How Does Workers’ Comp Work in Pennsylvania?

If you are injured at work or contract a work-related illness, many questions will be on your mind. Chief among those questions is likely what the Workers’ Compensation process will entail and how quickly you will be able to receive a payment.

How quickly an injury is reported, whether the insurance carrier grants or denies your claim, and whether any appeals are filed are some of the primary issues that can affect the amount of time invested in a worker’s compensation claim. If your injury was reported immediately, you have missed more than 7 days of work, and the insurance company accepted your claim, you should receive your first compensation check within 21 days. Highly contested claims that require several levels of appeals may take a year or more.

The Philadelphia Workers’ Compensation attorneys at Lerner, Steinberg & Associates can provide legal advice and assistance through every step of the claim process. Call us today at (215) 355-6400 to discuss your case in a free case review.

What Are The First Steps After I Have Been Injured at Work in Pennsylvania?

One of the most important actions to take following a workplace injury or illness – besides seeking medical care – is to report the occurrence to your employer as soon as possible. The sooner you notify your employer, the quicker a claim can be filed and processed. Your employer is required to inform all employees of the contact information for the Workers’ Compensation insurance company or internal contact person. If you are unsure of how to report an accident or illness, speak to your supervisor and request assistance.

A workplace injury should be reported to your employer within 21 days of the injury date. If an employee reports an injury or illness beyond 120 days from the date the injury occurred or the illness became known, compensation will be completely barred. There is an exception for progressive illnesses caused by workplace conditions, but this is not frequently the case.

After you report your injury or illness, your employer will notify their insurance company or self-insurance program contact and evaluate your claim. Your employer will also have to file paperwork with the Pennsylvania Bureau of Workers’ Compensation, which is a division of the Pennsylvania state government that oversees Workers’ Compensation claims. The next step in this process depends on whether the claim is accepted or denied.

What Happens When Your Pennsylvania Workers’ Compensation is Approved?

The best-case scenario when filing a Workers’ Compensation claim is to have your claim approved quickly and receive payment as soon as possible. Within 21 days of the date you reported your injury, your employer is legally required to take some action. If your claim has been accepted, you will receive a form called a Notice of Compensation Payable, which will detail the money you will receive.

It is beneficial to review this form with your Bucks County Workers’ Compensation attorneys to ensure that the compensation calculation is correct. If your employer incorrectly calculated your lost wages, our attorneys can coordinate an amendment to the form with the correct compensation amount.

Types of Workers’ Compensation Benefits in Pennsylvania

If your claim is approved and you receive a Notice of Compensation Payable, there are a few types of compensation you may be granted. If your injury prevents you from working, you can receive payment for lost wages. Lost wages can be compensated if you are totally disabled or partially disabled.

If you are completely unable to work, total disability is available for up to 104 weeks. At that time, your employer can request a medical examination to determine how impaired you are. If you are not at least 35% impaired, your status will be reduced to partial disability, which is available for no more than 500 weeks. While there are several ways to calculate lost wages, this compensation only totals about two thirds of your average weekly wage, limited by a weekly maximum.

Compensation for the cost of medical care incurred due to workplace injury or illness may also be granted. It is important to be aware that your employer may require you to receive medical care from a selection of physicians that they have chosen. Make sure that you discuss potential medical providers with your company’s Workers’ Compensation representative. Failure to abide by healthcare provider rules may prevent you from receiving compensation.

You may also receive specific loss benefits if you have permanently lost a body part, lost use of a body part, or suffered a serious, permanent disfigurement. If your workplace accident resulted in the amputation of a body part or the loss of a sense such as sight or hearing, this type of compensation would be available to you.

Finally, if a family member is collecting Workers’ Compensation on behalf of a deceased employee, death benefits may be given to the survivors.

Agreement for Compensation for Disability or Permanent Injury

Another avenue to receive possibly fast compensation for your injury or illness is to come to an agreement with your employer. Hiring our attorneys early in the Workers’ Compensation process will allow you to negotiate with your employer and potentially agree on compensation and non-financial concerns in lieu of a denial. Since a claim denial lengthens the timeline between an injury and a payment, this option may be preferable if you are facing a denial and need compensation quickly. In this case, you would receive an Agreement for Compensation for Disability or Permanent Injury, which is signed by all parties.

Notice of Temporary Compensation Payable

Employers may also extend the initial 21-day investigation period to 90 days. In this case, you will receive a Notice of Temporary Compensation Payable and will receive temporary payments while your employer continues to evaluate their liability for your injury or illness. The 90 days are a maximum time extension, but the employer does not have to use that entire period and can notify you of a denial or acceptance before reaching the 90-day deadline.

Denial of a Pennsylvania Workers’ Compensation Claim

Workers’ Compensation claims become more complicated and lengthier if the claim is denied. If your employer determines that they are not liable for your injury or illness, you will receive a Notice of Workers’ Compensation Denial. This form will be sent within 21 days of the injury reporting date unless your employer elects to pay you temporarily and avail themselves of the 90-day extension.

Filing a Petition with the Office of Adjudication

If you do not agree with the claim denial, you may file a petition with the Office of Adjudication within the Bureau of Workers’ Compensation. By law, you have 3 years to file this petition; however, the earlier it is filed, the sooner you will be able to resolve the dispute and receive compensation. Our Chester County Workers’ Compensation attorneys can assist with drafting the petition and will represent you throughout this adjudication process.

Once filed, your employer will then have an opportunity to file an answer to your petition, and your petition will be assigned to a judge who exclusively adjudicates matters of Workers’ Compensation. The judge will set a date and time for a hearing and may also schedule prehearing conferences. It is difficult to predict how much time will pass between filing a petition and attending a hearing as each judge has their own policies, but a few weeks would be reasonable.

Workers’ Compensation Hearings

The Workers’ Compensation hearing will proceed with a structure similar to a civil hearing. Our Pennsylvania Workers’ Compensation attorneys will present your case and argue why your claim is valid and your employer is liable. Likewise, your employer’s attorney will defend against these allegations.

The evidence presented at a Workers’ Compensation hearing could be extensive. Frequently, the injured employee will testify regarding the accident and the events leading up to it. Co-workers, supervisors, and bystanders can be used as witnesses to corroborate facts. Expert witnesses will also be used, especially medical providers who evaluated and treated your injury or illness.

Depending on the type and amount of evidence presented, the number of witnesses, and the need for additional medical evidence to be collected, your case may require multiple hearings. As such, the estimated time for this hearing phase of litigation is difficult to predict. Our Delaware County Workers’ Compensation lawyers can evaluate the magnitude of your case when they work with you to prepare for the hearing.

Hearing Results, Mediation, and Settlements

After the hearing process concludes, the judge will receive a transcript of the hearing, will review all evidence and witnesses presented, and will then issue a written decision on the matter.

Before a decision is rendered, the judge may schedule a mediation session for the parties. In mediation, an independent third party will meet with the employer and employee and attempt to broker a resolution to the dispute. Mediation allows an unbiased individual to suggest possible resolutions and can be particularly helpful when settlement discussions are heated and unproductive.

Separate from the mediation process, voluntary settlement is always an option. Even if your employer has a strong case, sometimes the growing expense of litigation may make them more favorable to settlement. Our Pennsylvania Workers’ Compensation attorneys can advise you of your options and help you evaluate if mediation or settlement would be beneficial.

Appeal to the Workers’ Compensation Appeal Board

Once the judge has issued their decision, either party has 20 calendar days to appeal the decision to the Workers’ Compensation Appeal Board. This means that if you are unhappy with the decision, you have an opportunity to have it reviewed.

Our Pennsylvania Workers’ Compensation lawyers will draft the written appeal for submission to the Board and develop a brief that is due 30 days after the appeal is received. Your employer will then have 30 days following your brief submission to submit their own brief. This 60-day briefing period can be extended if a request is made for a good reason. While a brief in support of the appeal is not required, it could significantly bolster your appeal arguments. Our Pennsylvania Workers’ Compensation lawyers can offer experience and knowledge valuable for this stage of the appeal.

After briefs have been submitted, another hearing for oral arguments will be scheduled. This will be very different from the initial Workers’ Compensation hearing. In this hearing, no evidence or witnesses will be presented; only the merits of the appeal will be argued. Currently, these hearings can be held either in person or electronically, and our attorneys will be making the argument.

Following the oral arguments, the appeal is presented to a member of the Appeal Board, who writes an opinion on the dispute. The other members of the Appeal Board will review the opinion and discuss their concurrence or dissent. Once they agree on an outcome, the decision is mailed to the parties. Our Montgomery County Workers’ Compensation lawyers can review the decision with you and discuss additional options if you are still dissatisfied.

Further Appeals to the Commonwealth Court and Pennsylvania Supreme Court

After appealing a case to the Workers’ Compensation Appeal Board, it can be further appealed within 30 days to the Pennsylvania Commonwealth Court, where the process will mimic the briefing and argument process before the Appeal Board. An unfavorable decision from the Commonwealth Court can be appealed to the Pennsylvania Supreme Court within 30 days of the Commonwealth Court decision.

Appeals of Workers’ Compensation matters at the Commonwealth Court and Supreme Court are very rare. It is crucial to speak with our Pennsylvania Workers’ Compensation attorneys to evaluate if your case is a good fit for such measures. Appealing a denied claim lengthens the time between an injury and compensation, and these further appeals could add years to the total timeframe.

Contact Our Pennsylvania Workers’ Compensation Claim Attorneys Today

The timeframe of a Workers’ Compensation claim can vary greatly; however, our Berks County Workers’ Compensation lawyers can provide guidance for every step of the process. Call Lerner, Steinberg & Associates today for a free case review at (215) 355-6400.