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How to file a workers’ compensation claim

Injuries can be life-changing and when they happen at work, the process of dealing with them can be especially complicated. Whether you suffer a back injury from lifting boxes or discover a respiratory disease from toxic exposure, you may be able to get compensation for the injuries you are now dealing with.

Workers’ compensation is meant to help those who suffer on-the-job injuries or because of work-related activities. It can help cover medical bills, wages lost from time off work, long-term life changes and effects of the injury or disease, transportation costs, disability benefits and death benefits. The Pennsylvania Department of Labor and Industry outlines the process of filing and fighting for a workers’ compensation claim:

First, you must notify your employer within 21 days of injury or recognition of injury. There will be no compensation if the injury is reported after 120 days except for in the case of progressive diseases.

You or your employer should then report the injury to your workers’ compensation insurer or person responsible for employer workers’ compensation insurance.

Your employer will make a First Report of Injury and a response within 21 days of the notice of injury, including these options:

  • Deny with a Notice of Workers’ Compensation Denial
  • Give Notice of Temporary Compensation Payable and later notice of stopping temporary compensation when no longer applicable and you return to work
  • Make voluntary payment and accept liability, filing Notice of Workers’ Compensation Payable, Temporary Compensation Payable or Agreement of Compensation

Following a decision of your employer to fulfill your workers’ compensation claims, there will be a Statement of Wages filed by your employer. Once you return to work, there will be a Notice of Suspension or Modification filed by the workers’ compensation insurer within 7 days. Following there will be a Final Statement of Account of Compensation Paid, Supplemental Agreement for Compensation and Final Receipt.

If you receive a denial and wish to pursue your claim further through litigation, you may petition for your injury with a Claim Petition. You can file this and reopen your claim within 3 years of denial.

Your case will go to a workers’ compensation judge. A hearing will be scheduled and held, or the judge will recommend and schedule an Alternative Dispute Resolution Session for mediation. The judge will send out a written decision concerning your claim.

Either you or your employer can appeal the judge’s decision with the Workers’ Compensation Appeal Board within 20 days after the decision. If that does not yield the result that you are looking for, you can continue to appeal with the Commonwealth Court within 30 days after the appeal decision. Then, you can use a Petition for Allowance of an Appeal with the Pennsylvania Supreme Court 30 days after the Commonwealth Court decision to continue pursuing the claim.

While a lawyer may be helpful at any point, including as early as your initial compensation claim, they will be especially important if you decide to litigate after a denial. The process can be long and complicated, so it can make a big difference if you know what to expect and have someone with legal expertise on your side.

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