What Are the Stages of a Workers’ Compensation Case?

Every state has a Workers’ Compensation benefit system designed to be “no fault.” This means it is irrelevant whether an employer’s or worker’s own negligence contributed to a work-related injury or occupational diseases. Pennsylvania’s no-fault system was put into place to protect workers by ensuring benefits for lost wages, medical care, or disability.

There are several stages involved in a Workers’ Compensation case. While every workplace injury case is different, there are common stages that workers can expect after experiencing an injury on the job, including giving notice of the injury, getting medical treatment, seeking legal counsel, and filing claims. There are also many factors to consider in a Workers’ Compensation case, including the nature of the accident, the extent of injuries, and the parties involved.

Notice of Injury

Giving notice of a workplace injury is a crucial step in all Workers’ Compensation cases. When a worker gives their employer notice of a workplace injury, it triggers the employer’s obligation to pay Workers’ Compensation benefits. Workers’ Compensation benefits are not payable until the employer knows, or has reason to know, of an employee’s workplace injury. Even employees who do not miss time from work should give notice of any work-related injury or illness as soon as it occurs. Putting notice in writing and keeping a copy can help workers avoid future disputes about dates of notice and the workplace incident.

Pennsylvania law provides that workers must notify their employers of a work-related injury within 120 days of the date it occurred, or within 120 days after the date a work-related illness was discovered, in order to receive Workers’ Compensation benefits. Workers must also give notice within 21 days of the date of injury to be paid from the first day of their disability. Otherwise, Workers’ Compensation is only payable from the date that notice was given. The longer a worker waits to give notice of a workplace injury, the more likely their employer will find reason to doubt the validity of their claim.

After receiving notice of a workplace injury, the employer or its insurance carrier has an obligation to start investigating the claim. Insurance company typically obtain records from employers about the nature of an injured worker’s job, what was said when notice was given, whether there were any eyewitnesses to the incident, and collect documents regarding medical treatment.

Medical Treatment

Workers should get medical treatment as soon as possible after an unexpected workplace injury. When an injury or illness develops over time, workers should seek treatment as soon as possible. If a worker’s injury is a sudden emergency, they do not need their employer’s authorization to get medical care.   For the first 90 days workers must treat with health care providers selected by their employer.  This is often referred to as Panel Physicians.  The worker can treat with any health care provider on the list or panel.  If a worker does not treat with one of the panel physicians, the worker’s compensation carrier does not have to pay for that treatment.  After 90 days the worker can treat with a physician of his or her choice.

Workers’ Compensation laws give employers a level of control over medical care for their workplace injuries. The Worker’s Compensation Act provides that a Bill of Rights be in place to protect the rights of injured workers. The Bill of Rights must include the following stipulations:

• Workers must obtain treatment for injuries from one or more designated health care providers for 90 days from the date of the first visit.
• Employers must pay all reasonable medical supplies and treatment related to workplace injuries as long as they are obtained from a designated provider during the 90-day period.
• Workers have the right to switch from one health care provider to another on a designated list during the 90-day period.
• Workers can get treatment from a referral provider if they are referred by a designated provider; employers must pay for the referral treatment as well.
• Workers can seek emergency medical treatment from any provider, but subsequent non-emergency treatment must be with a designated health care provider for the rest of the 90-day period.
• Workers can seek medical consultation from a non-designated health care provider during the 90-day period, but these services shall be at the worker’s expense for the applicable 90 days.
• Workers can get medical treatment from any health care provider after the 90-day period, which shall be paid for by the employer for reasonable and necessary care.
• Workers must notify their employers of treatment by a non-designated health care provider within five days of their first visit.
• Workers can seek additional opinions from a health care providers of their choice when a designated provider recommends invasive surgery.
• If an additional medical opinion differs from that of a designated provider and has a specific and detailed course of treatment, the worker can decide which course of treatment to follow.
• Written notice of these rights and duties must be provided to workers at the time of hire and as soon as possible after their injury.

Injured workers should notify their employers of their selected health care providers as soon as possible to allow for efficient processing of their medical bills. When employees are forced to miss time from work due to a workplace injury, they should get paid for a portion of their lost income during that time.

Cases Before Workers’ Compensation Judges

In the event that your employer denies your workers’ compensation claim you may have to file a claim for benefits and have your case heard before a Workers’ Compensation Judge.   This usually requires testimony by the injured work and presenting testimony of expert witnesses such as medical experts.   Workers’ have three years from the date of injury to file a claim.

There are many rules of procedure and strict time limitations to filing a claim.  The employer or it’s insurance company will be represented by an attorney.

Seeking Legal Counsel

While workers are not required to retain an attorney to file a claim for benefits, it is highly advisable to seek legal counsel as soon as possible after a workplace injury. It is not uncommon for employers and their insurers to reject an injured worker’s claim for benefits after performing an initial investigation. An experienced lawyer can review an injured worker’s case to determine the best route going forward if the worker’s claim is rejected.

Workers should keep in mind that many employers do comply with the Bill of Rights. Also, many workers are never asked to sign a document confirming they have received notice of the Bill of Rights. In these cases, the injured worker has the right to seek medical treatment from a health care provider of their own choice. When an employer refuses to pay for the injured worker’s medical treatment, legal remedies can be pursued with the guidance of a lawyer.

The following are additional ways a knowledgeable attorney can assist with a Workers’ Compensation case:

• Advise on whether to file a claim petition or other relevant petition.
• Gather evidence such as medical records and expert testimony.
• Take legal action if a worker is fired by an employer in retaliation for seeking Workers’ Compensation benefits.
• Explore potential third-party claims for the injury.
• Resolve disputes and negotiate settlements.
• Purse maximum compensation for permanent injuries or disabilities.

Our lawyers at Galfand Berger LLP are renowned for skillfully assisting workers and their families. Some of our past cases:

• $1.75 million pre-suit settlement for electrical shock and burn injuries. Our client was a masonry worker who suffered electric shock and burns when part of his aerial lift came in contact with a telephone wire. Our legal team was able to resolve the matter on behalf of our client for $1.75 million, one of the largest pre-suit settlements in Lebanon County.
• $800,000 settlement for natural gas explosion accident injuries. Our client was a laborer who suffered severe injuries in an explosion caused by a natural gas pipe leak close to where he was working. The injuries to his arm and shoulder required three separate surgeries. We were able to settle the matter on behalf of our client before trial for $800,000.

Workers should know their rights to Workers’ Compensation after an accident on the job. Galfand Berger LLP offers free legal resources to help workers make more informed decisions.

Philadelphia Workers’ Compensation Lawyers at Galfand Berger LLP Handle All Complex Stages of Workers’ Compensation Cases

Our skilled Philadelphia Workers’ Compensation lawyers at Galfand Berger LLP offer top quality representation at every stage of our clients’ legal matters. We make sure that our injured clients’ rights and best interests are protected during the Workers’ Compensation process. To schedule a free initial consultation, call us at 800-222-USWA (8792) or contact us online. Located in Philadelphia, Reading, Bethlehem, and Lancaster, Pennsylvania, we proudly serve clients in New Jersey and Pennsylvania, including Allentown and Harrisburg.