How Does Workers’ Compensation Insurance Work in Pennsylvania?
March 22, 2023 | Workers’ Compensation
The Pennsylvania Workers’ Compensation Act revolutionized the relationship between employers and employees. Ultimately, its reforms benefited both employers and employees. The following is a simplified description of the Pennsylvania workers’ compensation system.
The Tradeoff: From the Employer’s Point of View
For employers, the workers’ compensation trade-off looks like this:
- “The accident wasn’t my fault” is no excuse. You are liable (through your workers’ compensation insurance) even if your employee’s accident wasn’t your fault.
- Your employee cannot sue you in court. Instead, workers’ compensation will resolve the claim in a manner that will probably save you time and money compared to a personal injury lawsuit.
In certain situations, fault will relieve you of liability (see below).
The Tradeoff: From the Employee’s Point of View
For employees, the trade-off works like this:
- You don’t have to prove that your employer was at fault to win your claim. This makes proving your claim a lot easier.
- You cannot sue your employer in court.
In the case of certain kinds of workplace accidents, however, you can exit the workers’ compensation system immediately and file a personal injury lawsuit seeking both economic and non-economic damages. For this to happen, you need to identify an at-fault party other than your employer and prove they were at fault to the court’s satisfaction.
Employee Benefit Summary
- All of your “reasonable and necessary” medical expenses. This might not include “fringe” treatments such as acupuncture or homeopathy. It might also exclude unnecessary or excessive medical treatment.
- A portion of your pre-accident employment income if your disability lasts longer than seven days. Exactly how much you receive depends on your pre-accident income and the extent of your disability. Generally, the more you were making before your accident, the more you will make during your period of disability.
Although there is no absolute limit to the duration of disability payments under workers’ compensation, there is a weekly maximum amount. Additionally, you must return to work as soon as you are able.
How To File Your Claim
Filing a workers’ compensation claim in Pennsylvania is a bureaucratic process that takes time. It is important for you to understand the process in advance. Following is a basic description.
Notify Your Employer of Your Injury
You must notify your employer within 21 days to receive benefits backdated to the date of your injury. You must provide this notification within 120 days to remain eligible to receive workers’ compensation benefits.
Your Employer Must Notify Their Workers’ Compensation Insurance Carrier
Your employer must file a First Report of Injury on your behalf to report your claim to their workers’ comp insurance carrier. The insurance company must approve or deny your claim within 21 days of receiving notification of it.
Furthermore, the insurance company can investigate your claim for 90 days and ultimately reject it even after initially accepting it within the 21-day deadline.
You Can File a Complaint With Pennsylvania If the Insurance Company Denies Your Claim
If you wish to contest the denial of your claim by the insurance company, you must contact the Pennsylvania Department of Labor and Industry. Although Pennsylvania law requires you to file within three years of your accident, your best bet is to file as soon as you can get your paperwork in order. If you do not get satisfaction at this level, you can appeal. In fact, as long as you have grounds you can keep appealing, theoretically, all the way up to the Supreme Court of Pennsylvania.
Why Workers’ Comp Might Reject Your Claim
You might experience a workers’ comp rejection for the following reasons:
- You missed the statute of limitations deadline.
- You injured yourself by breaking workplace rules or working while intoxicated.
- Your employer accuses you of exaggerating your injuries.
- Your injury was pre-existing.
- You failed to seek prompt medical care.
- Your accident was not work-related.
Remember, the workers’ compensation insurance company is not your friend—they are trying to save money by denying your claim.
Your Chances Are Better With a Harrisburg Workers’ Compensation Lawyer
Nobody can offer you a guarantee of success in a workers’ compensation claim, and you should steer clear of any lawyer who tries. Nevertheless, the odds are good that if your claim is significant, your lawyer’s efforts will increase your benefits enough to offset any money you pay in legal fees. To get started, schedule a free initial consultation.
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