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Caroselli Beachler McTiernan & Conboy LLC
Phone: 412-391-9860
Email: info@cbmclaw.com
Injuries can occur to anyone at any time, and when you're injured on the job, you need help with medical expenses and lost wages. You also face the possibility of not being able to return to your original job.
Pennsylvania's Workers' Compensation laws were enacted to protect you, the employee, by providing medical and wage loss benefits through your employer. It also provides for death benefits in cases of fatal injury. While accidents are the most common form of on the-job injuries, you may also be entitled to benefits if you have a work-related disease or illness, if you have been exposed to a hazardous substance, if you have suffered a loss of hearing as a result of noise exposure at work, or if you have other ailments, such as a repetitive motion disorder. Even preexisting conditions that are aggravated by your employment may be covered under Workers' Compensation.
To be eligible for Workers' Compensation benefits, you must be able to show that you were employed at the time of your injury, that your injury did occur while you were on the job, and that your injury was related to your employment.
Although you may not need an attorney to help you collect your initial Workers' Compensation benefits, with the recent changes in the Workers' Compensation Act, you may want to seek the advice of an attorney regarding the benefits that are available to you and the length of time you can receive them.
You may need legal counsel if:
You are not receiving benefits even though you were injured on the job
You've received benefits for your injury that were discontinued for some reason, and you need to have them reinstated
You've been receiving benefits, but are faced with having them terminated, suspended, or modified
You've been receiving benefits and might qualify for a lump sum payment
You have been asked to submit to a medical examination in order to determine an impairment rating
Your employer has approached you about resolving your claim
Your employer has filed a request for compromise and release
An attorney who practices in the field of Workers' Compensation law has the skill and experience necessary to represent you in your Workers' Compensation claim.
If you're Injured At Work
If you are injured while at work, there are some important steps you should follow that could help you in collecting your Workers' Compensation benefits:
- If you are injured while on the job, you should seek medical attention immediately.
- As soon as you've been injured, you should notify your employer - preferably in writing - and explain how the accident occurred. (If you do not notify your employer within 120 days of your accident, you could be denied benefits.)
- If your employer provides you with a list of at least six medical providers, you must be treated by one of those providers for 90 days after your injury.
- The Workers' Compensation insurance company must notify you in writing within 21 days whether they accept or deny your claim. If your claim is denied, you should see an attorney to file a claim for benefits.
How do I know if I have a Workers' Compensation claim?
While you can file a Workers' Compensation claim for any injury you suffer while on the job, there are other factors that may qualify you for benefits. If you are engaged in any activity on behalf of your company - even if it is not at the place where you normally work - that may be considered to be on the job. You could be at a company party or picnic, or on your way to a seminar or trade show. If, for some reason, you are injured at your place of work, but not working at the time, you may still be covered.
Injuries that occur during business travel are usually covered, with the exception of your normal travel to and from work each day.
Illnesses that are caused by your job are covered, such as those caused by exposure to fumes or contaminants. However, getting sick while at work, such as with the flu, is not considered a work-related illness.
Is job-related hearing loss covered by Workers' Compensation?
Compensation benefits may be paid for partial hearing loss caused by long term exposure to excessive noise. If dangerous noise levels exist in your workplace, you should have your hearing evaluated to see if there is any hearing loss and if it is covered by Workers' Compensation.
What benefits are available to me under Workers' Compensation insurance?
Workers' Compensation provides for Medical Benefits, which pay for your reasonable and necessary medical expenses; Earnings Loss Benefits, which pay you a percentage of your wages while you are unable to work; and Death Benefits, which pay a percentage of your wages to your family in the event of a fatal injury.
When can I begin to collect my benefits?
Medical Benefits cover hospitals, doctors, nurses, chiropractors, therapists, medicines, and other medical expenses related to your injury. They are payable from the time your injury occurs, but for the first 90 days of treatment, you must use one of your employer's health care providers - if at least six are listed - in order to be covered. After the 90 days has passed, or if your employer has no such list of health care providers, you may use your own health care providers and still be covered.
Earnings Loss Benefits will not be paid to you for the first seven days after your injury occurs, unless your disability lasts for more than 14 days. If you are totally disabled, except in special circumstances, you will receive benefits for not more than 104 weeks unless your injury occurred before June 24, 1996. In that case, you are entitled to total disability benefits for as long as you are disabled. If you are partially disabled, you can receive benefits for up to 500 weeks, regardless of when your injury occurred. Earnings loss benefits are computed based upon your "average weekly wage.''
What is an "average weekly wage?"
Under the Workers' Compensation law, your "average weekly wage" can be calculated in a number of ways, but it is generally based on your gross pay before deductions. Your earnings loss benefit generally will be two thirds (66 2/3%) of your average weekly wage-up to the statewide limit.
How long can I collect Medical Benefits?
Medical Benefits are payable for as long as you are injured and receiving medical treatment. It is not related to your Earnings Loss Benefit, and can continue after your Earnings Loss Benefit ends. However, if the Workers' Compensation insurance company believes that your medical treatment was not necessary or that your bills were unreasonable, they can challenge the payment of those bills.
What do I do if the insurance company refuses to pay for my medical bills?
If the insurance company challenges your bills, they will send them to a Utilization Review Organization (URO), who will then determine whether or not they are reasonable or necessary. If the URO determines that the bills are not reasonable or necessary, you will be notified of their findings. Once you are notified that your treatment is no longer reasonable or necessary, you will have 30 days to file a Petition for Review. If you do not file a Petition for Review within 30 days, the insurance company will no longer be responsible for the payment of your bills.
How are death benefits paid?
Death benefits are paid when an employee dies from injuries received while on the job. The survivors receive a percentage of the employee's average weekly wage as a death benefit payment. Workers' Compensation also provides for $3,000 in funeral expenses.
When can my Workers' Compensation benefits be stopped?
Under certain circumstances, your employer and their insurance company can stop paying your Workers' Compensation benefits. These include:
- When you have returned to work without losing any wages and you are sent a notification of suspension
- When you have signed a Final Receipt
- When you have signed a Supplemental Agreement for the suspension of your benefits
- When an order of termination or suspension has been entered by a judge
- When you fail to report wages from employment or self-employment
- When you fail to complete and return a verification form
If your benefits have been stopped for any other reason, you should consult an attorney. In some cases, you may be able to file a Petition for Penalties, for which a judge can award you legal fees, interest, and other penalties if you can prove that there was a violation of the Workers' Compensation Act in stopping your benefits.
Do I need an attorney to file a Workers' Compensation claim?
Workers' Compensation claims that are paid immediately following an accident do not require a lawyer. However, if you are denied benefits or are asked to appear before a Workers' Compensation judge, the advice and representation of an attorney who is experienced in this area of law can be quite valuable.
You may also need an attorney if your employer attempts to terminate, suspend, or modify your benefits; if you wish to have your benefits reinstated after they've been discontinued; or if you wish to have your benefits commuted, meaning you would prefer a lump sum payment. It is important that you do not sign any papers that you don't fully understand without first showing them to an attorney.
What fees are involved in having an attorney represent me in my claim?
Workers' Compensation law states that these cases be handled on a contingency fee basis - with the fee being no more than 20% of the benefits your attorney obtains on your behalf. The number of weeks of Earnings Loss Benefit from which your fee is deducted is up to you and your attorney to negotiate. |
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© Copyright 2001 Caroselli Beachler McTiernan & Conboy LLC
312 Boulevard of the Allies, 8th Floor, Pittsburgh, PA 15222-1916
412.391.9860 Phone 1-800-222-8816 412.391.7453 Fax
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