal of experience negotiating and settling workers’ compensation claims. An injured worker should not undertake negotiations with the workers’ compensation insurance company without qualified counsel.

If you have been injured at work, make the right choice and call me for a free work injury consultation at 717-299-3726, or fill in the form to the right to tell me about your case.