13 Questions to Ask About Workers’ Compensation Coverage
Most people picture someone who needs workers’ compensation as a person who gets injured on a construction site. Maybe they see a lineman for the local phone company wounded while fixing a telephone pole during a storm. Or perhaps they think of someone working in a warehouse who injures their back while lifting bulky items.
While these images are correct, employees who are eligible for workers’ compensation toil in a variety of fields. For instance, did you know that in Pennsylvania, the largest number of workers who file for workers’ compensation is from the educational and health services fields? Or that the area of employment with the fewest number of compensation claims is one that most people would consider one of the most dangerous forms of work — mining?
Here are 13 frequently asked workers’ compensation questions and answers for you to consider if you have filed a claim or are thinking of filing one.
1. What Is Workers’ Comp?
In our state, the Pennsylvania Workers’ Compensation Act (PWCA) defines the laws that apply to workers’ compensation. The act covers everyone who has suffered a work-related injury or has contracted an illness or a disease that prevents them from doing their job. If you qualify for compensation, it covers all medical expenses connected to your injury or illness. It also provides wage-loss compensation, using a formula we will talk about below, to provide you with income for as long as you are unable to return to your job.
Sounds simple, right? Well, all that glitters is not necessarily gold. Pitfalls and landmines litter the workers’ compensation claim process, which is why one of your best decisions will be to find a good workers’ compensation lawyer to help you through the process.
2. What Kind of Injuries Qualify for Workers’ Compensation?
As we mentioned above, most people tend to think only severe injuries like a broken bone or a head trauma qualify for workers’ compensation. While these injuries certainly do qualify, many other less serious injuries are also included. Any injury you suffer on the job, or any disease you contract because of your employment, can qualify you for workers’ compensation. This includes injuries like:
- Hearing loss that comes after you have been exposed to loud noises for a long time — even if you have worn protective equipment
- Breathing problems caused by exposure to dangerous chemicals over an extended period of time
- A stress-related illness, such as a heart attack, caused by on-the-job stress — even if you suffered a heart attack away from work and can show the major cause was on-the-job stress, you are eligible for workers’ compensation
- Injuries to hands or fingers, like carpal tunnel syndrome or impingement syndrome, that you often find in jobs that require repetitive hand movements
- Back injuries
- Hernias, which can be caused by strenuous physical tasks
- Vision impairment caused by bodily harm, or exposure to chemicals or other kinds of airborne irritants.
- Eyestrain that hinders your ability to do your job, which can be caused by long periods of staring at a computer screen
So, you do not need to suffer a serious physical injury in to be eligible for workers’ compensation. If you have any additional workers’ compensation eligibility questions, speak to a qualified workers’ compensation lawyer.
3. What Benefits Can I Receive From Workers’ Compensation?
Workers’ compensation benefits in Pennsylvania fall into one of four categories:
- Payment for Lost Wages: Payment for lost wages applies particularly to hourly wage workers who have suffered an injury on the job that prevents them from working. For these workers, a work-related injury or disease can have serious financial consequences. Payment for lost wages helps them keep their families financially afloat. Even if you can only work part-time because of your injury, you are still covered by workers’ compensation. The amount of money you receive will take into account any part-time income.
- Death Benefits: Not every company provides a life insurance plan for their employees, nor can every employee afford their own plan. This is where workers’ compensation death benefits come into focus. They provide much-needed financial assistance to your survivors if you suffer a fatal injury on the job. This is also an area where it is imperative to work with a qualified lawyer to get your family all the financial benefits to which they are entitled.
- Specific Loss Benefits: Specific loss benefits apply to workers who have suffered more permanent injuries, such as the loss of an arm, a finger or a leg. Most employers and their insurance companies hesitate to pay these benefits because they can add up to a substantial amount. Again, we cannot stress enough how important it is to find a good workers’ compensation lawyer to work with you if you feel your employer will not grant you the compensation to which you are entitled.
- Medical Care: Suppose you have suffered an injury that has not prevented you from working. It has, however, resulted in numerous medical bills. Not only can workers’ compensation medical care benefits cover these expenses, but your employer is also required to tell you they will do so when you suffer an injury. Some of the expenses covered by the medical care benefit include medical supplies, prescriptions, visits to the emergency room and doctor’s office, surgery, orthopedics and prostheses if an injury is permanent.
Under the PWCA, your employer can create a list of up to six doctors to whom they can refer you when you suffer a workplace injury. You must use these doctors for the first 90 days after your injury. After 90 days, you may use your own doctor.
4. What Should I Do If I Suffer a Work Injury?
You should immediately report any workplace injury to the appropriate supervisor. The moment you report your injury starts the clock on when you can receive benefits. Do not just tell a coworker and think that is all you need to do — notify your supervisor. If your injury is serious, you are entitled to request immediate medical help, as well.
If your injury falls into the category of a serious but not an immediate injury — such as hearing loss or back pain, which can worsen over time — you should again tell your supervisor as soon as your injury makes it impossible for you to do your job.
If you cannot let your employer know about your injury immediately, you have up to 120 days to give them enough notice to qualify for benefits. If your employer denies you benefits, you have up to three years to make an appeal. If your injury falls under the area of an occupational disease, you must file a claim within 300 weeks from the last time you worked on a job where these kinds of hazards were present. You then have up to three years to file a workers’ compensation benefits claim.
If you are denied benefits for any reason, you should immediately contact a workers’ compensation lawyer.
5. What If I Suffer a Work-Related Injury Outside of the Workplace?
The location where you suffer the injury does not matter. If you suffer a work-related injury, regardless of where it takes place or how long it took to develop, you are eligible for workers’ compensation benefits.
6. How Do I File a Workers’ Compensation Claim?
The process of filing a workers’ compensation claim begins the moment you are injured and you report your injury to your supervisor. As we noted above, if you have suffered a serious injury of any kind, you should immediately ask someone at work to contact emergency medical services.
It is in your best interest to begin the documentation process as soon as possible. Keep notes on everything, including:
- When the injury happened
- How it happened
- Any medical expenses
- Your supervisor’s response(s) to your report(s) of an injury
- Any doctors visits or treatments you receive
After you have reported your injury to your supervisor, your employer and their insurance company are responsible for preparing a Notice of Compensation Payable and Statement of Wages, then filing it with the Pennsylvania Department of Labor and Industry.
You will receive a copy, and it is up to you to make sure all the information on it is correct. If you do not, it could cost you benefits in the long run. If there are mistakes in the report, contact a workers’ compensation lawyer immediately.
7. What If the Injury Is My Fault?
The person or people at fault for your injury does not matter. Workers’ compensation in Pennsylvania requires your employer and their insurance company to pay you benefits if you are injured on the job, even if it is your fault. Injuries caused due to drug use or alcoholism are the only exceptions to this rule.
8. Can I Sue My Employer If I Am Hurt on the Job?
Under the PWCA, you cannot sue your employer if you are injured on the job, nor can you sue your coworkers if their negligence was responsible for your injury. There are, however, some limited exceptions to the rule. Contact a workers’ compensation lawyer to determine if one of these exceptions applies to your particular case.
9. Who Qualifies to Receive WC Benefits in Pennsylvania?
The PWCA requires all employers in Pennsylvania to provide their employees with workers’ compensation. Employers covered by the act include nonprofit organizations and unincorporated businesses, even those who may only have one or two employees. This includes seasonal and part-time workers.
Remember, workers’ compensation is not a government-supplied benefit. It is a benefit provided by and paid for by employers and their insurance companies. This is why it is so important to work with a workers’ compensation attorney when you file a claim to ensure you get the benefits you deserve.
10. What Are My Maximum Benefits?
Under the PWCA, workers receive wage-loss benefits that equal two-thirds of their weekly wage. The act also provides for minimum and maximum adjustments. The annual maximum in place at the time you are injured determines the benefit rate. This is another reason to report your injury as soon as possible — rates can change.
In 2021, the maximum weekly compensation rate has been set at $1130. This is two-thirds of a weekly salary of $1695. So, if your salary was around $770 a week, your benefits would be $516 a week, and so forth.
11. When Do My Benefits End?
There are several different scenarios under which you will no longer receive benefits, including if:
- You pass away — however, if your death is work-related, your family can receive survivor benefits
- You and your physicians agree you can return to work
- When you return to work, you are earning as much or more than you did before the injury
- A workers’ compensation judge suspends your benefits — but, if they only terminate wage-loss benefits, you can continue with your medical benefits
- You sign a document releasing your employer from any further responsibility
12. What Do I Need to Return to Work?
At some point after your injury, your doctor may give you the thumbs up to return to work. If they do, there are some important things to remember. Describe your job in detail to your doctor, because they may want you to observe some restrictions on what you can and cannot do.
Regardless of any restrictions, when you get the green light to work again, your employer or their insurance company must send you a Notice of Ability to Return to Work before they can welcome you back to the job. If they send you a Return to Work offer before a Notice of Ability, call your workers’ compensation attorney immediately.
Calling your workers’ compensation attorney is also a good idea when your doctor says you can go back to work, but you know you are not ready to return to work or you still feel pain or ill. Sometimes, you will be asked to take an Independent Medical Examination (IME) with a doctor other than your own. This doctor may say you are ready to return to work when you are not, or that you can return to work at a level that ignores any restrictions your doctor has prescribed. Again, call a workers’ compensation attorney immediately if this happens to you.
You should also know if your doctor says you can return to work and you do not go without a good reason, you may forfeit your right to receive workers’ compensation benefits. When you are back on the job, your employer may ask you to sign some papers for a variety of reasons. Be suspicious and do not sign anything without talking to your lawyer first.
13. Do I Need a Workers’ Compensation Lawyer?
People can file for workers’ compensation benefits on their own, but you increase your chances of getting the benefits you deserve when you hire a workers’ compensation attorney to help you. Remember, this is not a government-guaranteed benefit. This is a benefit paid for by employers through their insurance companies, and history shows that they are often reluctant to pay up, even during the best of times. This is especially true if you are suffering from a disease caused by prolonged exposure to dangerous chemicals or other irritants.
When you hire a workers’ compensation lawyer, you pay them on a contingency basis. The lawyer will take a percentage of any awarded benefit, but it must be a percentage you and the lawyer have agreed upon. A workers’ compensation judge or the Workers’ Compensation Appeal Board must also approve this figure.
Let the Lawyers at KBG Injury Law Help You With Your Workers’ Compensation Claim
When you decide you need help with your claim, you will have lots of questions to ask your lawyer. Be sure to find an attorney who is very familiar with the process.
At KBG injury Law, we have years of experience in helping people with workers’ compensation benefits claims. When you are preparing to meet with a lawyer from KBG, you can count on the fact that we care deeply about doing our very best for you.
We offer a free consultation, 24-hours a day on our toll-free line (800) 509-1011. Or, visit our webpage to tell us about your situation and why you want to file a claim. We will contact you as soon as we can to discuss how we can help you.