York Workers’ Compensation Attorneys, PA

What is covered under workers’ compensation?

As mentioned earlier, workers’ compensation takes on a few forms. Workers’ compensation benefits can include:

• Payments for lost wages. One of the most important and commonly claimed workers’ compensation benefits covers wage loss. For those who cannot work at all while they recover from an injury or illness, these wage loss benefits will allow the worker to continue paying the bills and providing for their family. Even those who can only work part-time or in a limited capacity after suffering an injury are entitled to workers’ compensation benefits.
• Death benefits. Death benefits can be provided to the surviving spouse as long as they lived with the employee at the time the death occurred. If they were not living with the employee at the time of death, but were still legally married, they must also prove that they were financially dependent on the employee. Dependents under the age of 18 can also receive benefits, and full-time students may continue receiving benefits until age twenty-three. If there is no surviving spouse or dependent children, death benefits may be paid to the parent or siblings of the employee of they can prove that they were financially dependent on the employee at the time of death. Death benefits also include a one-time lump sum funeral benefit.
• Specific loss benefits. There are some cases where a work-related injury may result in the loss of, or the complete loss of use of a body part. For example, an accident may result in the traumatic or surgical amputation of a finger or appendage, or damage so severe to that finger or appendage that its use is lost for all practical intents and purposes. In these cases, there are specific loss benefits designed to compensate the permanent loss of that function. Specific loss benefits also cover the loss of hearing and vision and disfigurement of the head face or neck resulting from a work injury.
• Medical care. Even if a work-related injury or illness did not result in time off work, you are still entitled to benefits if you have incurred any medical bills related to your care. Covered medical expenses include supplies, medicine, emergency room or doctor’s office visits, surgery, orthopedics and prostheses. Many medical bills will be covered under either the employee or employer’s insurance, but the employer must cover any out-of-pocket costs.

However, be aware that if you seek medical care outside of Pennsylvania, some expenses may not be covered. Consulting with an experienced attorney will ensure you do not accidentally seek treatment that is not covered.

Also, if your employer has posted a list of six or more approved medical providers in the case of injury, your initial visits for medical treatment must come from this list, as well as any subsequent visits for the next 90 days.

You may be required to undergo an Independent Medical Examination (IME) or an Impairment Rating Evaluation (IRE). During an IME, a physician will evaluate your current condition, its causal connection to your work injury and your current work capabilities. During an IRE, a physician will calculate the percentage of your impairment to determine whether a worker should be on partial or total disability benefits. If you get scheduled for an IME or an IRE you should contact one of the workers’ compensation attorneys at KBG Injury Law to discuss your options immediately.

Your insurance company may also have a nurse contact you or accompany you to your doctor’s appointment. These Nurse Case Managers (NCMs) work for (and are paid by) the insurance company, and it is important to remember that you do not have to allow an insurance company nurse to come to your appointment, and you are not required to provide an NCM with your medical information. Talk to the attorneys at KBG Injury Law if you have any questions about this.