What Does My Employer Have To Provide?
All Pennsylvania employers are legally obligated to provide Workers’ Compensation insurance to their employees. The employer must also provide notice of all Workers’ Compensation rights in an area where the employees have access to the information. Employees must be informed of the following information related to their Workers’ Compensation plan:
- The name and contact information for the Workers’ Compensation carrier
- The names and contact information for a minimum of six approved health care providers the workers can choose to use for all work-related injuries or illnesses.
- An outline of the corporate Workers’ Compensation rules and policies
In addition to the employee notices, the employer is also obligated to follow the standard procedures when a work-related injury or illness is reported.
- Provide emergency care for an injured worker, including first aid treatment, ambulance, emergency room, and hospitals as needed.
- Provide follow up care relating to the emergency treatment as needed.
- Notification must be sent to the Workers’ Compensation provider within 24 hours of the accident or injury.
- Workers’ Compensation claim benefit forms must be given to the injured worker within 24 hours.
- Written instructions for the claims process must accompany the Workers’ Compensation forms.
Which Injuries and Illnesses are Covered Under Workers' Compensation?
All Pennsylvania employers are legally obligated to provide Workers’ Compensation insurance to their employees. The employer must also provide notice of all Workers’ Compensation rights in an area where the employees have access to the information. Employees must be informed of the following information related to their Workers’ Compensation plan:
- The name and contact information for the Workers’ Compensation carrier
- The names and contact information for a minimum of six approved health care providers the workers can choose to use for all work-related injuries or illnesses.
- An outline of the corporate Workers’ Compensation rules and policies
In addition to the employee notices, the employer is also obligated to follow the standard procedures when a work-related injury or illness is reported.
- Provide emergency care for an injured worker, including first aid treatment, ambulance, emergency room, and hospitals as needed.
- Provide follow up care relating to the emergency treatment as needed.
- Notification must be sent to the Workers’ Compensation provider within 24 hours of the accident or injury.
- Workers’ Compensation claim benefit forms must be given to the injured worker within 24 hours.
- Written instructions for the claims process must accompany the Workers’ Compensation forms.
What Does My Employer Have To Provide?
Work-related injuries and illnesses are generally covered under Workers’ Compensation benefits, but claiming the maximum amount of compensation available, or appealing a denial of benefits can be tricky. The most common types of work-related injuries and illnesses covered under Workers’ Compensation insurance include:
- Back, spine, and neck Injuries
- Traumatic Brain Injury (TBI)
- Broken bones
- Cuts and lacerations
- Torn muscles, tendons, and ligaments
- Burns
- Amputation of limbs
- Blindness
- Deafness
- Paralysis
- Repetitive task injuries
- Degenerative joints
- Nerve damage
- Cancer
- Mesothelioma
- Asbestosis
- Respiratory illness
Why Would My Workers' Compensation Benefits Be Denied?
It is not uncommon for Workers’ Compensation benefits to be initially denied, but the denial can be appealed. Consulting with an experienced Workers’ Compensation lawyer can ensure that the appeal is successful and that the maximum amount of compensation is available. There are several reasons that a Workers’ Compensation claim can be denied:
- The insurance provider claims the injury is a non-compensable injury.
- Failure to provide sufficient details to when, where, and how the injury occurred.
- The insurance provider claimed the injury is pre-existing and therefore not eligible for benefits.
- Insufficient medical evidence and documentation.
- Failure to grant the insurance carrier the permission to access prior medical records.
- Failure to meet the deadline to report the injury or accident to the employer.
- The injury or accident occurred prior to or after working hours, or off the work premises.
- Failure to show proof that the injury is directly related to job responsibilities.
- Exceeding time limits for return to work schedule.
What is the Appeals Process for a Claim Denial?
If your Workers’ Compensation benefits have been denied, it is vital to seek the counsel and representation of a qualified Workers’ Compensation lawyer. There are strict deadlines to meet throughout the appeals process and missing these deadlines could result in a permanent denial of benefits. A Workers’ Compensation lawyer will review your case and gather the pertinent evidence necessary to refute the denial. Access to medical records and justification for medical clearance or for time needed to fully recover can be difficult to prove.
