What Workers’ Compensation Benefits Are Available To Me?

If you’ve been hurt on the job, you’re naturally concerned about what happens next. Medical bills start coming in, you can’t work, and you’re worried about caring for your family. You may be wondering whether workers’ compensation is an option for you. Or you simply might not know what sort of benefits you might receive.

The workers’ compensation attorneys of Nikolaus & Hohenadel know how important these questions are. We’re here to help you receive the benefits you deserve so you can focus on getting better.

What Is Workers’ Compensation?

By law, all Pennsylvania employers are required to carry workers’ compensation insurance on their employees. This insurance is designed to provide financial assistance to employees who get injured or sick during the course and scope of their employment. Workers’ compensation is a no-fault system: the injured employee receives benefits regardless of who is to blame for the accident. It is also considered the “exclusive remedy” after an illness or injury, meaning you cannot sue your employer for additional benefits.

What Benefits Are Provided By Workers’ Compensation?

Workers’ compensation is intended to cover a number of expenses and losses incurred as a result of the workplace accident or injury, including:

  • Payment of medical bills and treatments for your injurie
  • Wage-loss benefits (two-thirds of your average weekly wages, subject to a maximum benefits cap)
  • Death benefits to survivors of workers who were killed on the job
  • Funeral expenses

How Do I Receive Payment For Medical Bills?

It’s important to understand, first, that you must report your injury or illness immediately to your employer. Waiting too long to report the injury could reduce your benefits or invalidate your claim entirely.

Also, be aware that your employer may have a list of healthcare providers from which injured workers must choose for their initial treatment. If your employer has a valid Panel List, you  must receive your first 90 days of treatment from a provider on that list. After your first 90 days, you can choose your own doctor.

You are not required to pay a copay, deductible  or any other out-of-pocket costs for your medical care. The healthcare provider will bill your employer’s workers’ compensation insurance carrier directly. 

What Injuries Are Covered?

Most injuries or illnesses that occur at or because of work will be covered. They include:

  • Neck and back injury
  • Traumatic brain injury
  • Amputation
  • Burn injury and electrocution
  • Hip, knee, shoulder, and elbow injuries
  • Occupational diseases

Are Any Injuries Or Employees Not Covered?

Your employer, or their workers’ compensation insurer, may not have to provide benefits in the following cases:

  • Self-inflicted injuries
  • Injuries that resulted from drug or alcohol use
  • Certain injuries that resulted from illegal activity
  • Injuries suffered while commuting to or from work
  • The employee is an independent contractor

Also, some employees – such as federal workers, railroad workers, and casual laborers – are not covered under the state’s workers’ compensation law. But the rules are tricky and very fact sensitive. For example, whether someone is truly an independent contractor is dependent upon several complicated factors. Just because your employer calls you an independent contractor does not mean you actually are one. If you’ve been told you are not eligible for benefits, for any reason, it’s critical that you consult with a Certified Workers Compensation Specialist.  

When do wage benefits start?

You must be out of work for seven days before wage benefits begin.  You are only  entitled  benefits for time lost from work beginning on the eighth day of being disabled. Once you have been injured for more than 14 days, you receive a retroactive payment for the first seven days.

If an injury has been timely reported, the worker can expect to start receiving payments 21 days after notice was given (unless the claim is denied). The worker should receive regular payments after that assuming disability continues.    If you‘ve been out of work for 21 days and have not received a workers compensation wage loss payment you need to consult with an attorney who is a Certified Workers Compensation Specialist.  Do not wait for the insurance company to do the right thing.  That is wasted time.

When do benefits end?

There are many factors that determine when benefits stop. For example the wage benefits will stop or be suspended when you earn wages equal to or greater than you pre injury wage.  That is to be expected.  But there are other, less than legitimate, basis for an employer to attempt to stop paying wage benefits.  Sometimes benefits are unilaterally stopped without legal basis whatsoever. 

With respect to medical treatment, your employer may file a utilization review to contest the reasonableness or necessity of the medical care you have received. Or, a judge can review the case in a hearing and make a decision to allow your employer to end the benefits.

Employees should not have to worry about receiving payments while they are unable to work. Unfortunately, many employers and insurers look for ways to terminate benefits so they can save money. Regardless of what sort of case you have, it is vital that you take immediate legal action if you have received a claim denial or a notice that your benefits will end.  Critically, if you’ve received any indication that a petition has been filed or the case has been assigned to a Workers Compensation Judge, you should consult a workers compensation attorney who is a Certified Workers Compensation Specialist immediately. 

Can I Also Receive Social Security, Unemployment, And Workers Compensation  Benefits?

You may be able to receive these benefits as a result of your injury or because of other conditions you have. However, they may cause your workers’ compensation benefits or your Social Security benefits to be reduced.

Employees are required to report other sources of income they receive while they are out of work and collecting workers’ compensation. In fact, not doing so could land them in trouble. But it’s important that the income is correctly reported and that any offsets are correctly calculated.   In cases like these, you should talk to an experienced Pennsylvania workers’ compensation lawyer before you do anything.

Contact Our Lancaster Workers’ Compensation Attorney

Although Pennsylvania’s workers’ compensation laws are some of the most generous in the country, not all workers understand their rights and obligations. If you’ve been injured at work, denied coverage, told your payments will be terminated, or you simply have questions about your benefits, give Nikolaus & Hohenadel a call today.