If you were injured on the job, Workers’ Compensation insurance provides payment to cover medical bills, prescription medications, physical or cognitive therapy, and lost wages. In some Workers’ Compensation cases, benefits can be initially denied; this does not mean the employee is ineligible for benefits. An experienced workers’ compensation lawyer can gather the evidence necessary to support the claim and successfully navigate through the appeals process.
Pennsylvania Workers' Compensation Law
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 Pennsylvania 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 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 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 workplace 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.
Injuries and Illnesses Covered Under Workers' Compensation
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)
Carpal Tunnel Syndrome
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
Steps to Take After a Work Accident or Illness
If you are injured or have developed an illness as a result of your job, it is essential to follow these steps:
Report the injury or illness immediately to your supervisor.
Seek medical attention for your injury or illness as soon as possible.
Notify the doctor that your injury or illness is work-related and provide the name of your Workers’ Compensation insurance company.
Keep detailed records of all medical treatment, including prescriptions and doctor’s notes.
Notify your employer in writing if your injury or illness causes you to miss work for more than seven days.
Contact an experienced workers’ compensation lawyer to help you navigate through the claims process and protect your rights.
Pennsylvania Workers' Compensation Benefits
The Pennsylvania Workers’ Compensation system provides a range of benefits to support injured workers, including:
Medical Benefits: Coverage for medical expenses for treatment, hospital stays, surgeries, prescription medications, and rehabilitative services.
Wage-Loss Benefits: Compensation for lost wages if you are unable to continue working or need to work a lower-paying job due to your injury.
Temporary and/or Permanent Disability Benefits: Financial assistance for temporary or permanent disabilities that prevent you from being able to work.
Death Benefits: Financial support for the dependents of an employee who dies as a result of a work-related injury or illness.
The Pennsylvania Workers’ Compensation Act is designed to provide comprehensive support to employees facing work-related injuries or illnesses. These benefits aim to alleviate the financial burden, ensuring that injured workers receive the proper medical care and financial assistance during their recovery period. By understanding and utilizing these benefits, injured employees can focus on their health and rehabilitation without the added worry of financial instability.
Denied Workers' Compensation Claims in Pennsylvania
It is not uncommon for Workers’ Compensation benefits to deny claims, but the denial can be appealed. Consulting with an experienced workers’ comp 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 workplace injury is a non-compensable injury.
Failure to provide sufficient details to when, where, and how the work injury occurred.
The insurance provider claimed the injury is pre-existing and therefore not eligible to receive 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.
Appeals Process for a Work Injury Claim Denial
If your workers’ comp benefits have been denied, it is vital to seek the counsel and outstanding representation of a qualified Philadelphia 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 attorney 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.
The steps for appealing a denied workers’ comp claim in Pennsylvania include:
Review the Denial Letter: Carefully examine the denial letter from the insurance company to understand the specific reasons for the denial of your claim. This letter will also provide important deadlines for filing an appeal.
Gather Documentation: Collect all documents related to the claim, including medical records, accident reports, witness statements, and any correspondence with the insurance company and your employer. Ensure you have detailed medical evidence that supports your injury or illness is work-related.
File an Appeal: Submit a Notice of Workers’ Compensation Claim Petition form to the Pennsylvania Bureau of Workers’ Compensation within the time frame specified in the denial letter, typically within three years from the date of injury or illness.
Request a Hearing: Upon filing your appeal, a hearing will be scheduled before a Workers’ Compensation Judge. Prepare to present your case with supporting evidence and testimony. This may include medical experts and other witnesses who can verify the severity and work-related nature of the injury.
Prepare for Mediation: In some cases, mediation may be required. During mediation, both parties attempt to reach a settlement agreement with the help of a neutral mediator. Be prepared to negotiate and have all necessary documentation available.
Attend the Hearing: Appear at the scheduled hearing and present your case in front of the Workers’ Compensation Judge. Provide all necessary evidence, including medical records, testimonies, and any other supporting documents. Your attorney will help you present your case and cross-examine the insurance company’s witnesses.
Await the Judge’s Decision: After the hearing, the Workers’ Compensation Judge will review the evidence and issue a written decision. This process can take several weeks. The decision will either affirm the denial, reverse it, or modify the benefits awarded.
Appeal to the Workers’ Compensation Appeal Board: If the Workers’ Compensation Judge affirms the denial, you have the right to appeal to the Pennsylvania Workers’ Compensation Appeal Board within 20 days of the Judge’s decision. The Board will review the decision and the evidence presented at the initial hearing.
Further Appeals: If the Appeal Board also denies the claim, you may appeal to the Commonwealth Court of Pennsylvania and, if necessary, to the Pennsylvania Supreme Court. Each higher court will review the legal aspects of the case, rather than the factual evidence.
Navigating the complex appeals process for a denied workers’ compensation claim can be daunting and overwhelming without professional assistance. Having a qualified workers’ compensation lawyer by your side significantly increases the likelihood of a favorable outcome. Their deep understanding of Pennsylvania workers’ comp laws ensures that no aspect of your case is overlooked, bolstering your chances of securing the benefits you rightfully deserve.
Why Hire the Law Offices of E. William Hevenor for Workers' Compensation Claims
At the Law Offices of E. William Hevenor, we understand the immense stress and uncertainty that a work-related injury or illness can bring to you and your family. That’s why we are here to provide you not just with legal experience, but with the compassion and personal attention that you deserve. Our Philadelphia workers’ compensation attorney is dedicated to standing by your side through every step of your Workers’ Compensation claim, from initial filing to navigating the appeals process if necessary. We believe that no one should have to fight alone for the benefits they are rightfully entitled to, and we are committed to achieving a favorable outcome for you.
Our personalized approach means that we take the time to listen to your unique situation and tailor our legal strategies to meet your specific needs. We pride ourselves on our thorough understanding of Pennsylvania Workers’ Compensation law and our track record of successfully advocating for our clients. By choosing the Law Offices of E. William Hevenor, you are entrusting your workers’ comp case to a law firm that is not only knowledgeable and experienced but also deeply invested in your well-being. Let us handle the complexities of your claim so that you can focus on your recovery and moving forward with your life.
Schedule Your Free Consultation Today
If you or a loved one has been affected by a work-related injury or illness, don’t wait any longer to get the help you need. Schedule a free consultation with the Law Offices of E. William Hevenor today to discuss your case with one of our experienced workers’ compensation lawyers. During your consultation, we will review the details of your situation, explain your rights and options, and provide you with the guidance and support necessary to pursue a successful claim. We are committed to fighting for the justice and compensation you deserve, and our no-obligation consultation is the first step towards securing your future. Reach out to us now and let us help you navigate through this challenging time with confidence and peace of mind.
