How Do I Preserve My Rights Under Workers’ Compensation?
If workers suffer an injury that affects their ability to work or affects their life as a whole, they are entitled to fair and just compensation for their suffering. Workers’ Compensation manages these issues, but the insurance policy carrier used by the company may not provide the care that is needed. Denials, bad faith management, and even poor treatment by doctors may cause problems when a worker reports an injury. It is important that workers follow the protocols that have been set forth by the company, report injuries, and prevent further injuries. These workers should receive the care that they need and should turn to an attorney if they do not know what to do.
Why is Workers’ Compensation Important?
The National Safety Council states that there are about seven million work injuries reported each year. These injuries range from mild to severe or even lethal. Workers’ Compensation serves nearly all those who suffer from injuries at work. This coverage only helps workers recover and pays a portion of their lost wages. Other factors may come into play when an injury occurs. Workers may not realize all the benefits to which they are entitled, and grieving families may not know what options they have if a loved one is killed on the job.
Requirements for Workers’ Compensation Coverage in Pennsylvania
The Pennsylvania Workers’ Compensation Act was enacted to protect workers injured while on the job and compensate victims for medical expenses and lost wages.
The Act is broad in scope, but it does not provide coverage for the following employees:
- Agricultural workers
- Chief executive officers who elect exemption from the Act
- Domestic service workers
- Persons granted religious exemption from the Act
Any injury, illness, or disease sustained at work is considered eligible for compensation. This includes activities directly related to work, but not specifically described in the job description, such as traveling for work, acquiring equipment for a job, or commuting to and from work.
The Act does delineate a few exceptions where coverage is not applicable, including the following situations:
- The injury or death is self-inflicted
- The employee engaged in illegal activity, such as drug use
- The injury or death was caused by the employee’s intoxication or reckless indifference to danger
A Workers’ Compensation lawyer takes the time to analyze each aspect of a specific situation to ensure that injured workers recover the appropriate compensation for their injuries. Workers may believe they cannot file a claim, or they may have been told they are not eligible. We will review the case, let our clients know what can be done, and fight vigorously for every client’s right to compensation.
Who Do We Represent?
We have experience working with a wide range of employees who have been injured on the job. This is not an exhaustive list of the employees we have represented in the past, but it gives potential clients an idea of who we can help. We are ready to speak with any injured worker who believes they have not been treated properly.
Anyone who falls into the following categories should feel free to reach out to us at any time for help with their Workers’ Compensation claim:
- Airport and air carrier employees
- Municipal employees
- Contracting crews
- Crane operators
- Factory workers
- Forklift operators
- Freight workers and stockers
- Oil and gas employees
- Health care workers
- Large truck drivers
- Anyone who works in general labor or contracting
- Miscellaneous machine operators
- Shale drilling workers
- Office workers
- Railroad hands
- Refinery workers
- Restaurant workers
- Retail workers
- Sanitation workers
- Anyone affiliated with a union
It is best to consult with a Workers’ Compensation lawyer when it seems unclear if coverage is available. There are workers who have been told they do not qualify, and some claims may be denied.
Which Workers are Exempt from Workers’ Compensation?
Although some workers are not provided coverage under Workers’ Compensation, other workers are provided coverage through different means. The Longshore and Harbor Workers’ Compensation Act allows anyone working in the maritime industry to receive compensation for work-related injuries.
The Maritime Act covers those who are working on ships that are launched from the United States, and the Defense Base Act covers contractors or military workers who are near defense bases at home and abroad. These workers may perform many of the same jobs that are covered by Workers’ Compensation on land, but there are federal laws governing how these protections are to be provided. If someone has been injured or killed at work, it helps for the family to know how their family members should be covered. For most traditional jobs that require manual labor of any kind, Workers’ Compensation will cover injuries and death benefits.
What is the Employer’s Responsibility in Workers’ Compensation Claims?
Workers’ Compensation coverage begins on the date of hire, and compensation and benefits should be paid beginning on the date of the injury. It is vital that injured workers report an injury immediately to establish a record of when coverage should begin.
Depending on specific circumstances, Workers’ Compensation provides:
- Damages for a specific loss, such as the loss of a limb or physical ability
- Death benefits, including funeral expenses and loss of income for any dependents
- Lost wages if the employee is unable to work
If an employer refuses to make these payments or denies liability for any injuries, our Workers’ Compensation lawyers will help recover the compensation owed. Our legal team provides comprehensive legal support for injured workers. Employers must also have a chain of command for reporting injuries. The chain of command allows a manager or foreman to report injuries to the insurance department or human resources office. The insurance company should be prepared to pay for the claim, and the employee should not be allowed to return to work until they are able to do so.
What is Workers’ Compensation Insurance?
Workers’ Compensation insurance is a no-fault system used to protect workers who are hurt on the job. These insurance policies are typically paid for by employers and managed by a third party. In some cases, Workers’ Compensation is handled in-house, as the company sets aside funds to pay for worker injuries, treatment, and lost wages. The insurance company will provide a high level of care to the injured worker, and the employee can coordinate their care once their claim is in the system.
Companies in Pennsylvania must carry Workers’ Compensation insurance and report that they have the appropriate coverage every year. Workers’ Compensation insurance requires that workers report their injuries as soon as possible. In Pennsylvania, workers have 120 days to report an injury to their superiors before benefits are nullified. Workers also have only 21 days to report their injuries so that they can receive retroactive wage loss benefits starting on the date of the accident.
In certain cases, workers may be afraid to come forward, and that situation is handled outside the purview of Workers’ Compensation. Any work environment that could produce retaliation or makes workers afraid to report their injuries could be considered hostile, and those work conditions must be addressed outside of the Workers’ Compensation claim.
How Do We Handle the Claims Process?
The Workers’ Compensation claims process can be complicated because workers may not understand how to report their injuries. Insurance companies that manage these policies want to know that workers were hurt on the job, and the claims process should include a recounting of the accident.
If the injury was deemed to be outside work hours or outside the typical duties of the job, the insurance company may deny these claims. Our Workers’ Compensation lawyers will ensure that all clients are proven to have been injured on the job. We understand how to file all the paperwork for the case, how to explain any medical care that is required, and how to handle any notice requirements as part of the claim or lawsuit.
One of the most important parts of the process is knowing how to talk to the insurance company. When the injury is reported to a supervisor, that supervisor will send the claim to the insurance carrier. Workers’ Compensation insurance could either approve care or begin asking questions.
We ask that clients do not give a recorded statement to the insurance company. The insurance company is responsible for determining if the injury should be compensated. Many clients might say something to the insurance company that could be used to deny coverage. When the insurance company denies coverage, we must investigate the case to determine the truth. The insurance company will be asked to settle so that they can provide coverage, or they could be taken to court to provide coverage.
How are On-the-Job Injuries Classified?
On-the-job injuries can involve machines, work tools, or slip and falls. Workers could be injured while attempting to complete traditional work duties, or they might be injured in car accidents involving their work. These accidents are especially common when workers are near the road or working on a highway.
Workers who have been engaging in horseplay, neglecting their work duties, or making unwise decisions may be denied benefits because those injuries fall outside of their normal work duties. When a client has been denied coverage, our lawyers will investigate the case and show that the injured worker should have been covered.
Injuries on the job must be related to something that is tangible. Workers who experience moderate to severe injuries must have some idea of how they were hurt. Therefore, we ask our clients to explain every aspect of the case that they can remember. We can use evidence, such as time clock records and machine logs, to prove that our clients were present at work when an injury occurred.
We also analyze the injury to show that the worker was not doing anything that would invalidate their claim. If workers cannot properly explain their injuries, they should report the injury to their supervisor and ask for help in filing a claim.
Claims adjusters may ask confusing questions that workers cannot answer properly, and it is better to have one of our lawyers present when speaking to an adjuster or when the insurance company needs more information. We can fill out claim paperwork for our clients and explain the process.
What are Common Workplace Accidents and Injuries?
Common workplace accidents and injuries should be on the minds of all workers. Some injuries might not seem serious, but they can get worse over time until the worker realizes they were injured on the job.
Common workplace injuries include the following:
- Cuts and deep lacerations
- Head injuries
- Muscle strains
- Back injuries
- Eye injuries
- Temporary blindness
- Inhaling toxic fumes
- Broken bones
- Carpal tunnel syndrome
- Chronic pain
Occupational diseases could be brought about by repetitive motion, as well as exposure to extreme conditions, such as sunlight or freezing temperatures. Although these conditions are difficult to spot, it is best to report any suspected issues so that a doctor can help. Even if the issue is not covered by Workers’ Compensation, the employee can go to their general practitioner for further treatment.
Even small injuries should be reported to a supervisor as soon as possible so that a Workers’ Compensation insurance claim can be filed. Employees should not continue to work if they are not able to do so because they could sustain further injuries or bring harm to someone else on the worksite.
Common Accidents We Handle
We have experience with specific accidents that could occur at any time.
Workers may not think that they could be involved in these types of accidents, but we recommend that clients reach out to us if the following accidents occur:
- Work-site accidents
- Oil refinery malfunctions
- Scaffolding falls or collapses
- Crane accidents
- Forklift accidents
- Falls from roofs or ladders
- Accidents involving other construction vehicles
Because the employer provides Workers’ Compensation insurance, they cannot be sued for anything that happened on a worksite. Companies that produce the scaffolding, faulty tools, or even errant workers can be sued for third-party liability regarding their part in the accident, injury, or death.
Types of Workers’ Compensation Benefits
Every worker who is covered by an eligible business can report their injuries to a supervisor who will file the claim and send the employee to a doctor who is covered by their plan.
Medical coverage: Workers are entitled to medical coverage for on-the-job injuries. The coverage they receive should help them recover from their injuries. At times, these injuries can take quite a long time to heal, and the worker should be covered until the doctor has signed off that they are fully recovered.
Medical coverage can last a long time, and that coverage will include prescription medications that are required by the doctor. Coverage may extend past the worker’s release to return to the job. This is important because employees have the right to continue working, make money, and advance in their careers. These workers, however, may need to continue treatment so that they can thrive long after they are released for work.
Physical therapy: Physical therapy may go above and beyond traditional treatment for injuries sustained on the job. Workers may need help refining their motor skills or using their extremities as they did in the past. If these workers are not given extensive physical therapy, they may not be able to return to work.
This care might also be needed if the worker is no longer able to work. Workers who are disabled after an accident will receive the care they need until they can file a claim for permanent disability.
Counseling or therapy: Workers may experience post-traumatic stress disorder (PTSD) or other emotional issues as a result of major injuries sustained on the job. An employer or adjuster may ask that the worker be evaluated before therapy begins to show that the worker must continue to receive treatment to function normally and even return to work.
Counseling or therapy will help workers injured on the job recover after a traumatic experience. At the same time, workers may wish to file a claim for psychological services if they witnessed a gruesome accident, injury, or death. For the business to function properly, all workers should feel comfortable going forward.
Wage loss benefits: Wage loss benefits are provided to workers when they report their injuries as soon as possible. In Pennsylvania, workers must report their injuries within 21 days to receive retroactive benefits. If the worker reports their injury after this deadline has passed, the benefits will begin on the date of the injury.
Wage loss benefits pay a portion of the worker’s salary until they can come back to work. A doctor needs to sign off on the worker’s state of health, and that statement must be provided to the employer for normal work duties to resume. Wage loss benefits are calculated using state guidelines. In Pennsylvania, a complex system is used to calculate how much workers should receive. Workers typically must use their last year of wages to calculate how much they will receive. The average worker will receive two-thirds of their weekly wages.
If workers believe that they have not been compensated properly, we will reach out to the employer for clarification. Communications from law firms are typically taken more seriously than calls or letters from injured workers. Workers have 120 days to receive wage loss benefits and three years to report their injury so that they can receive care from a doctor. Coming forward can be difficult or even embarrassing if the worker has not sought treatment sooner. Allow one of our attorneys to help with the claim.
Workers’ Compensation Denials
When our Workers’ Compensation lawyers are presented with denials, we will create a case that shows the worker should have been covered. There are many mitigating factors that could cause a denial, and there are times when the insurance report is filed incorrectly. A denial can be a major setback. Sadly, a worker who has been denied coverage might lose their job, have no job prospects, and not know how they can support their family. Therefore, we take denials seriously. Provide us with all the information about the case. We will communicate with everyone involved and reach out to a supervisor or the insurance company to have coverage reinstated. This is the quickest way for an employee to retain their position.
If necessary, we will begin negotiating with the insurance carrier and provide all the evidence needed to come to a favorable resolution. Negotiating with the insurance company is difficult because the insurance carrier has a team of lawyers who will protect the company’s interests. We know how to negotiate with insurance companies to avoid any further delays in coverage.
Denied coverage could also impact a worker’s earning potential. Because a worker’s earning potential has been altered, it can be difficult for them to get back to work and advance as they would have in the past. Lost earning potential may become part of a claim brought against the insurance carrier or anyone aside from the employer who may have been responsible for the accident or injury.
We are also prepared to go to court so that the insurance company can be forced to provide the coverage that is required. This is often the only way to ensure that a worker can recover and return to work. Disabled workers can receive the retroactive benefits they deserve, and grieving families may recover compensation if the insurance carrier’s inaction caused their loved one’s death.
Can I File a Workplace Wrongful Death Claim?
Workers’ Compensation insurance offers death benefits for those who are left behind after a death on the job. Spouses and children are often the beneficiaries of these benefits, which are paid through the same system that pays for medical coverage. Negligent parties may be cited in a wrongful death lawsuit.
Anyone who has lost someone in a job-related accident may work with a Workers’ Compensation lawyer to file a claim against the individual parties responsible and prove the following:
- The accident was caused by an entity’s negligence
- The accident directly caused the worker’s death
- The surviving family members depended on that worker
Wrongful death claims may also be filed if the insurance company did not move to cover the work-related injuries in a timely manner. Any level of inaction could cause someone to die while awaiting treatment, and that person’s family could be left with expensive medical bills and burial costs.
Philadelphia Workers’ Compensation Lawyers at McCann Dillon Jaffe & Lamb, LLC Help Injured Workers Recover the Benefits They Deserve
The Philadelphia Workers’ Compensation lawyers at McCann Dillon Jaffe & Lamb, LLC have more than five decades of combined experience fighting on behalf of injured workers. We will help make sure your employer pays what you are owed for being injured either at work or as a result of your job. Call us today at 215-569-8488 or contact us online for a free consultation. Located in Philadelphia, Media, and Abington, Pennsylvania; Wilmington Delaware, and Haddonfield, New Jersey, we serve clients throughout the surrounding areas, including Delaware County and Chester County.