Can You Be Disqualified From Receiving Workers Compensation In Pennsylvania?
June 7, 2022 | Workers’ Compensation
The Pennsylvania Workers’ Compensation Act requires most employers are required to provide workers’ compensation insurance coverage for their employees. Therefore, workers’ compensation covers most work-related injuries and illnesses. Employers who fail to provide workers’ comp insurance could face lawsuits from injured employees, state fines, and criminal prosecution.
However, workers’ compensation does not cover all injuries at work. There are exceptions to coverage and benefits.
Reasons You Can Be Disqualified From Receiving Workers’ Compensation in Pennsylvania
If you sustain an injury at work or are diagnosed with a job-related illness, you should qualify for workers’ comp benefits, including compensation for lost wages and medical expenses. However, instances in which you could be disqualified from receiving benefits include:
You Intentionally Caused Your Injury
Workers’ compensation is a no-fault insurance program. Therefore, you do not need to prove your employer was negligent to receive benefits.
Additionally, you can receive benefits even if your actions contributed to the cause of your injury. However, if you intentionally caused your injury, you are disqualified from receiving benefits.
Use of Alcohol and/or Drugs
Using illegal drugs and/or alcohol while on the job could disqualify you from benefits. If your injury would not have occurred had you not been intoxicated or impaired, workers’ comp insurance does not cover your injury. Your employer has the burden of proving your drug and/or alcohol use led to your workplace injury.
Failure to Report Injury or File a Claim
Employees should report injuries within 21 days. By law, you must notify your employer of a work injury within 120 days of the injury, or your claim is barred.
For an occupational illness or repetitive injury, the time to file a notice might not start until the employee knows or should have reasonably known about the illness.
Generally, employees have three years to file a Claim Petition with the state. However, this does not extend the time you must give your employer notice of the injury. Failing to file a claim before the deadline results in the loss of benefits.
Failure to Cooperate or Provide Information
Typically, the insurance company cannot force you to submit a recorded statement or sign a release. However, the company might use your refusal as grounds for disqualifying your claim.
On the other hand, if you intentionally fail to provide the required information or fail to cooperate with a required medical examination, it could be grounds for disqualification. Before talking to the insurance company, seek legal advice from a workers’ compensation lawyer. It can help protect you from unfair and deceptive insurance tactics.
Your Injury Did Not Occur at Work
For workers’ compensation to cover a work injury, the employee must have sustained the injury during the ordinary course and scope of employment. However, that does not mean a work injury occurring off-site is not covered by workers’ comp.
For example, suppose your employment requires you to go to a customer’s home to provide a service. An injury that occurs at the customer’s home could be covered. Likewise, workers’ comp should cover injuries traveling to and from a customer’s home.
However, traveling to and from work is generally not considered as being within the scope of employment unless:
- You must travel for your job
- Your employer gives you a special assignment
- Your employment contract covers transportation to and from work
Basically, the injury must occur while you are performing services for your employer at your employer’s request.
You Are Not an Employee
Workers’ compensation only applies to employees. Therefore, if you are an independent contractor, you would not be covered by workers’ compensation insurance. However, you could have a negligence claim against your client if they caused your injury as an independent contractor.
It is common for employers to misclassify an employee as an independent contractor to avoid claims. Talk to a workers’ comp lawyer if you believe your employer is wrongfully classifying you as an independent contractor.
What Should You Do if Your Workers’ Compensation Claim Is Denied?
If your employer or its insurance provider denies your workers’ compensation claim, you have the right to appeal the denial. Appeals for workers’ comp claims can be complicated. Your first step should be to contact a workers’ compensation lawyer.
An attorney reviews your claim to determine why the company denied the claim. Then, the attorney prepares a Claim Petition to file with the state. The appeal is assigned to a judge, and a hearing date is set.
Your lawyer gathers evidence proving you are entitled to benefits for a work-related injury or illness. Evidence could include:
- Medical records
- Opinions from medical experts
- Eyewitness statements and co-worker statements
- Photographs of the accident scene
- Video of the accident
- Results of an independent medical examination
Failing to file the Claim Petition before the deadline expires means you cannot pursue a workers’ compensation claim. Therefore, contact a lawyer as soon as you receive notice your workers’ comp payments are stopping or your claim is being denied.
Contact the Workers’ Compensation Lawyers In Pennsylvania at Marzzacco Niven & Associates For Legal Help With Your Case Today
Harrisburg Law Office
945 East Park Drive, Suite 103 Harrisburg, PA 17111