When you are injured while performing your job duties, you will undoubtedly need medical treatment for your injury(ies). If your claim is accepted by the workers’ compensation carrier, whether you are paying both wage loss benefits and medical benefits or just medical benefits with a panel provider, your medical bills should be covered for at least the first ninety (90) days by the workers’ compensation carrier. 

What is a panel provider?

When you suffer a work injury and report it to your employer, they should provide you with a list of “panel providers” for you to choose where to treat for the work injury. This list should have also been provided to you when you were hired. If you have not been provided with a list of panel providers, then you are free to treat your injury with whomever you want and the workers’ compensation carrier should still pay the bills.

In the workers’ compensation process, it is not unusual for there to be instances where there are issues with the medical bills either being sent improperly or with the treatment being covered. Medical providers must not only send the bills, but also the medical notes or reports supporting the treatment and also Health Care Financing Administration (HCFA) 1500 Claim Forms in order for the treatment to be considered to be covered.

According to the Pennsylvania Bar Association Workers’ Compensation Law Section and based upon Pennsylvania lifting the mask mandate, Workers’ Compensation offices are scheduled to reopen on August 16, 2021, throughout the Commonwealth. There are Workers’ Compensation Judges throughout PA, and each Judge has the flexibility and discretion as to whether they will schedule their hearings and mediations in person or virtually. The decision to go back in person or virtually can also depend on what type of hearing is involved.

If the hearings are settlement or status hearings, these most likely would have a better chance of being virtual as opposed to hearings requiring the injured worker’s (claimant’s) or other fact witness’ testimony, where the involved Judge would need to assess credibility.

Also, as part of the change, the PA Workers’ Compensation Appeal Board will still hear oral arguments virtually, but as of July 1, 2021, parties can request live oral arguments through the automated workers’ compensation system, WCAIS.

First of all, what is a Claim Petition? A Claim Petition is filed with the Workers’ Compensation Office of Adjudication if an injury claim is denied by your employer’s workers’ compensation carrier. If you are injured while working in the course and scope of your employment, you report the same to your employer and they send it to their workers’ compensation carrier to investigate and accept or deny your claim.

In order to file the Claim Petition, you must have a doctor give an opinion in writing that your injury is directly related to your work. If you are out of work and claiming ongoing disability which may last more than a year (52 weeks), then not only will you need a doctor’s note or report, but that doctor will have to testify on your behalf. This is referred to as a doctor’s deposition. The assigned workers’ compensation judge will set a trial schedule, typically giving you (the claimant), through your attorney, ninety (90) days to take your doctor’s deposition, the employer, through their attorney, will then be given (90) days thereafter to take their doctor’s deposition.

Who is the employer’s doctor? Well, the workers’ compensation carrier will choose what is referred to as an Independent Medical Examiner (IME) doctor to examine you one (1) time in conjunction with reviewing your medical records. That doctor will write a report and then testify from that report.

If you are receiving workers’ compensation benefits, your own treating doctor or a doctor hired by the workers’ compensation carrier may ask you to undergo a Functional Capacity Evaluation (FCEs) to determine what, if any, category of work that you are capable of performing. The goal of the workers’ compensation carrier is to eventually get you back to work, or at least stop your receipt of workers’ compensation wage loss and/or medical benefits.

According to Wikipedia, “A functional capacity evaluation is a set of tests, practices and observations that are combined to determine the ability of the evaluated person to function in a variety of circumstances, most often employment, in an objective manner. Physicians change diagnoses based on FCEs.”

FCEs can be performed in one or two days, with the total evaluation taking anywhere from 4-6 hours. Typically, physical and/or occupational therapists conduct the evaluations. The evaluation will not only measure what you physically are capable of, but also measures how valid your effort was. The more valid your effort, the more accurate the evaluation will be, and will also go a long way as to your credibility with the workers’ compensation carrier and workers’ compensation judge, if any presiding over your case.

Pennsylvania Workers’ Compensation Litigation and Practice has Continued Non-Stop During the COVID-19 Pandemic

Since mid-March 2020 when most everything went into “lock-down” in Pennsylvania, one practice did not, and that was the practice of PA Workers’ Compensation. Through the efforts of the Workers’ Compensation Office of Adjudication, a division of the Bureau of Labor & Industry and Governor Wolf’s office, the practice did not miss a beat. All Workers’ Compensation Judges throughout the Commonwealth continued to have hearings in which all involved parties could participate via some form of video or telephone.

The video formats typically used by the judges are Skype for Business or Webex. When a matter is ripe to have a hearing before a judge, the judge’s staff (all working remotely) will send out to both the injured worker’s and the employer’s attorneys a calendar invitation which can be accepted or a different date and time proposed, if the parties have a conflict in their schedule. Once the date and time are accepted by both parties, the hearing is set and a hearing notice will be issued in WCAIS, the automated system in place for PA judges, attorneys, and workers’ compensation insurance companies.

Filing a workers’ compensation claim is a time-bound process in Pennsylvania. If you fail to file the claim in a timely manner, your benefits could be delayed, or you might lose your right to seek benefits altogether. 

In some cases, the claim process might be delayed due to the negligence or deliberate inaction of your employer. What can you do in such cases? Let us take a look. 

How Does Workers’ Compensation Claim Process Work in Pennsylvania? 

Under Pennsylvania law, you are required to inform your employer about your injury or illness within a span of 120 days from the date of your injury or the day on which you were diagnosed with the illness. 

Once reported to your Employer’s workers’ compensation carrier, the assigned adjustor has twenty-one (21) days to either accept or deny your claim. 

The Employer’s Role in Workers’ Compensation Claim Process

Once you inform your employer about the workplace accident and the injuries you sustained, they are required to file a First Report of Injury (FROI) with the Bureau of Workers’ Compensation. They are also required to file a report with the insurance company. This is an important step, as the sooner your employer files the report, the sooner the workers’ compensation carrier can decide as to either accept or deny your claim.