Workers’ compensation is an insurance plan that compensates employees for injuries and illnesses sustained on the job. Every state has passed its own Workers’ Compensation Act and Pennsylvania is no exception. Benefits are paid from one of three sources – private insurance companies, employers who are self-insured and the State Workers’ Insurance Fund. Workers’ compensation claims must be filed in strict accordance with state regulations.
Eligibility
The Pennsylvania Workers’ Compensation Act generally covers employees working within the state of Pennsylvania including employees of non-profit organizations and unincorporated associations as well as part-time and seasonal workers, according to workers’ compensation attorneys Huber & Palsir. The Workers’ Compensation Act doesn’t cover everyone, however. Some of the categories of workers who are excluded from coverage include:
- Railroad workers, longshoremen, harbor workers and other federal employees (covered by federal programs)
- Independent contractors
- Domestic workers such as maids
- Volunteers
To qualify for coverage, your injury or illness must be caused or aggravated by your occupation, and it must be serious enough to require medical treatment beyond remedial first aid.
Filing a Claim
To file a valid workers’ compensation claim, you must promptly notify your employer of your condition and describe the condition as well as the place and date of its occurrence. Your employer is required to complete a worker’s compensation claim form and turn it in to the state Bureau of Workers’ Compensation. The Bureau of Workers’ Compensation will then determine whether or not your claim is valid and, if it is valid, determine how much money it will pay out on your claim. You should receive a decision on your claim within 21 days after your claim is filed.
Benefits
Workers’ compensation benefits include compensation for medical expenses, lost earnings (normally two-thirds of your average weekly wage), permanent disability and death benefits for your survivors, if applicable. In an ordinary personal injury lawsuit, you are entitled to claim damages for pain and suffering if you suffered a physical injury. It is common for pain and suffering damages to far exceed damages for medical expenses and lost earnings combined. If your injury is covered under workers’ compensation, however, you will probably not be able to sue your employer for pain and suffering damages, although you may sue a third party for these damages if the facts of your case warrant it.
Appeals
If you are dissatisfied with the decision on your claim, regardless of whether you feel that your claim was unfairly denied or that your compensation was insufficient, you may file a claim with the Workers’ Compensation Bureau. If you are dissatisfied with this decision, you may further appeal to the Workers’ Compensation Appeals Board. If you are still dissatisfied, you may appeal to a Pennsylvania court for resolution of your claim.
Why You Need a Worker’s Compensation Lawyer
Not all workers’ compensation claims require legal assistance. If your claim is complex or controversial, however, or if you intend to appeal your decision, the services of an experienced workers’ compensation attorney could prove invaluable. The appeals process in particular is highly formalized, complex and even byzantine at times.
Click here for more information about worker’s compensation claims in Pennsylvania.
