The Pennsylvania Workers’ Compensation Claims Process
Workers’ Comp benefits in PA help employees who suffer from workplace injuries or occupational diseases. Injured workers often miss days away from work because of these injuries resulting from work. Workers’ comp pays medical expenses and compensation during this time. Workers’ compensation benefits enable employees to focus on their recovery and plan for their eventual return to work.
Understanding the workers’ comp claim process is crucial for both employees and employers. The workers’ compensation claims process may vary by state. However, this blog will delve into the workers’ comp claims process in Pennsylvania.
We will shed some light on the steps involved in the claims process and how to file a workers’ compensation claim. We will also go over the rights of employees and the obligations of employers.
Filing A Workers’ Comp Claim
The Pennsylvania Workers’ Compensation Act mandates that most employers provide workers’ compensation coverage to their employees. This coverage includes medical care and disability benefits for employees who suffer work-related injuries or illnesses. The process to obtain these benefits involves several important steps.
Step 1: Reporting the Work-Related Injury
After an employee sustains a work injury or illness, they need to report it right away. To receive retroactive benefits back to the date of injury, employees must report their injury within 21 days. After those 21 days, the benefits will begin from the date of notice. If the employee fails to report their injury after 120 days, the employee may lose all rights to their benefits.
When providing notice of a work injury, this should be in writing. It should include details about the incident. For example, list information such as the date, time, nature of the injury, and all the affected body parts.
After receiving notice, the employer must report the claim to their workers’ compensation insurance carrier and the state. The employer has 21 days to either accept or deny liability for the claim. The injured worker should receive a claim form from the Department of Labor, notifying them of their employer’s decision. Expect to receive one of these three notices with this decision:
- Notice of Compensation Payable: The employer has accepted liability for the claim. This may include wage loss or only medical benefits.
- Notice of Temporary Compensation Payable: The employer will pay benefits for up to 90 days without admitting liability. This may include wage loss or only medical benefits. However, the employer can still deny liability within the 90 day period.
- Notice of Workers’ Compensation Denial: The employer has denied liability and has not agreed to pay any benefits.
Step 2: Seeking Medical Attention
After reporting the injury, the employee should seek medical treatment. The employer may have a list of their panel doctors for employees to choose from. The employee may have to treat with these providers for the first 90 days of their claim in order for their employer to pay.
However, for this to be the case, strict requirements exist. For example, the employer must provide the employee with proper notice of their rights and duties. In addition, the panel of doctors must meet the required criteria. Without meeting these requirements, the employee can seek treatment from any provider they choose.
Step 3: Filing the Claim Petition
Certain situations may prompt the filing of claim petitions. If the employer or its insurance company fails to provide benefits, this would prompt the need to file a claim petition. Just as a denied claim or a dispute over the extent of the injury would provoke the filing of a petition.
The employee can file a claim petition with the Pennsylvania Workers’ Compensation Office of Adjudication. This legal document starts the formal process to resolve the dispute and seek benefits.
Step 4: Evaluation and Decision
Once you file the claim petition, the court schedules a hearing to consider the evidence of both parties. A workers’ comp judge will review the case, consider medical evidence, witness testimony, and other relevant evidence. The judge will then make a decision. This stage usually requires the use of expert medical testimony to prove an ongoing disability.
Step 5: Appeals Process
Both parties have the right to appeal within 20 days of the judge’s decision. The appeal process involves escalating levels of review, including the Workers’ Compensation Appeal Board. If necessary, the Commonwealth Court may hear the appeal.
Conclusion
@thwesq Replying to @helencurtin575 the right time to talk to a lawyer after a work injury is as soon as possible. The insurance company has someone working hard for them. You should know the legal landscape you’re getting into before something goes wrong. Report the injury, see a doctor, call a lawyer. Not legal advice, informational only. #workersrights #workerscompensationattorney #lawyersoftiktok #lawyer #fyp ♬ original sound – Tom Wing
The Workers’ Comp claims process in PA demands knowledge of procedures and specific rules. Both employers and employees need awareness of their rights and responsibilities. By following these steps, people involved in workers’ comp claims can secure the benefits they deserve.
For questions on the claims process, you can call our office 24/7 at (215) 609-4183.
