Steps Of The Claims Process
Any injury which occurs during the course of your job duties qualifies for Workers' Compensation, regardless of who was at fault. When workers get injured on the job, it's important for them to follow procedure in the immediate aftermath. If you find yourself in this situation, make sure to follow these steps:
Report The Injury To Your Employer
In Pennsylvania, you must inform your employer within 120 days of discovering your injury or illness. If you haven't made a report within 120 days, you will no longer be permitted to seek compensation. However, it's best to notify your employer the first chance you get, ideally immediately after the injury. Claims filed within 21 days are eligible for benefits from the date of injury, but claims filed after 21 days are only eligible for benefits from the date you filed your report.
Your employer must immediately report your injury to their insurance carrier. Additionally, he or she is required to file a First Report of Injury with the Bureau of Workers' Compensation within 48 hours for fatal injuries and within seven days for nonfatal injuries which result in at least one missed day from work. After receiving the report, your employer's insurance company has 21 days to accept or deny your claim.
Seek Medical Care
It's important to receive treatment for two reasons. First, of course, is protecting your own health and preventing your injuries from getting worse. Secondly, in order to receive benefits, you must provide detailed medical evidence that your injury has impaired your ability to do your job and that it occurred during the course of your job duties.
Your employer is required to provide you with at least six medical providers. You're permitted to choose your own doctor from one of these six providers, but you are only required to see this doctor for the first 90 days following your injury. After 90 days, you're permitted to choose any doctor you wish and are not bound by the list of six or more providers.
This initial evaluation is an extremely important aspect of any Workers' Comp claims. Make sure to provide the doctor with as many details as you can, including when, where, and how you got injured and the symptoms you've been experiencing.
File Appeal If Claim Gets Denied
Within 21 days of the First Report of Injury, you should hear back from the Bureau on the status of your claim. One of three rulings could be made:
- If your claim is accepted, you'll receive a Notice of Compensation Payable and start receiving benefit payments.
- The insurance company may refuse to admit liability bus still issue a Notice of Temporary Compensation Payable, which means they will begin paying out your benefits. However, the insurance carrier can revoke this Notice within 90 days.
- If your claim gets denied, you will receive a Notice of Workers' Compensation Denial.
If your claim gets accepted, you can begin receiving compensation for your lost wages and medical expenses. However, you may be eligible for additional compensation through Social Security Disability. In some cases, workers are injured by negligent third parties and have the option to file a personal injury lawsuit.
If your claim gets denied, you may feel frustrated, anxious, angry, and confused. Unfortunately, even though the Workers' Compensation Act is designed to simplify the process of claiming benefits, many employers care more about keeping insurance premiums low than protecting their workers. At this stage, it's usually necessary to enlist the help of an aggressive work injury lawyer who has experience fighting for workers' rights.
How Lawyers Protect Injured Workers
Many injured workers wait until their claim has already been denied before they contact a lawyer. If you're unfamiliar with how the Workers' Compensation system works, it's easy to trust that your employer and their insurance company will be there to look out for you when something goes wrong on the job. Sadly, too many injured workers realize that this is not the case when their claim gets disputed by their employer or denied by the insurance company.
This is why it's important to consult with a knowledgeable work injury lawyer shortly after your injury. At Monheit Law, our lawyers know how the Workers' Comp system works. We know how insurance carriers and employers both try to take advantage of injured workers who are unfamiliar with the system. And we're prepared to fight back so that you can get the compensation you need in a timely manner. Insurance companies are much less likely to play games if the other side has qualified legal representation.
We understand the financial stress you may be feeling. That's why we offer free consultations and will only ask for payment as a percentage of your benefits payouts if we win for you. If you're injured, out of work, and struggling to make ends meet without benefits, we're here to help you get your life back on track.