Philadelphia Workers’ Compensation Lawyers

What is a Workers’ Compensation Injury?

In the course of a workday, you may face the risk of injury or death. Many workers are unaware of the hazards to which they are exposed, and others, while understanding the risks, cannot choose a safe work environment. Your employer controls your workplace, and you may be exposed to significant safety and health hazards.

• Safety hazards are those conditions that cause burns, electrical shocks, cuts, bruises, sprains, broken bones or loss of limb, eyesight or hearing.
• Health hazards include toxic and carcinogenic chemicals and dust, often in combination with noise, heat, and other contaminants. Health hazards react with your body. The result can be lung disease, heart disease, cancer, neurological disorders, or systemic poisoning. Unlike safety hazards, the effects of health hazards may be slow, difficult to diagnose, and complicated by non-occupational factors. While an unguarded blade in a rotary saw may present a serious danger, it is often difficult to recognize the serious danger of a brief exposure to a cancer-causing chemical that can take years to cause a tumor or death. Yet, the risk of dying of cancer may be just as high as the risk of having an accident with the saw.

Because you cannot eliminate the safety or health hazards that cause injuries, you should do everything possible to make sure your employer bears the burden of the economic losses caused by work-related injuries.

One of the original principles of Workers’ Compensation was to provide injured workers and their families with sufficient resources to maintain an adequate standard of living, despite the disability or death of the primary breadwinner. Workers’ Compensation places the burden of a substantial portion of an injured worker’s economic loss on the employer. However, Workers’ Compensation only pays a portion of your loss; it does not pay for the full loss of wages, pain and suffering, loss of enjoyment of life’s pleasures, or the loss of dignity and confidence seriously injured workers suffer. Yet, because Workers’ Compensation is the only right the injured worker has against the employer, it is important that you know your rights and make sure your employer meets its obligation under the law.

What Should Employees Do After Sustaining an Injury?

No one expects to get hurt at work, but if that happens, there are several steps workers should take to provide themselves with the best medical care and to protect their rights as an employee.

• Seek medical help. If the accident rises to the level of requiring emergency services, someone should call 911 as soon as possible. If the injury does not appear to be that severe, the employer should allow the employee to leave so that they can seek medical assistance. Companies are required to have Workers’ Compensation insurance and therefore may have a list of approved doctors who the employee can see for care.
• Report the injury. This should take place as soon as possible, ideally immediately. The employee should speak with their supervisor on how best to report the injury and follow the procedures in place.
• Keep all records. The injured worker should keep all records and bills accumulated because of the injury, including those for doctor visits, tests, and any procedures. In case there is a problem with benefit payouts later, the worker will have a record of the expenses incurred.
• Gather evidence. Someone should take pictures of the accident site and obtain a copy of the employee’s timecard or any other evidence that proves that they were working legally at the time of the accident.

Are Workers’ Compensation Benefits Better Than Group Benefits?

If you are injured at work, aggravate a pre-existing physical problem at work, or develop a disease from your job, you are entitled to Workers’ Compensation benefits. Yet, many workers are told by their employers to apply for group insurance benefits when they really should be covered by Workers’ Compensation. Group benefits, which also are called sickness and accident benefits, or S&A Benefits, are disability benefits to which you are entitled if you have a non-work-related injury or illness. If your injury or illness is work-related, even partly, you should apply for Workers’ Compensation benefits. Workers’ Compensation benefits are better than group benefits for many reasons, including:

• Workers’ Compensation benefits are not subject to income tax, while taxes are deducted from Group benefits;
• In Pennsylvania, Workers’ Compensation benefits are typically higher than Group benefits;
• Total disability benefits under Workers’ Compensation can be paid as long as the disability continues. Group benefits are usually paid for a maximum period of 26 weeks, and in many cases, even less;
• If you are receiving Workers’ Compensation benefits and return to work at a lower rate of pay because of your injury, you are entitled to weekly compensation benefits equal to two-thirds of your pay loss. Group benefits programs do not provide for partial benefits; and
• Workers’ Compensation provides a comprehensive coverage of your work injury medical expenses. Medical payments under Blue Cross and Blue Shield, or similar coverage, are limited. This means that under group benefits coverage, you have to pay those medical expenses that are not covered by Blue Cross and Blue Shield.

If you are denied Workers’ Compensation benefits, you should apply for group benefits, and immediately contact an experienced Workers’ Compensation lawyer to help you file for benefits. The group insurance carrier should pay your disability benefits if you are denied benefits. Receiving group benefits will not prevent you from filing a claim; you will not be liable for payment of your medical bills and will receive payment equal to the difference between Workers’ Compensation benefits and the group benefits.

What Injuries Does the Workers’ Compensation Act Cover?

If your work causes any injury, illness, or disease, you are entitled to Workers’ Compensation. If your job contributed to or aggravated your disability, you are entitled to Workers’ Compensation benefits, regardless of your previous condition. This is also true for back injuries, neck injuries, or for any other condition that you had prior to your work-related injury. If your job aggravated the condition causing your disability, you are entitled to Workers’ Compensation benefits. This is true regardless of your previous condition. For example, if you had a heart attack or open-heart surgery and your job causes you to sustain another heart attack or disabling chest pain, you are entitled to receive Workers’ Compensation benefits.

Do not let your employer tell you that you are not entitled to Workers’ Compensation just because you had a prior back problem, heart problem, or lung problem. This simply is not true. You have a right to Workers’ Compensation regardless of your prior condition.

Will Workers’ Compensation Cover a Disease or Illness Caused by Work?

Accidental injury can be a single event. It is easy to understand, and injured workers feel the effects immediately. Disease and illness, however, often result from working conditions, but the way they develop may be complex and not well understood. Many workers are exposed to different chemicals, solvents, fumes, dirt, dust, and other health hazards at work. These agents can cause various diseases and illnesses and, in some cases, even can result in death. If your disease or illness was caused, in whole or in part, by your job, you are entitled to Workers’ Compensation benefits. If you suspect that your injury, illness, or disease is caused, in whole or in part, by your job, discuss this with your doctor. Explain why you think your job is causing your physical problems. If your doctor agrees that your job is the cause of your trouble, then you must tell or give notice to your employer. Notice means letting your employer know you have a disease or illness, and the disease or illness was caused by the job.

When Do Payments Start and How Long Do They Last?

Compensation benefits should be paid within 21 days of the date the company is notified of an injury. The length of time that payments will continue will depend on the type of injury the worker experienced and the state in which they live. Those with a temporary total disability can receive benefits for 90 days in Pennsylvania and a maximum of 400 weeks in New Jersey. If a worker has a permanent partial disability, which means they are 49 percent or less disabled and assumes they cannot return to work within 90 days, they can receive a benefit of up to 500 weeks in Pennsylvania. In New Jersey, a worker can receive benefits for up to 600 weeks.

What is the Injured Workers’ Bill of Rights?

There are a lot of rules and regulations regarding care and treatment you can receive from a doctor. In order to protect a worker’s rights, the Act provides for a Bill of Rights. The employer must advise you of your rights. The first notification usually comes at the time of hire or shortly thereafter. Your employer must not only orally explain these rules so you understand them but also provide you with a written document to sign, confirming that your employer has complied with the Act.  The Bill of Rights must include the following:

• An employee has the duty to obtain treatment for injuries from one or more designated health care providers for 90-days from the date of the first visit with that provider;
• The employee has the right to have the employer pay all reasonable medical supplies and treatment related to the injury as long as such treatment is obtained from a designated provider during the 90-day period;
• The employee has the right during the 90-day period to switch from one health care provider on the list to another on the list and all treatment must be paid for by the employer;
• The employee has the right to seek treatment from a referral provider if the employee is referred by a designated provider, and the employer shall pay for treatment rendered by the referral provider;
• The employee has the right to seek emergency medical treatment from any provider, but subsequent non-emergency treatment shall be by a designated provider for the remainder of the 90-day period;
• The employee has the right to seek treatment for a medical consultation from a non-designated provider during the 90-day period, but these services shall be at the employee’s expense for the applicable 90-days;
• The employee has the right to seek treatment from any health care provider after the 90-day period has ended, and that treatment shall be paid for by the employer for reasonable and necessary care;
• The employee shall notify the employer of treatment by a non-designated provider within 5-days of the first visit;
• The employee has the right to seek an additional opinion from any health care provider of the employee’s choice when a designated provider prescribes invasive surgery. If the additional opinion differs from the opinion of the designated provider, and the additional opinion provides a specific and detailed course of treatment, the employee shall determine which course of treatment to follow. If the employee opts to follow the course of treatment outlined by the additional opinion, the treatment shall be performed by one of the health care providers on the employer’s designated list for 90-days from the date of the first visit to the provider of the additional opinion;
• Written notice to an employee of these rights and duties shall be provided at the time the employee is hired and immediately after the injury or as soon as possible under the circumstances of the injury. If the employee’s injuries are so severe that emergency care is provided, notice of the employee’s rights and duties shall be given as soon after the occurrence of the injury if possible;
• Any failure of the employer to provide evidence of notification of a signed copy of this Bill of Rights releases employees from any duties specified in the notice and the employer remains liable for all treatment rendered to the employee.
• An employee may not refuse to sign an acknowledgement to avoid the duties specified.

We have found it is very unusual for employers to comply with this Bill of Rights.  For example, even though you are supposed to have a right to choose a doctor from a list of physicians, often times the employer directs you to one particular doctor to receive treatment. Also, we rarely find that employees are even requested to sign a document confirming they have received notice of the Bill of Rights. Such a failure by the employer means the injured worker has the right to seek treatment from a physician of his or her own choice. In such cases, the employer must pay for treatment of that work injury.

What If a Company Denies Benefits or Does Not Pay?

If the company denies benefits, it should send a written notice of denial. If an employee receives the written notice of denial or hears nothing from the company within 21 days, an experienced Workers’ Compensation lawyer will help steer them through the appeals process, which can become lengthy, regardless of whether the employee works in Pennsylvania or New Jersey.

• Pennsylvania. If the employer denies the claim, the employee can appeal that decision by filing a claim petition with the state Bureau of Workers’ Compensation’s Appeal Board. It will make a ruling based on the evidence presented. After it makes its decision, either the employee or the employer has 30 days to appeal that decision to the Commonwealth Court. They will review the case to determine if any mistakes were made in the previous ruling. Most Workers’ Compensation cases end at this point, but some can move forward to the state Supreme Court.
• New Jersey. Injured workers have two options: file a claim petition or an Application for an Informal Hearing. The informal hearing is similar to a mediation session in that a judge of compensation will hear the case within a few weeks of the request and suggest ways for the worker and their employer to resolve it. The judge’s suggestions are non-binding, meaning the worker can still file a formal claim petition. The formal hearing will also take place before a judge of compensation and will take place within six months of the request. A trial will be held, where both sides will present their evidence and the judge will make a binding ruling. It is important to know that in New Jersey, an employee will have two years from the date of the injury or from when the employee received their last compensation check to file a claim petition. Filing for an informal petition does not change this timeframe. If the employee disagrees with the judge’s decision, they have the option to appeal the ruling with New Jersey’s Superior Court Appellate Division.

What If a Supervisor Blocks the Injury Report?

It is illegal for an employer to deliberately prevent an employee from filing an injury report. They may have several motivations why they would take this illegal action. They might be trying to make the company look good in terms of the number of at-work accidents. They could also not want to pay out a Workers’ Compensation claim, knowing that it will increase the company’s insurance rates.  Although the employer might have their own motivation for preventing a worker from filing an injury report, they do not have the legal right to do so.

A company might also try to avoid paying out an actual Workers’ Compensation claim and attempt to settle with the employee immediately. In that situation, they might send the company’s lawyer to speak with the worker and attempt to pressure them into negotiating a settlement. The injured worker should not agree to speak with them or even discuss a settlement without speaking to a lawyer themselves.

The company may also try to intimidate an employee into dropping a claim through subtle warnings or peer pressure. They may get co-workers to try to convince the employee that their job could be in jeopardy if they elect to proceed with the Workers’ Compensation claim. Some employees might even tell stories of past incidents in which employees lost hours or benefits because of such a claim. Regardless, an injured employee should not allow co-workers to intimidate them; they should seek legal advice on how to handle these situations.

Can an Employee Lose Their Job for Filing a Workers’ Compensation Claim?

An employer cannot fire or discipline an employee in any way for reporting an injury or filing a claim for compensation. Firing a worker for filing a Workers’ Compensation claim is illegal and discriminatory.

What Should an Injured Worker Do While the Process is Ongoing?

After reporting the injury, an employee must be proactive with their employer, as well as the company’s insurance provider. The employee should chronicle their interactions with the employer, making note of the time, date, and what the two parties discussed.

In Pennsylvania, the employer will file a Notice of Compensation Payable and Statement of Wages with the Pennsylvania Department of Labor. This important document will detail the employee’s wages, details of the injury, and the employee’s job description. The worker should make sure to obtain a copy of this document and scrutinize it significantly to make sure that all the information is accurate. Any incorrect information could lead to a delay in benefits or even a denial.

Philadelphia Workers’ Compensation Lawyers at Galfand Berger LLP Advocate for Injured Workers

If you or a loved one was injured at work, the Philadelphia Workers’ Compensation lawyers at Galfand Berger LLP are ready to assist you. We will thoroughly review the details of your case and fully explain the process of filing for benefits. Our dedicated legal team will protect your rights and ensure that you receive the assistance you deserve for your injuries. To schedule a free consultation, please call us at 800-222-8792 or contact us online. From our offices in Philadelphia, Bethlehem, Lancaster, and Reading, Pennsylvania, we help clients throughout Pennsylvania and New Jersey, including Allentown and Harrisburg.