Workers’ Compensation Q&A
How are workers' compensation claims handled in Pennsylvania?
In Pennsylvania, workers' compensation claims are governed by two separate laws, the Pennsylvania Workers’ Compensation Act and the Occupational Disease Act. Claims are processed through the Pennsylvania Bureau of Workers' Compensation located in Harrisburg. These laws are enforced by special administrative judges, called workers' compensation judges, who are located in each county, and appeals are handled by a deliberative body known as the Workers' Compensation Appeal Board. Only rarely will your local Court of Common Pleas, which handles most civil matters, be involved in your case. As the rules, procedures, and practices in workers' compensation differ than in civil court, a law firm that has the knowledge and experience in workers' compensation law and features several lawyers who practice in this area is best suited to get you a good result.
What is my most important right?
Your right to have a lawyer is your most important right in successfully protecting your interests in your work injury claim. It is extremely difficult for a layperson to handle a workers' compensation case. It is even difficult for attorneys who do not specialize in compensation law. This is because workers' compensation as it has developed is a specialized practice where knowledge of specific rules, decisions, and practices are important to protecting your rights. Most workers' compensation judges tell Claimants they should get an attorney at the first hearing. Indeed, an attorney is certainly necessary in most cases involving serious work injuries (those expected to last over a year) because you will need a doctor to testify on your behalf "within a reasonable degree of medical certainty" at a medical expert deposition.
When should I give notice to my employer of my work injury?
You should give notice about your injury to your employer immediately as there are time limits which will affect your right to benefits. There are many and crucial advantages to giving notice as soon as possible and no disadvantages.
Will my employer retaliate against me for reporting my work injury?
It is against public policy for an employer to retaliate against you for reporting your own work injury or that of another injured worker. Most employers follow the law and will not terminate your employment for rights asserted pertaining to a work injury. Employers know they can be sued in civil court if they violate public policy by retaliating against you. If your employer retaliates against you for reporting a work injury, we can help. Wusinich & Sweeney has vigorously fought employers who retaliate against injured workers. Call us and learn more about how we can help you.
What should I do if my employer refuses to recognize my work injury?
You will need, in most circumstances, to file a workers' compensation claim within 120 days of the date of injury. But it is best to file it as soon as possible. If the claim is denied, you have up to three years to file an appeal. This three-year period can be extended under certain circumstances. Sometimes the payment by your employer or its insurance company of wage loss or medical benefits can extend the three-year period. There are other rarer circumstances which must be analyzed on a case-by-case basis.
How much time does an employer's insurance company have to pay my medical expenses?
An insurer must pay medical expenses within 30 days after receipt of the required bills and records from your healthcare provider. Often, insurance companies will not pay your bills without your knowledge. You only find out about the failure to pay because your healthcare provider tells you.
An insurance company that unilaterally stops payment of a claimant's medical bills assumes the risk that it will be subject to a penalty for non-payment of bills. This penalty is within a workers' compensation judge's discretion but can be up to 50 percent of the outstanding amount of unpaid bills.
Do I need to respond to a Petition relating to my work injury filed by my employer or its insurance company?
Yes, it is essential that you respond promptly to a Petition filed by your employer or its insurance company. If you do not respond, eventually the employer will be granted the relief it requested in the Petition. It is essential to contact an attorney as soon as you receive a Petition.
There are many types of Petitions that can be filed against you which could affect your continuing right to wage loss benefits or medical treatment. The Bureau of Workers' Compensation has developed specific forms to be used to answer the Petitions of your employer or its insurance company. Our attorneys have years of experience in handling the various types of Petitions employers file.
If your employer has filed a Termination, Modification or Suspension Petition against you, at the first hearing you will need to submit appropriate evidence, including medical evidence, on your behalf in a proceeding known as "supersedeas." This hearing is important for you to win as it will determine whether or not you will receive work loss benefits during the time you are fighting the employer's Petition.
Can I receive workers' compensation again where I was working "light duty" at my job and have been laid off?
Yes, it is quite possible that your employer is required to start your workers' compensation benefits on an ongoing basis where you suffered a previous work injury, you have been laid off or terminated, and you were working with restrictions. Often the employer will not voluntarily fulfill its obligation to start your compensation again. You will be forced to file a "Reinstatement Petition" and litigate your entitlement to continued benefits.
Do I have to follow up with job openings that the insurance company has sent me in the mail?
This is a good question but has a complex answer. When you receive jobs in the mail, the insurance company is likely going to be trying to cut off or cut back your entitlements soon. If your work injury claim occurred before 1995, you will need to apply to each job in person or risk losing your benefits. Claims after 1995 are subject to Act 57 where there is no particular requirement that you follow up with jobs. However, it is still advisable that you do follow up with the proposed job openings.
In either case, it is advisable that you consult an established workers' compensation firm once you receive a letter informing you of job openings. You will need in all probability to take actions concerning your rights either immediately or in the near future.
Am I eligible for a lump sum settlement of my workers' compensation claim?
Yes, almost any Claimant is eligible for lump sum settlement. The amount of the settlement is dependent on the severity of your injury, how much you earned pre-injury in wages, what your doctor opines about your injury, and other factors.
Which doctor can I go to after I am injured?
One of the harsher aspects of workers' compensation law is that under most circumstances you are required to go to a doctor on an employer-designated list for 90 days after your work injury. If you refuse to go to a doctor on the employer's list, the employer does not have to pay for your medical treatment. The employer, however, remains liable for your expenses if it fails to give you written notice that treatment with a panel physician is required. This notice should be given to you at the time you begin work as well as after the work injury.
For cases that involve injuries that last over 90 days, you should consider seeking your own doctor to review your condition and treat you. Our experience has been that some doctors on the employer's panel list tend not to treat your condition with the attention it deserves, while others give excellent care. As consistent treatment is one of the things that workers' compensation judges look for in determining your case, it is important that you are comfortable with your doctor's level of skill and interest.
Do I have a lawsuit outside of the workers' compensation system?
This is a commonly asked question and one which our attorneys are uniquely fit to answer in the specific factual context of your case. The answer depends on the unique facts of your case. Call us. Our firm has extensive experience in personal injury and construction accident cases, some resulting in very large settlements and awards.
A person injured at work typically has as his sole and exclusive remedy the right to pursue his employer in a workers' compensation claim. The major exception to this rule is if there are other(s) who may be liable for your injury besides your employer. We often have invested funds to consult engineering, construction, or other experts to help us determine whether you can sue for personal injury as well as in the workers' compensation arena.
What are "litigation costs"?
"Litigation costs" is a term used to describe the cost of litigating each case by a Claimant. "Litigations costs" can be very expensive and may involve the expenditure of thousands of dollars. These costs include the cost for a doctor's medical deposition and costs for deposition transcripts. A growing practice among many practitioners of work injury cases is to require their client to pay their own litigation costs as the case is ongoing. This places you in the awkward position of being charged for something at a time when you can least afford it.
In most cases, we do not follow this practice. Wusinich & Sweeney typically pays the costs of litigation. If we win or settle your case, we recover these costs from the employer or its insurance company. If we lose, we absorb the costs and will not pass them on to clients who cannot afford to pay. We believe our practice is best suited to the interests of our clients who usually live day-to-day on their paychecks.
Pennsylvania Workers’ Compensation Lawyers at Wusinich & Sweeney, LLC Pursue Maximum Compensation for Injured Workers
If you have been seriously injured on the job and need help filing a work injury claim, or if you have already filed but was denied benefits, the experienced Pennsylvania workers’ compensation lawyers at Wusinich & Sweeney, LLC will fight for you. Contact us online or call 610-594-1600 today to arrange a free consultation.