How Do I Get Workers’ Comp Benefits? – Easy Guide
In PA, the workers’ compensation benefits system falls under the Department of Labor and Industry. The process can seem overwhelming for injured workers. It has many steps, forms, and legal proceedings. Here, we hope to simplify this process to help injured workers get the benefits they deserve.
Pre-Litigation: Initial Steps
After a work injury or illness, understanding and familiarizing yourself with the important steps and forms becomes essential. The employer has 21 days, after receiving notice of the work injury, to either accept or deny liability.
The Bureau of Workers’ Compensation and the Workers’ Compensation Office of Adjudication (WCOA) have developed specific forms. Each of these forms plays a role in the claim process.
Starting A Workers’ Comp Claim
Notice of Compensation Payable
Used by the employer or their insurance carrier, this form accepts a work-related injury and starts compensation. This acceptance is the first step toward securing your benefits. Also referred to as form LIBC-495.
Agreement for Compensation for Disability or Permanent Injury
This document represents a mutual agreement between you and your employer to start compensation payments. Basically, the employer acknowledges the disability or permanent injury, but without fully admitting liability. Also referred to as form LIBC-336.
Temporary Injuries
Notice of Temporary Compensation Payable
This form allows employers to begin medical payments for up to 90 days without formally acknowledging the injury’s compensability. This offers a temporary solution while conducting a further evaluation. Also referred to as form LIBC-501.
Notice Stopping Temporary Compensation
Employers use this form to stop temporary compensation. This step generally leads to a dispute regarding the eligibility of the injury for compensation. Also referred to as form LIBC-502.
Dealing With Claim Denials
Notice of Compensation Denial
If you have a denied claim, you will receive a Notice of Denial. This form outlines the reasons for the claim’s denial. If you choose to dispute the decision, this form sets the stage for the potential litigation. Also referred to as form LIBC-496.
Key Tips for Payments
Reporting and Record-Keeping
- Report your injury promptly. Make sure to report your injury right away in writing.
- Maintain you injury records. Keep everything that has to do with your work injury.
@thwesq Replying to @Shaun M you should always document and report an injury immediately. Insurance companies look for any reason to deny coverage. #workersrights #workerscomp #workinjury #workinjurylawyer #lawyer ♬ original sound – Tom Wing
Steps to Begin Payments
- A Notice of Compensation Payable must formally begin the payment process. Any agreement made prematurely (within the first seven days of injury) does not count.
- Employers may opt for Medical-Only Payments. In this situation, the employer initially chooses to cover medical expenses without paying wage loss. This decision could affect the employee’s ability to seek future wage loss benefits.
Litigation: Time For Court
Litigation becomes vital when a disagreement occurs between parties. Typically, this involves the compensability of the injury, the extent of the disability, or improperly denied or terminated benefits. If you have not done so yet, the time has come to hire a lawyer.
Filing a Claim Petition
Claim Petition
This form challenges the employer’s or their insurer’s decision. Essential for beginning compensation payments, following a denial or cessation of temporary benefits. Also referred to as claim form LIBC-362.
Fatal Claim Petition
Workers’ comp provides for a death benefit. In tragic circumstances that involve a work-related death, this petition seeks compensation on behalf of the deceased’s heirs. Also referred to as form LIBC-363.
Burden of Proof
Proving Your Case
As an injured worker, you must show the validity of your claim. This includes the work-related nature of your injury and the impact it has had on your ability to work.
Employer Counter-Arguments
Expect that your employer may try to show that you can return to work. They may also try to claim that the work-related injury did not directly cause your loss of earnings. These types of arguments occur often.
Conclusion
The workers’ compensation insurance process in PA has many tough steps and procedures. Staying up-to-date on the forms that you may come across will better prepare you and help you to avoid costly delays. Whether fully or partially disabled, workers compensation programs assist injured workers in need of medical care, facing lost wages.
Secure your rights and benefits under Pennsylvania’s workers’ compensation laws and speak to a lawyer today. We are here to help, don’t go it alone. Reach out to our offices 24/7 for a free and confidential case evaluation (215) 609-4183.
