FAQ
Frequently Asked Pennsylvania Workers Compensation Questions
How do workers’ compensation lawyers get paid?
Workers’ compensation lawyers typically get paid on a contingency fee basis. This means that the lawyer only gets paid if they win the case or negotiate a settlement on your behalf. If you do not receive any benefits or compensation, the lawyer will not get paid.
@thwesq How do #workerscomp #lawyers get paid in #pennsylvania ? #contingencyfee #catcameo ♬ original sound – Tom Wing
Will my employer pay my workers comp attorney?
A court will order an employer to pay for an injured worker’s attorney’s fee for an Employer’s unreasonable contest of a claim and in other limited circumstances.
Under section 440 of the Pennsylvania Workers’ Compensation Act, if an employee prevails in a litigated case, the Workers’ Compensation Judge (WCJ) will award reasonable counsel fees against the employer as a cost, unless the employer meets its burden of establishing facts sufficient to prove a reasonable basis for the contest.
The WCJ must award counsel fees unless the employer establishes a reasonable contest, even if the employee has not requested that counsel fees be assessed against the employer. When an injured worker prevails, the law presumes that the employer should bear the cost of the employee’s attorney’s fee.
A WCJ may also award counsel fees in other circumstances, such as when an employer attempts to terminate medical benefits or contests the reasonableness of ongoing medical care.
At McMenamin & Wing, we only get paid when you get results.
What are the top 3 reasons to hire a workers’ comp lawyer?
A workers comp lawyer’s knowledge and experience can increase an injured worker’s recovery and protect their rights under the Pennsylvania Workers’ Compensation Act.
Knowledge and Experience: Workers’ compensation laws and procedures can be complex, and a qualified workers’ comp lawyer has the knowledge and experience to guide injured workers through the process. They can help you navigate the legal system, understand your rights, and make sure you receive the benefits and medical treatment you are entitled to.
Maximizing Benefits: A workers’ compensation lawyer can help injured workers obtain the maximum benefits available under the law. They can help you gather evidence, negotiate with insurance companies, and represent you in court to ensure that you receive the compensation you deserve.
Protecting Your Rights: A workers’ compensation lawyer can help protect injured workers’ rights and interests throughout the entire process. They can help you appeal a denied claim, negotiate a settlement, and ensure that your employer or its insurance company do not take advantage of you.
Having a lawyer on your side can help safeguard your rights and ensure you receive every dollar you deserve.
Do I really need a lawyer for a workers’ compensation claim?
It depends on the complexity of the case, but a free consultation with an experienced workers’ comp lawyer costs nothing, regardless of whether or not you end up hiring a lawyer.
It depends on the specific circumstances of your case. If you sustain a minor injury and can return to work quickly, you might not need a workers’ comp lawyer. However, should your injury prove severe, necessitate ongoing medical treatment, or if the insurance company denies your claim, hiring a workers’ compensation lawyer could serve your best interests
A lawyer can help you navigate the legal system, understand your rights, and ensure that you receive the maximum benefits available to you. They can also represent you in court and protect your rights throughout the entire process.
Ultimately, the decision to hire a lawyer for a workers’ compensation claim depends on the individual circumstances of your case, but since a free consultation has no risk, we advise injured workers to have every at least evaluated by a lawyer.
What does the workers’ compensation lawyer do once I hire them?
Once you hire a workers comp lawyer, they will typically take on the responsibility of managing your workers’ compensation claim. This includes reviewing your case, gathering evidence, communicating with the insurance company, filing paperwork, attending court appearances, providing legal advice, and assisting with coordinating medical treatment.
Review your case: Your lawyer will start by reviewing the details of your case, including the nature of your injury, the circumstances under which it occurred, and the medical treatment you have received.
Gather evidence: Your lawyer will gather evidence to support your claim, which may include medical records, witness statements, documentation of lost wages, and other expenses related to your injury.
Communicate with the insurance company: Your lawyer may communicate with the insurance company on your behalf, negotiating for the benefits you are entitled to receive under the law.
File paperwork and claims: Your lawyer will file all necessary paperwork and claims, ensuring correct and timely submission of your claim.
Attend hearings, depositions, and mediations: If your case goes to court, your lawyer will represent you and advocate for your interests, hire expert witnesses, and cross-examine the insurance company’s witnesses.
Provide legal advice: Your lawyer will provide you with legal advice throughout the process, answering your questions and advising you on your options.
Help you get the medical treatment you need: Your lawyer can help you navigate the workers’ compensation system to ensure that you receive the medical treatment you need for your injury.
Overall, the best workers comp lawyers protect your rights and strive to help you get the maximum recovery for your injury.
What is workers’ compensation and what does it cover?
Workers’ compensation provides benefits to employees who suffer injuries or illness as a result of their employment. This system provides financial support and medical care to workers injured on the job and protects employers from costly lawsuits.
Workers’ compensation typically covers medical expenses related to the injury or illness, lost wages or income, specific loss benefits for disfigurement or loss of use of a body part, and in some cases, death benefits for the worker’s dependents. The specific benefits and coverage will vary depending on the individual circumstances of the case.
Fault for the injury does not matter in workers comp. This means that the injured worker does not need to prove that their employer had fault for their injury or illness. As long as the injury or illness occurred within the course and scope of their employment, the employer may owe workers’ compensation benefits.
Who is eligible for workers’ compensation benefits?
Typically, most employees suffering from illness or injury as a result of their job qualify for workers’ compensation benefits. However, the specific eligibility requirements may vary depending on the individual facts of each case.
- The injury or illness must have occurred within the course and scope of the worker’s employment.
- The worker must be an employee of the company, not an independent contractor or freelancer. Note: Many companies misclassify employees as independent contractors. When a misclassification happens, an employer may be required to pay workers’ compensation benefits.
- The worker must tell their employer of the injury or illness in a timely manner, typically within 120 days of the incident. For repetitive trauma type injuries, the time limitation runs from the last day of employment.
@thwesq Who is eligible for #workerscompensation benefits? #injured #lawyerup #philly #pennsylvania ♬ Hurts Me (Alone At Prom) – Tory Lanez
How do I file a workers’ compensation claim?
If you have been injured or become ill as a result of your employment, you should immediately report the injury, seek medical treatment, submit any necessary paperwork, follow up on your claim, and speak to a lawyer.
Notify your employer: Notifying your employer of your injury quickly can ensure prompt payment of compensation. Your employer has 21 days from the date you provide notice of the injury to accept or deny liability for your injury.
Seek medical attention: Seek medical attention for your injury or illness as soon as possible. Your employer should provide you with a list of panel physicians. They may direct you to see a specific doctor or medical provider, or you may have the option to choose your own. Be sure to save all paperwork you receive and note any conversations directing you to see a particular doctor.
Fill out the necessary paperwork: Your employer should provide you with the necessary paperwork to file a workers’ compensation claim. This may include a claim form, medical release form, and other documents.
Submit your claim: Once you have filled out the necessary paperwork, you should submit it to your employer or their workers’ compensation insurance carrier. Keep copies of all documents for your records.
Follow up on your claim: You should actively follow up with your employer or their insurance carrier to confirm the processing of your claim and to ensure you receive the necessary benefits.
Speak to a lawyer: You should speak to a workers comp attorney as soon as possible after a work injury for a free consultation. Certainly, if anything doesn’t seem right to you or more than 21 days since you provided notice of your injury to your employer, you should consider hiring a workers comp lawyer to ensure you receive all of the benefits you are entitled to.
What types of injuries or illnesses are covered by workers’ compensation?
Workers’ compensation typically covers injuries and illnesses sustained in the course and scope of employment. This can include a wide range of injuries and illnesses.
Traumatic injuries: broken bones, burns, cuts, and bruises
Repetitive stress/trauma injuries: carpal tunnel syndrome and tendonitis
Occupational illnesses: hearing loss, lung disease, and exposure to toxins
Mental health conditions: depression, anxiety, and post-traumatic stress disorder (PTSD) that result from a workplace incident or conditions
Injuries sustained while traveling for work or during work-related activities: attending a conference or meeting
It’s important to note that workers’ compensation may not cover injuries or illnesses resulting from the employee’s own misconduct, such as injuries sustained while under the influence of drugs or alcohol, self-inflicted injuries, or injuries sustained during horseplay or other non-work-related activities.
What benefits am I entitled to under workers’ compensation?
The individual circumstances of your case will determine the benefits you receive under PA workers’ compensation. However, in general, workers’ compensation benefits may include Wage Loss, Medical Expenses, Specific Loss benefits, and Death Benefits.
Medical expenses: Workers’ compensation will typically cover the cost of medical treatment related to your work-related injury or illness, including doctor visits, hospital stays, medication, and rehabilitation.
Lost wages: If you cannot work due to your work-related injury or illness, workers compensation can provide temporary total disability benefits or temporary partial disability benefits.
Specific loss benefits: If your injury or illness caused the loss of use of one or more parts of your body, or caused head, face or neck scarring/disfigurement you may be entitled to receive additional benefits aside from lost wages and medical expenses.
Death benefits: If an employee dies as a result of a work-related injury or illness, their dependents may be entitled to death benefits, such as funeral expenses and ongoing financial support.
@thwesq What kinds of #benefits does #workerscomp provide? #lawyer #fyp #morethanyouthink ♬ Nourish The Soul – Deep Mix – DJ Taz Rashid & Momentology
Specific benefits and coverage will vary depending on the individual case. Consult with an experienced workers’ compensation attorney to fully understand your rights under Pennsylvania workers’ compensation law.
Can I choose my own doctor for my workers’ compensation claim?
Employers must only pay for treatment in the first 90 days of a claim with an approved provider if they provide an appropriate list of medical providers and comply with the Act and regulations. If the employer does not follow the rules, the employee can treat with the doctor of their choice.
Employers have the right to create a list of designated healthcare providers for injured workers. To comply with the Act’s regulations, the employer must fulfill certain obligations. First, they must provide a clearly written notice to employees that outlines their rights and responsibilities. The employer must have this notice signed by the employee upon hiring, whenever the list changes, and at the time of injury.
The list itself must include a minimum of six providers, with at least three being physicians. The definition of providers extends beyond just physicians. Each provider’s name, address, telephone number, and specialty must be included on the list.
If the list does not have the necessary medical specialty for the injury, the employee may choose a healthcare provider of their choice. Employers may not direct employees to a specific provider on the list, and employees have the freedom to switch from one designated provider to another.
Further, the listed providers must be geographically accessible, and their specialties should be appropriate for addressing the anticipated work-related medical problems of the employee. In the event that the employer’s list of designated providers fails to comply with the Act and its regulations, the employee retains the right to seek treatment from a provider of their choice.
The law does not require an employee to treat with a designated provider. An employee may obtain a second opinion outside of the employer’s list at any time. The law only states that the employer does not have to pay for medical treatment, within the first ninety days, from a provider other than the designated providers as long as the employer has complied with all of the requirements of the law.
What happens if my employer denies my workers’ compensation claim?
If your employer or their insurance carrier denies your workers’ compensation claim, you have the right to challenge the decision. The process for challenging a denied claim typically involves the lawyer gathering evidence and filing a Claim Petition with the Workers’ Compensation Office of Adjudication.
File a Claim Petition: A Workers’ Compensation Judge (WCJ) will hear your claim and take any relevant evidence or testimony before making a decision.
Provide evidence: You will need to provide evidence to support your claim, such as medical records or expert depositions, witness statements, and other documentation related to your injury or illness.
Attend a mediation or settlement conference: In many cases, you may attend a mediation to try to resolve the dispute before proceeding to a formal decision.
Appeal the decision: You may be able to appeal decision of a WCJ to the Workers’ Compensation Appeal Board.
You may find the process of challenging a denied workers’ compensation claim complex and time-consuming. Consult with an experienced workers’ compensation attorney who can guide you through the process and help you to build a strong case.
Can I receive both Workers’ Compensation and Social Security Disability benefits?
Yes, you can receive both workers’ compensation and Social Security disability benefits, but the amount of workers’ compensation benefits you receive may reduce the Social Security disability benefits you get.
Social Security disability benefits replace a portion of your lost income if you cannot work due to a disability, while workers’ compensation benefits provide financial support for work-related injuries or illnesses.
The specific rules for combining workers’ compensation and Social Security disability benefits can be complex, and will depend on the individual circumstances of your case. It’s important to work with an experienced attorney who is knowledgeable about both workers’ compensation and Social Security disability law to ensure that you are receiving the full benefits you are entitled to under the law.
How long do I have to file a workers’ compensation claim?
Typically, you have three years from your date of injury to file a claim. However, you must provide notice of your injury to your employer within 120 days of your date of injury.
Time limitations differ depending on the type of injury and whether you will need to make a claim with the Uninsured Employers Guaranty Fund, which has short and strict time limitations for notice and filing, separate from the notice you must provide your employer.
Speak with an attorney as soon as possible after an injury, to ensure a properly and timely filed claim, since a missed deadline can end entitlement to benefits forever.
What should I do if my workers’ compensation benefits are terminated?
If your workers’ compensation benefits are terminated, it’s important to take action promptly: You should review the reason for the termination, Appeal the decision, and consult with an experienced workers comp attorney immediately.
Review the reason for termination: Find out why your employer terminated the benefits. Sometimes a change in your medical condition, a return to work, or other factors can result in a termination of benefits.
Appeal the decision: If you believe that your employer terminated your benefits unfairly or in error, you may have the right to appeal the decision. Keep in mind, you only have a limited amount of time to appeal, so you must act quickly.
Consult with an attorney: An experienced workers compensation attorney can help you understand your rights and options, and can represent you in the appeals process.
You must act quickly if your employer terminates your benefits, as strict deadlines apply to appeal decisions.
What should I do if my workers’ compensation benefits are suspended?
When workers comp benefits are suspended, it’s important to take action promptly. You may need to find out why benefits were suspended, continue medical treatment, consult with a workers comp attorney, or appeal the decision.
Find out why your benefits were suspended: You should ask your employer or the workers’ compensation insurance carrier to provide an explanation for the suspension of your benefits. It may be due to a change in your medical condition, a return to work, or other factors.
Get medical treatment: If your benefits were suspended due to a change in your medical condition, it’s important to continue to seek medical treatment to address your condition and to document your ongoing need for benefits.
Consult with an attorney: If you believe that your benefits were suspended unfairly or in error, you may wish to consult with an experienced workers’ compensation attorney. An attorney can help you understand your rights and options, and can represent you in the appeals process.
Appeal or challenge the decision: If you believe that your benefits were suspended unfairly or in error, you may have the right to appeal the decision or file an Employee Challenge.
It’s important to act quickly after a suspension of workers’ compensation benefits, as strict deadlines apply to appeals.
@thwesq Top three reasons why workers compensation benefits have stopped outside of litigation: Claim denial, Failure to return wage verification forms, & Illegal suspension by the insurance company. #longervideos #1min #foryou #lawyer #PA ♬ Suspenseful and tense orchestra(1318015) – SoLaTiDo
Can I get a loan while waiting for workers’ comp?
Many injured workers qualify for legal funding, also known as lawsuit funding, which is a financial arrangement where a company provides cash advances to claimants in a workers compensation case in exchange for a portion of the eventual settlement or award.
Legal funding helps individuals involved in a personal injury lawsuit, workers’ compensation claim, or other types of civil litigation. The funding is non-recourse, which means that if the plaintiff loses the case, do not repay the money advanced. Instead, the legal funding company assumes the risk of losing their investment. Legal funding can be helpful for plaintiffs facing financial difficulties while waiting for their case to settle. It can provide them with the financial resources they need to cover living expenses and medical bills. Legal funding can also help claimants avoid settling their case for less than they deserve due to financial pressure.
@thwesq What is #legal #funding ? #lawsuit #injury #lawyer ♬ Idea 10 (Slowed & Reverb) – Gibran Alcocer
How long does it generally take to settle a workers’ compensation claim?
The time it takes to settle a workers’ compensation claim can vary widely from a few months to years depending on several factors, such as the complexity of the case, the severity of the injury, the medical treatment required, and the insurance company’s responsiveness.
In general, simple workers’ compensation claims can can take a few months, while more complex cases can take a year or longer to settle. The process usually involves several stages, such as filing a claim, obtaining medical evidence, negotiating with the insurance company, and many times attending hearings or mediation sessions.
During this time, the injured worker may receive wage replacement benefits and medical treatment. It’s important to work with an experienced workers’ compensation lawyer who can help guide you through the process.
Will I get pain and suffering for my workers’ compensation injury?
Not from the workers’ compensation claim. The workers’ compensation system provides wage loss, medical, specific loss, and death benefits for a workplace injury or illness. However, the injured worker may have other claims related to the injury where you can recover pain and suffering.
In personal injury lawsuits, you can typically claim pain and suffering damages if you prove that another party’s negligence or intentional conduct caused your injury. Sometimes, an injured worker can file a personal injury lawsuit against a third party, like a manufacturer of the defective equipment that caused the injury or a driver responsible for a motor vehicle collision. In such cases, the injured worker may recover pain and suffering damages in addition to workers’ compensation benefits. However, Workers’ Compensation does not pay pain and suffering. Consulting an experienced workers’ compensation lawyer proves crucial for understanding your rights and exploring options to seek injury compensation.
Can I be fired for filing a workers’ compensation claim?
No. That’s illegal. Employers cannot retaliate against employees who file for Workers’ Compensation. This includes actions like firing, demotion, or cutting hours or pay. If you face retaliation after filing a workers comp claim, speak to an experienced workers’ comp lawyer immediately.
One of the biggest concerns while filing a workers’ compensation claim involves fear of employer retaliation. Some employers hesitate to support their employees’ claims or discourage them from filing to avoid higher insurance premiums. This behavior can create a hostile work environment or lead to termination. However, remember that the law prohibits employers from retaliating against employees who file workers’ compensation claims. Retaliation includes actions like firing, demotion, reducing hours or wages, or other forms of punishment. If an employer retaliates against an employee for filing a workers’ compensation claim, the employee can pursue legal action against the employer.
It’s important to document any incidents of retaliation or intimidation and speak to a lawyer. An experienced workers’ compensation lawyer can help protect your rights without fear of retaliation.
What are the reasons NOT to hire a workers’ compensation lawyer?
While hiring a workers’ compensation lawyer can be beneficial in some cases, you may not need one in simple or minor claims. However, getting a free consultation with a workers’ comp lawyer always stands as a good idea, even if hiring one isn’t necessary.
Straightforward Claim: If your claim is simple and straightforward, such as a cut or a scrap needing no serious medical attention, and there are no issues with your employer or the insurance company, you may not need the help of a lawyer. In some cases, workers’ compensation claims are approved quickly and without any disputes, particularly if they are minor and self-limited.
Minor Injuries: If you have relatively minor injuries and can return to work without long-term effects, you might not need a lawyer’s assistance. However, if you suffer serious injuries, need ongoing medical treatment, or experience wage loss for more than 7 days, you should consider seeking legal help from an experienced workers’ comp lawyer.
Do workers’ compensation lawyers make the case more valuable?
In many cases, hiring a workers’ compensation lawyer can help to make your case more valuable since a lawyer can accurately value your claim, provide strong legal arguments on your behalf, negotiate a higher settlement based on their knowledge and experience, and appeal decisions from the employer or insurance company that impact the value of your case.
Accurately valuing your claim: An experienced workers’ compensation lawyer can help you understand the true value of your claim, including both the costs of your medical treatment, the extent of your lost wages, and any other benefit entitlements you have. This can help to ensure that you receive fair compensation for your injuries.
Providing a strong legal argument: A lawyer can help you build a strong legal argument for why you deserve workers’ compensation benefits. They can help you gather evidence to present a compelling and persuasive case.
Negotiating with the insurance company: Insurance companies are often more likely to offer a fair settlement to claimants when they have a lawyer. Lawyers have strong negotiation skills and understand the value of your claim, and the insurance company knows it.
Appealing a denied, modified, or suspended claim: If a judge or employer denies, modifies, or suspends your workers’ compensation claim, a lawyer can assist in navigating the appeals process and advocate for your right to receive benefits. This can potentially increase the value of your claim and help you get the compensation you deserve.
How often should I hear from my workers’ comp lawyer?
Your workers’ comp lawyer should keep you updated on your case and its progress regularly. The frequency of communication can vary depending on the stage of your case and the complexity of the issues involved, but generally at least every 30 days.
Generally, expect monthly updates from your lawyer. They should inform you about significant developments like the filing of your case, scheduling of hearings, or any settlement offers. They should also timely address your questions or concerns.
If you go a few weeks without hearing from your lawyer, you should follow up and check in on the status of your case. You need to communicate clearly with your lawyer to ensure you both understand each other and work towards a favorable outcome
In our office, each client has their lawyer’s personal cell phone number and can reach a person on the phone 24/7. Effective representation must include clear lines of communication.
@thwesq The number one complaint about lawyers from clients is communication. I give more second opinions on cases due to a lack of communication than for any other reason #communication #tiptok #lawyer #fyp #getittogether ♬ Nourish The Soul – Deep Mix – DJ Taz Rashid & Momentology
How is a workers compensation claim valued?
Several factors determine the value of a workers’ compensation claim. These include: The severity of the injury, the required medical treatment, and the employee’s wages and earning capacity before and after the injury.
Medical Treatment: The cost of medical treatment, which includes hospitalization, surgery, physical therapy, medication, and other related expenses, significantly influences the value of a workers’ compensation claim.
Wage Loss: The time an employee cannot work and their wage rate play crucial roles in calculating the value of their claim. Typically, wage loss benefits compensate for a portion of the wages the employee loses while unable to work. The risk to the employer that they will keep paying wage loss benefits plays a significant role in settlement valuations.
Permanent Disability: If the employee has suffered a permanent disability as a result of their work injury, the value of the claim may increase. The severity and extent of the disability, as well as the employee’s age, occupation, and earning capacity can all impact the value of the claim.
Future Medical Expenses: If the employee will require ongoing medical treatment for their injury, the cost of these future medical expenses contributes to the settlement value of the claim.
Other Factors: Other benefits such as specific loss benefits can also contribute to an increased value. Further, the jurisdiction of the claim can have an impact on its value.
Overall, the unique circumstances of each individual case and a variety of factors specific to the employee’s injury and work situation determine the value of a workers’ compensation claim.
What will my workers compensation lawyer need from me?
When you hire a workers’ compensation lawyer, they will need to gather information from you to build your case such as injury details, job description, medical records, wage information, your contact information, and other relevant documents.
Details about your injury: Your lawyer will need to know the details of your injury, including how it occurred, when it occurred, and what medical treatment you have received.
Medical records: Your lawyer will need copies of your medical records, including reports from doctors, hospitals, and other medical providers. Typically, our office will obtain these directly from your doctors once you provide an authorization.
Proof of lost wages: Your lawyer will need to know how much income you have lost as a result of your injury, and will need documentation of your wages and earnings both before and after your injury.
Contact information: Your lawyer will need your contact information, including your phone number, email address, and mailing address, so that they can reach you and provide updates on your case. Keeping your contact information current holds vital importance. You should also have an emergency contact on file at your lawyer’s office in the event they cannot reach you.
Information about your job: Your lawyer will need to know about your job, including your job duties, work schedule, and any other relevant information that may impact your case.
Other relevant documents: Your lawyer may need other relevant documents, such as accident reports, witness statements, or insurance policies.
You should always maintain honesty and transparency with your lawyer, providing all necessary information and documents to build a strong case. Working together, you and your lawyer can protect your rights and secure the benefits you deserve under the law.
What happens if my employer does not have workers’ compensation insurance?
The Pennsylvania Uninsured Employers Guaranty Fund (UEGF) may step in and pay benefits when an injured worker’s employer does not have workers’ compensation insurance.
You should immediately consult an experienced workers’ compensation lawyer if you know or suspect your employer lacks insurance, as claims involving the UEGF carry strict time limitations. Missing a notice or filing deadline could prevent you from recovering any benefits.
What will my workers compensation lawyer ask me when I testify?
If you testify in your workers’ compensation case, your lawyer will likely ask you a series of questions to help build your case and establish the facts of your injury such as background information, details of the injury, medical treatment, your recovery process, the impact of the injury on your life, and expectations for future medical care.
Background information: Your lawyer may ask you questions about your employment history, including how long you have worked for your employer and what your job duties involve.
Details of the injury: Your lawyer will likely ask you to describe the circumstances surrounding your injury, including how it occurred and what injuries you sustained.
Medical treatment: Your lawyer may ask you to describe the medical treatment you received, including the doctors you saw, the tests and procedures you had, and any medication prescribed.
Recovery process: Your lawyer may inquire about your recovery process, focusing on progress made and challenges encountered along the way.
Impact on your life: Your lawyer may ask you to describe how your injury has impacted your life, including any physical or emotional limitations you have experienced, as well as any financial or other hardships you have faced.
Future medical treatment: Your lawyer may ask you about any ongoing medical treatment you may require as a result of your injury.
Overall, your lawyer’s questions will be designed to help establish the facts of your injury and to demonstrate the impact it has had on your life. By providing honest and detailed answers to your lawyer’s questions, you can help build a strong case and increase your chances of receiving the maximum recovery.
Will I have to go to court for my workers’ compensation case?
Whether you need to go to court for your workers’ compensation case will depend on its specific circumstances. In some situations, you might resolve your claim through negotiations with your employer’s insurance company, eliminating the need for a court appearance. However, in other scenarios, attending court may become necessary to resolve disputes or to seek a favorable outcome for your claim.
Denied Claim: If the insurance company denies your workers’ compensation claim, you will likely need to appeal the decision in court and argue your case before a Workers’ Compensation Judge (WCJ).
Modified or Suspended Benefits: If your employer modifies or suspends your benefits before full recovery, you may need to go to court to get a continuation of your benefits
Outstanding Medical Bills or Under-Described Injury: If the insurance company did not accept liability for your entire injury, you may have to go to court to ensure you can receive the medical treatment you need to recover.
Disputed Amount of Benefits: If a dispute arises regarding the amount of benefits owed, you might need to go to court to settle the issue and present your case before a WCJ.
If your employer disputes your claim: If your employer challenges your claim or argues that your injury did not occur at work, you might need to go to court to clarify the facts of your case and advocate for your right to workers comp benefits.
In any of these situations, having an experienced workers’ compensation lawyer to represent and advocate for your rights proves crucial. Your lawyer can assist you in navigating the legal system and ensure protection for your interests throughout the process.
I have a pre-existing condition that was aggravated by work, do I have a case?
Yes, you may be eligible for workers’ compensation benefits if a work injury aggravated a pre-existing medical condition. In Pennsylvania, the workers’ compensation system provides benefits for aggravation of a pre-existing condition caused by a work-related injury or occupational disease.
However, to be eligible for benefits, you will need to prove that your work-related injury was a significant contributing factor to the aggravation of your pre-existing condition. This can be a complex process, and it may require medical evidence and legal assistance to establish a causal link between your work-related injury and your aggravated medical condition.
If you believe that your work-related injury has aggravated a pre-existing medical condition, you should report the injury to your employer as soon as possible and seek medical attention. You should also consider consulting with an experienced workers comp attorney who can help you navigate the process and protect your rights.
@thwesq Pre-existing conditions can be covered by workers compensation if the underlying condition is aggravated by a work injury #lawyer #tiptok #fyp #medical ♬ One Night – Frank Bramble & Slip.stream
What is Utilization Review?
In Pennsylvania, workers’ compensation insurance companies use the utilization review (UR) process to determine the reasonableness and necessity of medical treatments or services for work-related injuries or illnesses.
The process generally begins when a medical provider request payment for a particular treatment or service for a patient who has suffered a work-related injury or illness. The insurance company requests and the Bureau then assigns the case to an independent UR organization (URO). The URO carries the responsibility of reviewing medical evidence and determining the reasonableness and necessity of the requested treatment.
A qualified healthcare professional, licensed in the field of the treatment under review, performs this evaluation. For example, a chiropractor will review chiropractic treatments.
The reviewer bases their evaluation on medical evidence, including medical records, diagnostic tests, and other information relevant to the worker’s injury, along with statements from both the healthcare provider and the injured worker. The reviewer’s task involves assessing the treatment’s appropriateness and its potential to aid in the worker’s recovery.
Significantly, the review focuses on the treatment’s reasonableness and necessity for recovery, not on its cost. The utilization review process aims to ensure injured workers receive proper medical treatment to facilitate recovery and enable a prompt return to work.
However, insurance companies often use this process as a cost-saving measure. Therefore, you must file timely appeals against unfavorable utilization review decisions, as insurance companies do not have to pay for treatments deemed unreasonable or unnecessary if no timely appeal occurs.
