How to File for Worker's Compensation Claims in Pennsylvania
Most Pennsylvania employers must provide worker’s compensation, meaning you can file for a claim if you’ve been injured at work or developed a work-related illness. A workers’ compensation claim will help cover medical expenses, lost wages, and other damages incurred during the accident.
However, filing a claim can be hectic, especially if you’re unfamiliar with the steps involved. To make your work easier, we’ll guide you through the entire process of filing for workers’ compensation in Pennsylvania, ensuring that you get the benefits you’re entitled to.
Step 1: Report Your Injury Immediately
You should report the injury or accident to your employer immediately. In Pennsylvania, you have up to 21 days to inform your employer of the incident. If you report the incident after 21 days but within 120 days, you can still file for a claim. But you may not get your compensation on time.
You don’t have to write a formal notice. You can simply let your manager or supervisor know about the injury or illness verbally. However, it’s good to put it in writing since you can use it as evidence if there’s any dispute later on. The report should include the date, time, and details of the incident.
Remember, the clock starts ticking from the day you’re injured or when you’re first diagnosed with your work-related illness. If you’re suffering from an illness that developed over time, such as carpal tunnel syndrome or lung disease, you should report it as soon as you notice symptoms.
Step 2: Seek Medical Treatment
After reporting the injury, the next step is to get medical attention. You should go to the hospital even if the injury seems minor. That’s because some injuries may appear less severe initially but can worsen over time. Keep your medical records because you’ll need them later in the claims process.
Your employer may have a list of approved doctors to treat work-related injuries or illnesses. If they do, then you should choose a physician from that list within the first 90 days. If your employer doesn’t provide you with this list, then you can choose any doctor of your choice to treat you.
Step 3: File Your Workers’ Compensation Claim
Once you’ve notified your employer and started treatment, your employer will formally file a workers’ compensation claim on your behalf. They will notify their workers’ compensation insurance company of your injury. The insurance company should begin processing your claim immediately.
If your employer refuses or delays filing your claim, you can take matters into your own hands by contacting the Bureau of Worker’s Compensation. You’ll be required to fill out Form LIBC-362, found on the bureau’s website. Filing this form initiates a legal process to get the benefits you deserve. You can get an experienced attorney to guide you through this process.
If your employer doesn’t have workers’ compensation or if their workers’ compensation coverage is insufficient, you can file a claim with the Pennsylvania Uninsured Employer’s Guaranty Fund. This ensures injured workers are compensated if their employer doesn’t carry an insurance policy. Your attorney can help you figure out if this is a viable option for your case.
Step 4: Wait for a Decision From Your Employer’s Insurance Company
After your employer reports your injury to their workers’ compensation insurer, the insurance company will have 21 days to decide whether to accept or deny your claim. The insurer can make either of the following decisions:
- Accept your claim and pay your benefits immediately.
- Issue a Notice of Temporary Compensation Payable, which provides benefits for up to 90 days while they investigate further.
- Deny your claim and issue a Notice of Compensation Denial, explaining the reason for the denial.
If your claim is accepted or temporarily approved, you should begin receiving wage-loss benefits and medical coverage for your injury or illness. These benefits help cover a portion of your lost wages and the cost of treatment, rehabilitation, or any necessary surgeries.
Step 5: Appeal a Denied or Disputed Claim
Unfortunately, not all claims go smoothly. If the insurance company denies your claim, you can file an appeal to challenge the denial. You have up to three years to file a claim petition with the bureau. If you don’t file the petition within three years, you might not be compensated, even if you were legitimately injured at work.
Once you’ve filed the claims petition, a workers’ compensation judge will review the details of your case. Sometimes, disputes may arise over the amount of benefits you should receive, for how long you should receive them, or whether your condition was truly work-related. If you’re facing these kinds of issues, the appeal process will give you a fair chance to present your side. Your attorney should guide you through this process to ensure your rights are upheld. They will help you gather medical evidence, file necessary paperwork, and represent your interests in court.
Step 6: Receiving Your Benefits
If your claim is approved, you will receive the following benefits:
Medical Benefits
The workers’ compensation should cover all reasonable medical expenses related to your injury. These include costs for:
- Treatment in an emergency room
- Hospital stays
- Surgeries
- Medications
- Therapies
Wage Benefits
You should be compensated for the income you lost due to a work-related injury or illness. However, you don’t receive compensation for all lost income. You only receive two-thirds of your average weekly wage, up to a certain maximum set by the state. These benefits are paid bi-weekly as long as you’re unable to work due to the work-related injury or sickness.
If your injury affects your ability to earn the same income as before, you will receive partial disability benefits. Also, if your injury leaves you permanently disabled, you may qualify for permanent disability benefits.
Get the Compensation You Deserve
Filing a workers’ compensation claim in Pennsylvania can be quite overwhelming, but things get easier when you understand the process. Keep in mind that most Pennsylvania employers must provide worker’s compensation, so your employer and their insurance carrier should take your claim seriously. If you run into any obstacles, don’t hesitate to seek legal advice to ensure you get the compensation and care you deserve. Your health and financial well-being are too important to leave up to chance.
