Coatesville Workers’ Compensation Lawyers

What Is Workers’ Compensation Insurance?

Although injuries at work can be life changing and, in the worst cases, result in death, there is a financial resource for almost all employees in the state of Pennsylvania: Workers’ Compensation insurance.

This insurance offers a compensation package for the injured worker or the worker’s family. Medical bills are covered through the program, and the worker receives regular financial compensation to make up for about two-thirds of the income lost while injured. If the worker dies, there is also a death benefit for the deceased’s family.

Often, workers do not remember signing an agreement for this benefit when signing the multitude of papers many employers require for new employees. But one of those forms that require a signature is the Workers’ Compensation insurance package.

This is insurance that will pay out benefits to the injured worker regardless of whether their injury was the result of their own mistake. Employees are covered from the moment they start work to their last second at the job.

Like a no-fault auto insurance plan, Workers’ Compensation provides quick payouts for damages, regardless of who is at fault. However, like no-fault auto insurance, the benefits are limited.

What Are the Benefits?

In many ways, offering Workers’ Compensation Insurance serves both employer and employee.

Benefits for the worker. Here are a few examples of the benefits for the worker:

• Wage benefit. This consists of regular payments to the worker or the worker’s family while the employee is unable to do their job.
• Medical expenses. Medical bills are covered while the worker is recuperating. This includes hospitalization, doctors’ appointments, surgeries, medications, and other medical necessities. Medical equipment such as braces, walkers, and wheelchairs may also be covered.
• Rehabilitation. Sometimes rehabilitation requires a step-down hospital or outpatient care facility, including physical and occupational therapy and vocational rehabilitation to relearn certain tasks, personal grooming skills with the injury, and possibly learning new job skills if the injury will prevent the worker from returning to the same job.
• Temporary partial disability. This is when an injured worker can return to work, perhaps in a different job and for a part-time schedule. The worker will be bringing home some salary plus collecting benefits equal to two-thirds of the income for the reduced hours. This benefit can continue until a doctor gives approval for a full return to work.
• Permanent partial disability. When the injury limits workers from doing certain types of work for life, or if they had surgery for the injury.
• Permanent total disability. When a worker becomes permanently and totally disabled because of a work injury or occupational disease, they will receive permanent total disability. The injured worker must be deemed by a doctor to not be able to return to work. Those who have suffered traumatic head injuries, amputations, and paralysis are covered by this benefit in the plan.
• Disfigurement and specific loss. Some injuries damage a person’s ability to do not just work but live the life they once did. Disfigurement and specific loss benefits target those who have suffered permanent impairments.
• Death benefits. If a worker dies of the incident, the worker’s family will receive a death benefit, including a sum for funeral expenses.

Benefits for the employer. The Workers’ Compensation system serves the employer as well by providing the following benefits:

• Protection from lawsuits regarding the accident or injury by the worker, or in the case of severe disability or death, the worker’s family. By offering the insurance package and the employee signing the contract to accept it, the employer is shielded from lawsuits regarding the incident.
• Offering the insurance provides a controlled cost to cover the bills that result from workplace accidents, which will likely be far more expensive than the Workers’ Compensation insurance premium.
• The fact that the employer offers a package to compensate workplace injuries is attractive to employees. It is mandated under Pennsylvania law that most employers offer the package, but not all are required to do so. Those who do are offering a benefit that workers find valuable: protection if something goes wrong at work.

Workers Exempt from Pennsylvania Workers’ Compensation Insurance Laws

Although almost all employers are required to provide Workers’ Compensation insurance by the state of Pennsylvania, there are a few exempt categories:

• Railroad workers, longshoremen, and federal employees. These categories are already covered under a different Workers’ Compensation act, separate from the state.
• Domestic servants. Employers can choose to offer Workers’ Compensation insurance, but they are not required to do so for domestic employees.
• Agricultural workers. Those who work fewer than 30 days or earn less than $1,200 in a calendar year from one employer.
• Executives. Those in executive positions can be granted an exemption.

How Do I File for Workers’ Compensation Insurance?

When an accident or injury happens at work, it is very likely that it is immediately reported to the employer as an emergency requiring immediate attention.

But not all workplaces are the same; some employers are not informed immediately of an incident because they are not anywhere near by or cannot be reached.  Often, there are also circumstances in which a disease results from a workplace incident, and that requires pinpointing the cause and where the exposure may have happened, such as a toxic chemical stored at work.  In such circumstances, neither the employer nor the employee might know the exact time of the incident.

It is important for workers to know that although the employer may offer the insurance plan, there is a 21-day time limit in Pennsylvania to report an injury.

Regardless of if the injury or illness is reported by the employee or a coworker or loved one, the details around the incident need to be shared with the employer as soon as possible, preferably in writing. The following details are needed: the names of those involved; the location; the time and date; and the cause, or what appears to be the cause.

Putting the information down in writing does not mean that it needs to be sent in a letter by mail. An email will accomplish this task as well.

Once it is reported to the employer, a claim needs to be filed by the company to the Workers’ Compensation insurance carrier, which also likely is done immediately in an emergency.

Although sometimes this will have to be done by someone other than the worker, it is best to have that report in writing; an email will suffice. Likewise, employers may well have taken care of filing a claim with the insurance carrier, but the state of Pennsylvania requires the paperwork to be filed within 120 days.

Paperwork gets complicated, and work injuries and illnesses are likely to involve multiple medical practices and may involve a long stretch of time in which the worker is unable to go back and earn a regular salary. To ensure that everyone is paid as quickly as possible in this situation, the best course of action is reporting the incident and filing the insurance claim immediately.

Types of Workplace Injuries

There are a lot of different ways an injury can happen anywhere in life, but work accidents often impact the injured person’s ability to do their job, which is why Workers’ Compensation insurance is so vital.

Some common work injuries are as follows:

• Slip and fall injuries. Although this is a very common injury, it is often a debilitating one. Slipping and falling, particularly when striking a stationary object as the result of the slip and/or fall, or falling from heights, could be the result of a spill, a weather event, poorly structured scaffolding, or chemical leak. The results can include concussions, traumatic brain injuries, and broken bones.
• Overexertion. This is another common injury and often is not reported immediately because workers often think that it will get better with some rest. Sometimes, it does. However, overexertion, which means going beyond one’s physical limitations, can have long-term impacts. For example, lifting too much weight, too often, can result in back injuries that require medical attention and likely physical therapy and work modification as well.
• Electrocution. Whether it is a loose wire, an improperly grounded outlet, or exposure to lightning outdoors, electrocutions result in burns, which can be life altering and, depending on the voltage, can throw a person back into a stationary object or wall. This is an injury that requires immediate medical attention.
• Repetitive motion injuries. Also referred to as repetitive strain injury, this is an overuse injury. It is a common workplace injury for office workers, factory workers, and clothiers, which are jobs in which carpal tunnel syndrome can result from using the same muscles, in the same way, repetitively. Tenderness, stiffness, and tingling in the affected area are common symptoms.  Often, these injuries are treated with anti-inflammatory drugs and physical therapy.