Question 1

How Should I Report My Injury?

Accepted Answer

In Pennsylvania, an employee must report an injury within 21 days of the incident. If they do not report the injury within 21 days, they are not eligible for any wage loss benefits until the injury is reported. For example, if an employee reported an injury on the 35th day after they were hurt, wage loss benefits will not start until that day. If an employee reported their injury properly, wage loss benefits start from the day of the accident. An employee has up to 120 days to report an injury to receive any Workers’ Compensation benefits at all.

Question 2

How Should I Handle Insurance Companies?

Accepted Answer

Speaking to the insurance company might make problems worse. The insurance company often records calls for training purposes, and they will use anything an employee says against them. When an employee reports the injury to their employer, give them a basic summary of what happened. Employees do not need to give a recorded or written statement to the insurance company because Workers’ Compensation policies offer no-fault coverage. It is vital to forward all phone calls and letters from the insurance company to our office. We will communicate with employers or insurance companies to obtain any information we need, and we will only give the insurance company the information needed to process a claim or to work out a settlement with our team.

Question 3

How Do I Recover Lost Wages?

Accepted Answer

Workers’ Compensation provides a portion of the employee’s salary based on average weekly wages. Our lawyers will review each case and help injured employees understand their entitled compensation. The type of benefits depends on the severity of the injury and whether the employee can continue working in some capacity. Common types of benefits include:nnTemporary Total Disability: If an employee cannot work at all during their recovery, they may be entitled to approximately two-thirds of the average weekly pay up to a maximum set by the state. If an employer argues that an employee can return to work, we will work with medical experts to show that the employee cannot perform their job duties.nnPermanent Partial Disability: If an employee can work in a limited capacity, but is earning less than normal pay, Workers’ Compensation benefits may provide around two-thirds of the difference for a period of no more than 500 weeks, or until the employee is able to work at full capacity, whichever comes first. An employer or their insurance carrier may claim that the employee can return to a full work schedule before they are ready, and we will help the employee retain benefits if they are not ready to work a full schedule.nnMedical Benefits: Workers who suffer from a job-related illness or injury also have their medical treatments covered by Workers’ Compensation. In Pennsylvania, workers must receive treatment from a company-recommended practitioner chosen from a list provided by the company. For the first 90 days of treatment, the injured employee must see a doctor from the original list. After the 90-day window has lapsed, the employee may choose their own practitioner. Doctors and other specialists submit their claims directly to the company’s insurance provider, and workers should never be charged a co-pay. Covered treatments must be reasonable and necessary to address the worker’s injury. Employees may submit receipts as part of their claim if they were charged for treatment by the insurance company or doctor. In these cases, both the doctor and the insurance company can be held liable for negligent or fraudulent behavior.

Question 4

What are Specific Loss Benefits?

Accepted Answer

Some workplace injuries can result in permanent loss or disfigurement. In these cases, workers may be entitled to additional compensation that is paid in a lump sum. Specific loss covers any injury that results in the loss of a body part or use of a body part, such as:nnAmputation: An employee may have lost limbs or extremities during a workplace injury or after treatment began. We will work with doctors to learn why amputation was necessary and about the treatment plan. These benefits depend heavily on how long the treatment lasts.nnScarring or disfigurement: Scarring and disfigurement are common during workplace injury cases, and an employee may not be able to function like they did in the past. We will use medical records or doctors’ statements to show that the scarring and disfigurement will affect the employee for the rest of their life.nnPartial or total loss of hearing or sight: Everything changes if an employee is partially or completely deaf or blind. We will work with our medical experts to show that employees should be compensated for this injury. The payout for a specific loss is calculated based on the employee’s average weekly earnings and the value of the lost function as determined by the state. For example, if a worker loses the use of one of their arms, they will receive an amount equivalent to two-thirds of the weekly salary for 410 weeks.

Question 5

What About Death Benefits?

Accepted Answer

If a worker dies from their work-related injury or illness, their family may be eligible for compensation. Spouses, children, and other dependents may receive benefits based on the employee’s weekly wages. The length of the benefits depends on the relationship to the worker. The worker’s spouse will receive weekly payments until they remarry, while children will receive benefits until they turn 18 years old, or 23 years old if a child is a full-time student. Other dependents can include parents or siblings who are each entitled to a portion of the deceased worker’s wages. The family of the deceased worker can also claim up to $3,000 to cover funeral costs.nnIn Pennsylvania, most employers are required to carry Workers’ Compensation insurance. Insurance companies often try to minimize the amount they pay out or deny workers’ claims altogether by refusing to authorize treatments or claim that the injury is not eligible for benefits. If you suffered from a workplace injury or illness, it is important to speak to one of our experienced lawyers at Freedman & Lorry, P.C.

Question 6

Why are Claims Denied?

Accepted Answer

Workers’ Compensation claims may be denied for several reasons. An employer or insurance carrier might claim the employee:nn    Was not on the job when they were hurt or was not performing their job dutiesn    Was intoxicated or using illegal substancesn    Did not report the injury in a timely mannern    Did not establish an employer-employee relationship with the companyn    Was traveling for work, which might not constitute a work-related dutynnIf a claim has been wrongfully denied, we will investigate the claim, present evidence that proves the injured employee should be covered, and obtain compensation the injured employee deserves.

Workers’ Compensation Benefits