Pennsylvania Workers Compensation: Eligibility, Denials and Permanent Injuries

Workers compensation functions as a financial safety net for workers that are injured on the job. The Pennsylvania workers compensation act provides coverage for all employees working in the state, except for Federal Government employees.  For the families of workers that are killed on the job, PWCA also pays death benefits.

While the law provides that any worker injured on the job be compensated through the act, most injured workers find that getting benefits is not as easy as filing a claim. Most benefits are paid through a private “for-profit” insurance company, and as such, many legitimate claims may initially be denied.

Important Information for Injured Workers

Workers compensation law is a complex area, and there are some important things employees should be aware of if injured on the job:

  1. An worker must report any injury to his or her employer immediately, no later than 120 days, or else the claim may be thrown out
  2. In Pennsylvania, there is a three year statute of limitations on workers compensation claims. This means that an injured worker may be barred from recovering any benefits if a claim is not made with the bureau of workers compensation within that three year window.
  3. Be wary of signing any documents from the workers compensation insurance company immediately following a claim. Insurance companies may try to get a quick settlement before workers realize the real expenses of their injury, or may get workers to sign away important rights without them realizing what they are doing.
  4. Talking to a private workers compensation attorney is a safe way to ensure all compensation is paid appropriately.

Who is Covered by Workers Compensation?

The Pennsylvania Workers Compensation Act covers all employees working in the state. There are a few exceptions, most of whom are covered by Federal Law:

  • Shipyard and Harbor Workers
  • Longshoremen
  • Railroad Workers
  • Federal Employees Working in Pennsylvania

Shipyard and harbor workers, as well as longshoremen are covered under maritime injury laws. There are some additional exceptions, but only for very specific situations.

Workers compensation benefits include coverage of related medical expenses, as well as a portion of the wages not earned while the worker recovers and cannot work.  Generally, lost wages will be paid at two-thirds of the workers normal gross pre-tax earnings.

Why Did My Claim Get Denied?

It is almost customary for a workers’ compensation insurance carrier to initially deny an otherwise valid claim. Often times, a claim will be denied for administrative reasons, such as filing too late, mishandling of paperwork, incomplete paperwork or the employer fails to report the claim.

Alternatively, the insurance company may claim that the injury was not covered by the act, or that the injury was self-inflicted intentionally in order to obtain compensation, or that it was due to a pre-existing condition or did not happen on the job.  The aggravation of a pre-existing condition is a work injury in Pennsylvania if it occurred on the job. While insurance fraud is a real problem for workers compensation insurance carriers, most claims are legitimate.

If a claim is initially denied, the injured worker can file a claim to have the case heard before a Workers Compensation Judge. If a claim is further denied, the case may be brought to the Workers Compensation Appeal Board.  The injured worker can present his testimony and the evidence and testimony of his doctors in support of his claim.

Is a Workers Compensation Lawyer Necessary?

It is not required that claimants have their own attorney, although it is strongly recommended. The state documentation reads:

"You may represent yourself in WC proceedings, but a non-attorney cannot represent you. However, you should be aware that WC litigation is complex, and your employer or your employer’s insurance carrier will be represented by an experienced attorney. If you hire an attorney, you should discuss fee and cost arrangements."

While some workers compensation claims may be for mild injuries, that will require only a short recovery period.  Many other more serious injuries may end up costing  thousands of dollars in medical expenses in addition to significvant losses from the inability to work.

For all injuries, it is always best to have legal representation when dealing with the insurance companies lawyers, so that your best interests are protected.

Serious or Permanent Injuries

For serious injuries resulting in long recovery times, or work related accidents leading to permanent injury or disability, the payouts from workers compensation may be substantial and the insurance company will likely try to minimize their losses. In these types of cases, having professional legal representation is absolutely essential, and well worth the cost.

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