Understanding the Pennsylvania’s Worker’s Compensation Act can help you get the coverage you need when an injury causes lost wages, disfigurement or need for medical treatment. The list of important facts about workers’ compensation below will help you understand your position, so you can feel confident in your employment situation.
1) Make sure you are covered. In the state of Pennsylvania, workers are lucky to be covered in almost every situation. Even part-time and seasonal workers are to be covered by the company that hires them. It is the law in Pennsylvania that all employers must obtain workers’ compensation insurance for their workers. However, there are some exceptions such as workers’ compensation does not cover intentional injury or illness, or loss due to drugs or alcohol use.
2) If your employer does not have proper coverage you can still attempt to collect workers’ compensation, by filing a Claim with the Uninsured Employer Guaranty Fund otherwise known as the (UEGF). It is important to obtain an experienced workers’ compensation lawyer in order to file a Claim with the UEGF, as there are very specific rules that must be followed, or your Claim will be dismissed.
3) Getting proper coverage when injured on the job requires you to report your injury to your supervisor, human resources, foreman or boss. If you do not immediately tell your employer about an accident they may not have to cover your losses, or your payments could be delayed. You have up to 120 days following a work injury to report it to your employer. The “Notice” requirement is essential to any workers’ compensation Claim.
4) If you are temporarily injured, and your Dr. gives you restrictions of light or sedentary work, your employer, if able, can offer you work within your restrictions, but they do not have to. If your new position doesn’t pay the same amount as your normal job, you may be eligible for partial wage loss compensation to make up for it. However, if you are completely disabled, and your Claim is accepted, you will be compensated for lost wages.
5) Loss of certain body parts may entitle you to specific loss benefits. This would be paid in addition to the wage loss benefits and medical benefits. This type of loss includes loss of fingers, a hand, foot, arm, leg, hearing, sight or scarring disfigurement to certain parts of the body.
6) All medical bills that are reasonable, necessary, and causally related to your work injury are to be covered by your employer’s workers’ compensation carrier. The carrier always has the option or filing a Utilization Review to challenge the reasonableness or necessity or any of your ongoing treatment, while you are receiving workers’ compensation.
7) In Pennsylvania, for the first 90 days, you are required to treat with your employer’s Panel Providers, provided certain rules are met by the employer. Thereafter, you are entitled to choose your physician or hospital for treatment. You can also get coverage for a second opinion from a physician of your choosing if the same is needed.
8) Workers’ compensation covers illnesses caused by conditions in the workplace even if you have already left the job. The illness must have occurred in a certain time period before the actual diagnosis in order to get coverage.
9) You can get payment for partial loss of wages if you are out of work for more than seven days total following a work-related injury or illness.
10) If your employer offers you a position within your scope of abilities and you decline it, your benefits may be reduced or suspended altogether, depending on if you are paid less or the same than your pre-injury wages.
11) In Pennsylvania, once you are receiving workers’ compensation benefits (on comp.), you will remain on comp. until such time as you settle your workers’ compensation case, or a Judge orders that your comp. be modified, suspended, or terminated.
12) If you are on workers’ compensation or you file a Claim to get on workers’ compensation, you can mediate your case to try and resolve it for a lump sum amount of money. Mediations can be mandatory or voluntary, but in all cases, both parties (the employer/carrier and you, the claimant) must be in agreement to mediate before a Workers’ Compensation Judge.
13) A legal representative is not required but it is highly recommended. You should have a lawyer represent you. Workers’ compensation is very complex and you could end up missing out on valuable benefits without the help of a professional.
For more in-depth explanations and answers, feel free to contact Robinson Law LLC.