Answers to Common Questions About Workers’ Compensation Legal Claims

The Workers' Compensation Claim Process: Everything to Know
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Workers’ comp can be a big strain on a person’s life. If you have to go through with the legal process to get it, it usually means you’ve been injured or were somehow incapacitated while on the job. From that point on, it turns into a flurry of paperwork and legal proceedings the average person just isn’t used to. Workers’ compensation is something that we’re all familiar with, yet many of us don’t know what it entails. It’s a crucial system that most of us are not taught in schools. When we start a new job, we are usually aware of its existence via a snippet in our onboarding papers, but most don’t give it much attention. Every company has their own system on how they take care of the issue, but the details are still, somehow, a mystery to the vast majority of employees. 

Here are a few commonly asked questions about worker’s compensation and their corresponding answers. 

Who do I report an injury to? 

If you experience an accident or an injury while on the job, it’s important that you tell your immediate supervisor. He or she is obligated to file that claim. From that point, your employer may give you forms to fill out, so that you can detail exactly what happened in your own words. If your immediate supervisor refuses to file a claim for you, you can go directly to human resources or the worker’s comp division of the company you work for. In the state of Pennsylvania, you have up to 120 days to report your injury, but waiting can hurt your claim by giving your employer a reason to say you were not injured at work.

How much am I supposed to receive? 

Generally, wage-loss benefits are 75% of your Average Weekly Wage, or AWW. This is determined by looking at your pay over the past year, including overtime, and a standard calculation is supposed to determine your minimum and maximum payout depending on your status and extent of your injuries. Along with this, your employer’s workers’ compensation company has to pay for all medical bills and treatments deemed necessary. Although these are the general guideline companies have to follow, it can be offset by other benefits your employer pays out like unemployment, Social Security, retirement pension, and severance. But after everything is factored in, how much are you really going to get? Because of the open-ended nature of Pennsylvania law, Williamsport workers compensation attorneys often answer this question for their clients. The Pennsylvania Workers’ Compensation Act allows for multiple ways of determining the Average Weekly Wage. The range in actual take-home money is between 50% of the State-calculated AAW or 90% of the workers’ AWW–whichever one comes out lower. 

Do I have to tell my employer I hired a lawyer? 

Some people don’t feel comfortable trusting an employer and their insurance company up front. It’s a reasonable concern, as nobody on that side is in the business of paying you the maximum amount you’re owed. For that reason, contacting and employing a compensation lawyer is one of the best options to make sure you’re not being low-balled on top of your physical injuries. Many people fear that their employer will take offense to this. You are not obligated to tell your employer that you’re seeking guidance from a legal team. Unless you’re taking the case to court, you can freely get the advice you need for peace of mind and reasonable wage-loss benefits. 

Can I get fired for my claim? 

An employer cannot fire you for filing a worker’s comp claim. If you are, it’s best to contact a lawyer immediately. Even if you are let go, you are still entitled to full workers’ compensation benefits, unless you explicitly break the agreement documented between you and said employer. If you’re going to be out of commission for a significant amount of time, do not hesitate to ask for FMLA (Family Medical Leave Act) leave. It may very well be granted depending on your case. 

Who pays for the doctor visits? 

Soon after your injury, your employer is obligated to make sure you understand your rights and duties under Section 306(f.1)(1)(i) of the Pennsylvania Workers’ Compensation Act. You should receive a notice after you’ve been cleared to go home after your doctor visit. Under that provision, all your related medical bills, including surgery, hospital stays, treatments, and supplies are to be paid by your employer. You’re not required to pay your usual deductibles or co-payment. Furthermore, you can’t legally be charged for the difference between what your employer pays and what the doctor charges unless you seek treatment outside of the state. They cannot legally pressure you or get you to pay through your regular health insurance. 

What do I do if my claim was denied or halted? 

If you’re denied your claim, you can file a claim petition or look for other options in front of a workers’ compensation judge. If your employer claims that your injury did not occur at work, or does not recognize that you’re injured, you should seek immediate council from an attorney. Your employer’s insurance company can use a host of reasons to not pay or halt payments. They may site physical status and even opioid use at their disposal, even if it was prescribed by your doctor. Understand that to many companies, this is a big deal and paying you is not in their best interest. 

What’s an IME? why does my employer wants me to get one? 

A common dispute is with insurance companies requesting an Independent Medical Examination. An IME is a visit to the doctor that your employer’s insurance company hires to determine if you’re really injured. This can happen at any time. In this situation, the IME doctor, having been hired on the side of your employer can determine that you’re ready to go back to work while your personal doctor may disagree. This is one of the most common scenarios following an IME visit and a common source for horror stories surrounding workers’ comp. If this is to occur, contact your lawyer. This is used as a move to settle on a lump-sum compromise and release your claim. Afterwards, you will not be entitled to any more benefits from the insurance company. All medical costs, from that point on, will be solely your responsibility. 

As stated before, having to avail of workers’ comp can be a stressful time for you and your family. It’s a complete disruption of one’s everyday life and responsibilities. But with the right tools at your disposal, a solid claim, and an experienced attorney, getting everything you’re entitled to can be done swiftly and efficiently. This should give you all the time you need to get healthy and back on your feet. 

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