Workers' Compensation Claims: The Basics
If you're preparing to file a Pennsylvania workers' compensation claim or have recently filed one, you're probably dealing with paperwork and insurance companies, as well as an injury that's preventing you from going back to work. We've provided a few commonly asked questions and answers to help you navigate this complex legal process.
If you still find yourself feeling confused, call our law firm at 412-618-2696 or submit your information at the top right of this page for a free consultation.
Frequently Asked Questions - Claims
How long do you have to file a claim?
- Immediately report any work-related injury or illness to your employer or supervisor. In Pennsylvania, you have 120 days to let your employer know that you suffered a work injury.
- You have 3 years from the day you were injured to file a claim petition for an injury.
Can your claim be denied if you don't report the injury in time?
If you are hurt at work, notify your employer as soon as possible. Under the Pennsylvania Workers' Compensation Act, if you don't tell your employer that you were injured within 120 days, you can't receive workers' compensation.
You live in Pennsylvania but work in a different state. Where do you apply for workers' compensation payments?
Pennsylvania's workers' compensation payments are higher than those in many surrounding states. So, obviously, you will want to see if you can receive workers' compensation payments in Pennsylvania.
You may be able to receive Pennsylvania workers' compensation payments if:
- You work in Pennsylvania
- You live in Pennsylvania but work in another state
- You were hired by a company based in Pennsylvania
Each claim is different and must be evaluated on an individual basis. Unfortunately, just because you meet one of these criteria doesn't mean you'll be eligible for workers' compensation in Pennsylvania. Our workers' compensation lawyers can help you with these issues. The best way to get started is to take advantage of our free legal consultation by filling out the form at the top right of the page.
Can your employer fire you for filing a workers' compensation claim?
No, your employer cannot fire you for filing a workers' compensation claim. But, you may be fired for other reasons, including an extended absence from work even if it's the result of your injury. If you are a member of a union, the union may protect your job security. But your employer may stop other benefits, such as your health insurance.
What forms should I sign? What forms should I not sign?
The Workers' Compensation Bureau prints almost all forms on the same color paper, and they can be very confusing. You should make sure you read the documents very carefully. In Pennsylvania, if you sign a document, the Courts believe that you have read it and understood it, and they will enforce what you have signed, even if you made a mistake.
You should sign the following forms:
- Authorization for Medical Records: This form releases your medical records so that the insurance company can review them to process your claim.
- Employee Verification Form: You must complete this form whether or not you have earnings from alternative employment. You must return this form within 30 days of receipt or jeopardize your right to receive benefits.
Be careful if you are asked to sign the following forms. Our law firm recommends that you do not sign these until you have first consulted with an attorney:
- Supplemental Agreement: Usually this form states that you can go back to work and your claim is still open. However, this form may state that your benefits are being terminated. Do not sign this form unless you are fully recovered from your injury.
- Final Receipt: Do not sign this form unless you are fully recovered from your injury. If you are being pressured to sign and you don't think you are completely recovered, our Pennsylvania workers' compensation attorneys can help.
What if your employer refuses to file an accident or incident report for your injury?
If your employer refuses to complete an injury report on your behalf, you may file a claim petition for workers' compensation payments. You will need to go to a series of hearings with a workers' compensation judge. While you are not required to have an attorney with you at the hearing, we highly recommend consulting an attorney. The workers' compensation process can be very tricky, with opportunities to make mistakes at every turn.
What should you do if your workers' compensation claim was denied?
If you were denied workers' compensation benefits even though you know that you're too hurt to work, you need to contact a lawyer right away.
There are many situations in which your workers' compensation claim may be denied even though you're still too hurt to go back to your job. If you were denied workers' compensation benefits even though you know that you're too hurt to work, you should contact a workers' compensation attorney right away.
Is the workers' compensation insurance company allowed to follow you, take photos, and talk to your neighbors?
Yes, Pennsylvania workers' compensation insurance companies often use investigators. They are allowed to follow you, take photos, and talk to your neighbors.
In addition, we suggest you be very careful about anything you post on social media sites, regardless of your privacy settings. These networks are considered 'public domain,' which means insurance companies and judges may use the information against you.
If you are seriously injured and are following your doctor's orders regarding restricted activities, you should have nothing to worry about.
Frequently Asked Questions - Eligibility & Coverage
Who is eligible to receive Pennsylvania workers' compensation?
You may be eligible for workers' compensation payments in Pennsylvania if you:
- Are hurt on the job
- Aggravate a pre-existing injury
- Develop a work-related illness
You're generally not eligible to receive payments if you were hurt while traveling to or from work or during a break.
Under workers' compensation laws in Pennsylvania, can you receive payments if you were injured while volunteering?
Probably not. In most situations, you must be paid in some way for your work in order to be covered.
However, some volunteers, such as firefighters, ambulance workers, and special school police, are able to collect Pennsylvania workers' compensation payments.
Can you receive payments if your work injury was your own fault?
Yes. Pennsylvania workers' compensation laws allow you to request payment for work-related injuries regardless of fault. But, intentional, self-inflicted injuries are not covered under workers' compensation.
Can you receive payments if your job requires travel — or lacks a fixed place of work — and you are injured in a car accident while driving?
People who have no fixed place of work — like traveling nurses and consultants — are generally covered once they take to the road and are on the clock. For example, in most cases, a traveling salesperson would be eligible to receive payments if injured in a car accident while visiting clients.
Can you receive payments if you were injured on your lunch break?
Probably not. The general rule is that any personal time taken during the work day — including lunch breaks — would not be covered under Pennsylvania workers' compensation.
Can you receive payments if a previous injury was aggravated on your current job?
It depends on whether the aggravation is a new injury or a recurrence of the old injury. If your medical records show that you have a new injury and that it was related to your current job, you would be able to receive workers' compensation payments.
Can you receive payments if you were injured at home while doing work for your employer?
If you chose to take work home, you would not be covered. However, if your employer specifically asked you to do work at home, you probably are covered.
What injuries and illnesses are covered?
The majority of all injuries and illnesses caused by a work-related accident or a condition are covered under Pennsylvania workers' compensation. You may request workers' compensation payments even if you are at fault for your work injury.
The only injuries that may occur in the workplace and are not covered under workers' compensation are:
- Injuries that are intentionally self-inflicted, including suicide
- Injuries caused by your own intoxication or illegal drug use
- Injuries that result when a co-worker attacks you for personal reasons
- Injuries that result when a person unrelated to your employer or your workplace attacks you for some reason not related to your job
- Injuries caused by breaking the law
Furthermore, accidents that occur while traveling to or from work or during breaks generally do not qualify for Pennsylvania workers' compensation.
Under workers' compensation laws in Pennsylvania, can you receive payments for repetitive motion injuries such as carpal tunnel?
Yes. If you can prove that your injury is work-related, you could request workers' compensation payments. Jobs that require repetitive motions to perform them can cause carpal tunnel syndrome and other disorders.
Who is responsible for providing workers' compensation benefits?
Your employer is required by law to provide workers' compensation coverage to their employees. Those who are self-employed may be rare exceptions to this law. In the same way that it's required by law to have car insurance but plenty of drivers are still uninsured, employers are required to have workers' compensation coverage but some neglect to carry it.
Are all workers covered under Pennsylvania workers' compensation?
Most Pennsylvania full-time and part-time workers are covered by the Workers' Compensation Act. Even if an employer only has one employee, that employee is covered. Generally, those who are not covered are self-employed.
Coverage begins from the first day of employment
Can you sue your employer or co-worker for causing your injury or illness?
No, you can't sue your employer or co-worker for causing your injury or illness. You can only file for workers' compensation to pay for your lost wages and medical bills. You are not paid for pain and suffering from your work injury.
There are two exceptions:
- If your injury or illness was caused by a defective product, you may have a personal injury case against the manufacturer of the product.
- If a co-worker assaults you based on a personal matter; you may be able to file a civil or criminal lawsuit against your co-worker.