Even in safe workplaces, accidents can happen, and you or a family member may get injured on the job. If you work in a hazardous environment, you are also at risk of developing a disease or illness caused by your occupation. If you become injured or ill while on the job or performing your work duties, you may be eligible for workers’ compensation benefits. Know your rights and learn how to file a workers’ compensation claim so you can get your rightful benefits.
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What Qualifies as Workers’ Compensation?
Workers’ compensation covers harm that occurs as a result of employment duties or while an employee is on the job. Workers’ comp typically falls into two categories — an injury or an illness/disease. An injury that qualifies for workers’ compensation must be the result of a verifiable event that caused the injury within the scope of the injured person’s employment or while performing work-related duties. For example, an employee may be physically injured from equipment while at work or may slip on ice on their employer’s property.
An illness or disease that qualifies for workers’ compensation may develop quickly or over time. For example, an employee may develop asthma from continued exposure to air particles in the work environment or could incur hearing damage while working in a loud workplace. To qualify for workers’ compensation the injury or illness/disease must be significant enough to require medical treatment beyond basic first aid.
What Does Not Qualify as Workers’ Compensation?
In some instances, a workplace injury or illness may not qualify for workers’ compensation. Here are some common events and conditions that may not qualify for workers’ compensation in your state:
- Injuries that are self-inflicted or caused by the injured person themselves.
- Injuries occurring while the employee was under the influence of alcohol or drugs.
- Injuries occurring while the employee was violating company policies.
- Injuries caused by fighting in the workplace.
- Illnesses relating to stress.
- Illnesses related to other psychiatric injuries.
Each state has different workers’ compensation laws, and an injury that qualifies in one state may not qualify in another. In Pennsylvania, workers’ compensation is covered by the Pennsylvania Workers’ Compensation Act. Be familiar with the laws in your state so you can properly file your workers’ comp claim.
Can I File a Claim Online?
In Pennsylvania, employees may file a workers’ compensation claim online through the Pennsylvania Department of Labor and Industry with the Workers’ Compensation Automation and Integration System. Employers must create an account to log in to this online portal and submit a workers’ compensation claim. For those who prefer to submit paper forms for a workers’ compensation claim in Pennsylvania, these forms are available through the Pennsylvania Department of Labor and Industry. Whether claims are filed online or with physical paperwork, employees and employers should retain copies of all documentation.
What Information Do I Need to File a Claim?
If you are injured or develop an illness from your employment duties, your employer should provide you with an official workers’ compensation claim form to begin the claim process, or you may find one online with your state’s workers’ compensation board. While each state may have slightly different requirements regarding workers’ comp claims, here is some general information you may need for a workers’ compensation claim:
- The date and time the injury occurred.
- The location where the injury occurred.
- The type of injury.
- The affected area or areas of the body.
- Any parties involved with the accident.
- How the accident or injury occurred.
- Any medical treatment the employee has received.
When Does My Employer File a Claim?
The first step to filing a workers’ compensation claim is to report the injury or illness/disease to your employer. Once you make your employer aware of the injury or illness/disease, they should submit a claim with their insurance provider immediately.
The employer or employee should also file a claim with your state’s workers’ compensation board or office. In Pennsylvania, employers should also file a First Report of Injury online with the Bureau of Workers’ Compensation within seven days for any injury that results in a disability lasting more than one day, shift or turn of work. If the accident or injury results in death, the employer must submit the First Report of Injury within 48 hours.
What Happens If I Do Not Follow the Claim Process Correctly?
If the workers’ comp claim process is not followed correctly, both the employee and the employer could suffer consequences. If the employee fails to retain copies of paperwork or cannot offer sufficient documentation of the accident or injury, their workers’ compensation claim may be denied. If the employee waits too long to report an injury or illness to their employer, they may be disqualified from submitting a workers’ compensation claim.
For employers, they must carry workers’ compensation insurance or they could receive a hefty fine. Employers are required to report injuries or illnesses in a timely and accurate manner. Employers must also submit workers’ compensation claims for all covered employees and supply accurate information to employees. If the employer misclassifies an injury or employee, they can receive fines. After an employee is injured or becomes ill, they should receive a doctor’s diagnosis of their injury or illness, and the employer is not permitted to influence this diagnosis in any way. Employers may appeal a workers’ compensation claim, but if they appeal a claim without probable cause, they may have to pay a fine.
How Long Does It Take to File a Workers’ Comp Claim?
If you start the documentation process for a workers’ compensation claim as soon as possible after an injury or illness, filing a workers’ compensation claim can be a fairly efficient process. Your employer should be able to provide the necessary paperwork for submitting your claim, and you can document details about the event right away. Once the workers’ compensation claim is filed, the employer’s insurer must respond to your claim within a specified period of time. In Pennsylvania, insurers have 21 days to deny or accept a workers’ compensation claim. If the claim is accepted, the employee may begin to receive benefits within 21 days of the injury.
Filing a workers’ compensation claim can become a longer and more complicated process if the employee delays in reporting the injury or illness. As time passes, the details of the accident may be more difficult to recall, making it more challenging to accurately complete documentation. The employer’s insurer may also question why filing the claim was delayed and may be more likely to deny the claim if they believe it may not be legitimate.
What Is the Deadline for Filing a Workers’ Comp Claim?
The deadline for filing a workers’ compensation claim varies from state to state, and some states have different deadlines for different types of injuries or illnesses. Be sure to check your state’s specific workers’ compensation laws. In most states, an injury must be reported within about 30 days of when it occurred. In Pennsylvania, an employee should report an injury or accident within 21 days from when it occurred. If an injury is not reported within 120 days, the employee may lose their rights to file a workers’ compensation claim and no benefits will be given.
For diseases or illnesses that develop over time, the employee should report the illness as soon as they suspect that it was caused by their work environment or work duties. If an employee must take time off of work because of an illness, they should consider if the illness may qualify for workers’ compensation. Some states may be more lenient about workers’ comp claim deadlines for progressive diseases or illnesses that developed over time, but in other states, insurers may be able to deny a claim if it is not reported promptly. In Pennsylvania, an employee suffering from an occupational disease must file a claim within 300 weeks from the date of their last employment in the occupation where they were exposed to the hazard or work environment that caused the illness.
Any injury or illness that occurs in the workplace or as a result of work duties should be reported as soon as possible. Employees may choose to report a workplace accident even if the resulting injury is not serious or no injuries are immediately suspected. This will allow the employee to file a claim later should the injury worsen.
How Do I Start the Workers’ Compensation Claim Process?
You should begin the workers’ comp process as soon as an injury or illness occurs. There are several steps you will take to file a workers’ compensation claim:
- Contact emergency medical services: If you sustain a work injury that is serious, requires emergency medical attention, or is a head injury, ask someone to contact emergency medical services immediately.
- Report the injury as soon as you can: Follow the rules of your workplace to formally report the injury to your manager, supervisor or other correct authority in your workplace. If you report the injury verbally, it is best to follow up with an email or another physical document so you can retain a copy for your records. The injury report should include all pertinent details, including the date, time and place of the injury, how the injury occurred, details of the injury itself and any witnesses who were present.
- Start the documentation process as soon as possible: Take note of when the injury occurred and keep records of any medical or other expenses. Record all treatments you receive and keep track of your symptoms, noting particularly if your injury or illness worsens or gets better. You may even choose to keep a journal of how your injury or illness affects your work and daily life. Retain copies of any correspondences regarding your injury with your employer or other authority. The more documentation you have, the better prepared you will be should you choose to appeal if your claim is denied.
- Seek medical attention through your employer’s network: Some employers may require employees to seek medical attention for any workplace injury. However, it is in your best interest to go to a doctor for an official diagnosis and medical report even if your employer does not require you to. These documents can be filed with your workers’ compensation claim and serve as an official record of your injury or illness.
- Contact an attorney for support: If you would like support through the claim process, you may also wish to contact an attorney early on in the filing process. An attorney will be able to assist you in completing all the necessary steps to correctly file your workers’ compensation claim.
Once you have reported the injury, your employer will submit a workers’ compensation claim to their insurance provider. The employer and their insurance company are responsible for filling out a Notice of Compensation Payable and Statement of Wages and filing it with your state’s workers’ compensation office. In Pennsylvania, this notice must be filed with the Pennsylvania Department of Labor and Industry.
You will get a copy of this documentation to keep for your records. When it arrives, review it carefully for any mistakes and make sure the description of your injury, your work position, employment details and your wages are correct. If they are not correct, you may not get the benefits you should get for your injury. If the information on the form is inaccurate or if you cannot get a copy of your Notice of Compensation Payable and Statement of Wages, contact a workers’ compensation attorney.
What Happens After I File a Workers’ Compensation Claim?
In Pennsylvania, your employer’s insurer must respond within 21 days with a denial of your workers’ comp claim or with your benefits. These benefits may be offered in several different forms, including medical benefits, specific loss benefits, wage loss benefits for partial disability or wage loss benefits for total disability. These benefits may be ongoing or temporary.
While you are receiving benefits, keep an eye out for letters regarding your workers’ compensation benefits. Hold onto these letters and respond to them appropriately. For example, if you get a notice about a vocational interview, independent medical examination (IME) or impairment rating evaluation (IRE), keep in mind that all these evaluations can be used to reduce or stop your benefits. You must not ignore these requests, but you will also want to work with a workers’ compensation attorney to ensure your benefits are protected.
If your claim is denied, you may file a petition with the Workers’ Compensation Bureau to appeal the decision. You may be requested to attend a hearing with a workers’ compensation judge who will review your case. If the denial stands, you can appeal that decision with the Workers’ Compensation Appeal Board and then appeal their decision to the Commonwealth court if necessary. The appeal process can become complicated, so you may choose to contact an attorney to navigate this process and get your rightful benefits.
In some cases, you may receive benefits but they are less than you expect or your checks may arrive late. If you believe your workers’ compensation benefits are not being provided properly, contact an attorney. Working with an attorney can strengthen your claim and protect your benefits.
Contact KBG Injury Law for a Free Consultation
If you have been injured at work, contact KBG Injury Law for a free consultation. KBG Injury Law has served South Central Pennsylvania for over 30 years and our experienced attorneys can guide you through the workers’ compensation process. Attorneys at KBG Injury Law will help strengthen your workers’ compensation claim and ensure it is filed properly so you can get the results you deserve.