Every day our Philadelphia workers’ compensation lawyers hear from people who were injured on the job. They might have fallen on a wet floor, suffered a repetitive motion injury, had something hit them on the head, cut themselves badly with a tool, or suffered any of numerous kinds of workplace injuries.
It is always unfortunate when someone is injured, but, fortunately, if you are injured at work, you have a right to benefits that can protect you. Those benefits and protections come from the Pennsylvania Workers’ Compensation Act. But it is important to keep in mind, your chances of obtaining fair benefits are greatly improved by retaining a personal injury attorney such as Jim Mogul.
What Are Some Workers’ Comp Benefits?
The benefits provided to injured workers’ are meant to protect you financially. Available benefits include:
- Lost wages. Payment for a portion of wages you lost due to your injury.
- Medical care. Payment for all medical care related to the work injury, including: medicine, surgery, hospitalization, orthopedic appliances and other related items.
- Death benefits. Those who lose a family member due to a work injury may be entitled to benefits.
- Amputation and specific loss. These benefits are provided if you lose the use of a part of your body. They are also available if you suffered sight or hearing loss, or suffered a permanent and serious disfigurement on your head, face or neck.
- Disability benefits: based on the amount and severity of an injury, benefits may be temporary or permanent, and either for partial or total disability
- Disfigurement benefits: benefits to cover permanent and serious disfigurement of your head, face or neck
- Dependency benefits or death benefits: benefits that may be available for a financially dependent surviving spouse and children—if the children are under the age of 18, full-time students younger than 23, or physically and/or mentally disabled
Workers’ compensation pays medical expenses related to diagnosing and treating a work-related injury. If a work-related injury causes disability or death, workers’ comp also provides for lost wages to the employee or a death benefit payment to surviving dependents. The amount of the wage-loss benefit varies; however, in Pennsylvania, the payment is approximately two-thirds of an employee’s average weekly salary up to a maximum amount ($1,025, for injuries sustained after January 1, 2018). A lawyer in Philadelphia could help you seek any of these benefits in a workers’ compensation claim.
The Workers’ Compensation Claims Process
If you’ve been injured during the course of your employment, before doing anything else, 1) seek medical attention and 2) notify your employer of your injury. These two actions are critical in protecting your rights under the Pennsylvania Workers’ Compensation Act.
You may go to any health care provider, unless your employer accepts your claim, and has a posted list of six providers. In that case, for at least initial treatment, you must go to one of those providers. After a work injury, your employer should assist you with filing a claim. Many times, filing a claim through an employer is a straightforward process—particularly in instances of minor injuries. Once you’ve filed the necessary paperwork, your workers’ compensation claim will either be approved or denied by your employer, though the decision is usually based on advice from its insurance company.
If your claim is accepted, and you’ve missed more than one week of your work, you may start to receive Workers’ Comp payments within 21 days. Unfortunately, denials of claims are not an uncommon part of the process, but your claim doesn’t have to end there. Instead, you may file an appeal via a claim petition with the Pennsylvania Bureau of Workers’ Compensation. During the appeal, you’ll need medical experts to support your claim, to demonstrate that you are restricted in performing your job. An administrative judge will then use this evidence to decide your appeal and your Philadelphia workers’ comp lawyer will be by your side during every step.
How Is Workers’ Comp Calculated in Philadelphia?
Workers’ compensation amounts are based upon your average weekly wage. Insurance companies calculate this wage by averaging your weekly wages in 13-week blocks for the 52-weeks prior to the date of your injury. They discard the 13-week block with the lowest average, then they average the totals of the remaining three blocks to reach the final amount. Once the insurance carrier has determined your average weekly wage, the Pennsylvania Department of Labor & Industry’s workers’ compensation rate schedule determines how much you are entitled to receive.
According to the 2018 schedule, if your average weekly wage is:
- between $1,537 and $768.76, compensation is 66-2/3 percent of your average weekly wage.
- between $768.75 and $569.44, compensation is a flat rate of $512.50.
- less than $569.44, compensation is 90% of the wage.
An attorney in Philadelphia could help you calculate how much workers’ compensation you may be able to receive.
What Kinds of Work Injuries Are Eligible for Benefits?
Virtually any kind of work injury is eligible for workman’s compensation benefits. In addition, even if you are not physically at work, you might be eligible for benefits if you were acting in the “work and scope of your employment.” For example, if you are traveling specifically for work and are in a car accident, you might be eligible for benefits. Keep in mind, traveling for work does not include your traditional commute to and from your office. The best way to determine your eligibility for workers’ compensation is to speak to our Philadelphia attorneys. Some of the more common kind of work injuries that are eligible for benefits include:
How Long Does Workers’ Compensation Last?
The length of a workers’ compensation period depends on whether the employee is partially or totally disabled, as a result of his work-related injury. State law considers an employee partially disabled, if his injury leaves him less than 50 percent impaired. The maximum compensation period for a partial disability is 500 weeks. Pennsylvania state law considers an employee totally disabled if his injury leaves him at least 50 percent impaired, according to American Medical Association standards. Insurance providers can require reevaluation of an employee with a total disability after 104 weeks.
If you are told to return to work before you are able, or your benefits are terminated before you feel they should be, you should immediately contact our Philadelphia workers’ compensation lawyers to discuss your rights. The same holds true if your insurance company or employer informs you that it is seeking to terminate your benefits. You also should contact a lawyer if your employer sends you to an independent medical exam. Receiving a notice that your workers’ compensation benefits are being terminated can be terrifying, especially if you’re concerned about how you will support your family. Know that an insurance company can only terminate your workers’ compensation benefits for good reason, and you can fight wrongful termination.
When To Claim Compensation Following a Workplace Accident
As soon as you have been hurt on the job you should take immediate action to file a claim for your workers’ compensation. The longer you wait to file for workers’ comp the longer it may take for you to receive it, not only that it could hurt your claim and make it harder for your Philadelphia workers’ comp lawyer. While filing your claim there may be difficulties and you may need a workers’ comp attorney to aid you. Lowenthal and Abrams have the most qualified Philadelphia workers’ compensation attorneys for you that can help you with all of your questions and concerns.
How Will Your Workers’ Comp Lawyers Seek Benefits For You?
If you are injured, your employer should work with you to begin the claims process. If your injury is minor, as long as your employer cooperates, the claims process and payment for any medical expenses should be relatively straight-forward. If your employer does not cooperate and refuses to file a claim for you, you should contact a Philadelphia work injury lawyer immediately to protect your rights.
If you suffer a major injury such that you will be out of work for at least several weeks, require surgery, lost a body part or suffered a facial scar, you are best off contacting an attorney as soon as you are able. Remember, it will be an insurance company that will be handling your workers’ compensation claim. And insurance companies are not well known for paying out large sums of money.
Can Employees Be Terminated When Filing for Workers’ Comp?
An employer cannot terminate you as punishment for filing a workers’ compensation claim. The Pennsylvania Supreme Court ruled in Shick v. Shirey (1998) that if an employer fires an injured employee for retaliatory reasons, the employee is entitled to sue the employer for wrongful dismissal.
The employer may, however, fire you for other reasons. For example, if you violate company policy or the company is downsizing, an employer may still lawfully terminate you. If you are fired after filing a workers’ compensation claim, immediately contact a Philadelphia attorney to assess whether your employer had legitimate grounds for termination.
What if the Insurance Company Denies a Claim?
While it is very upsetting to have a claim denied when you know you were hurt while doing your job, it is not uncommon for this to occur. Claim denials are one of the reasons it is important to involve a work accident lawyer early after you have suffered a work-related injury. If your claim has been denied, you will need to go through an appeals process.
The appeal will require that you visit medical experts. There will be experts that support your claim and most likely, experts that will support the insurance company. You will need a top-notch workers’ compensation lawyer in Philadelphia to deal with the medical experts and to prepare your case for the judge.
Should I Retain a Lawyer for My Workplace Accident Case?
The workers’ compensation system can be quite complex. There are many traps for the unwary. Insurance companies will often seek to terminate benefits long before the injured person is able to work, seeking to minimize the financial cost of the injury.
Nurse case managers from the insurance company will claim they are seeking to help you, while they are really looking for excuses to terminate your benefits. Injured workers are normally required to see supposedly independent doctors, who are often biased in favor of the insurance company. As a result, if you are seriously injured you could find yourself facing termination of your benefits or a substantially lower lump sum payment than you should receive.
Given this, it is always wise to consult a workers’ compensation attorney in Philadelphia early on in your case. It won’t cost you any money to consult with our firm, and you will only end up with a fee if it becomes necessary for us to intercede on your behalf. Should we need to step in, you won’t have any fee unless we are able to help you.
How Much Are Workers’ Compensation Settlements?
Insurance companies pay workers’ compensation settlements only after a judge has held a resolution hearing and approved the settlement. During the hearing, your attorney will ask you questions about the settlement agreement (a.k.a., the “compromise and release agreement”) to demonstrate that you understand its terms and legal consequences. Once the judge is assured that you understand the agreement, you will be issued a written decision. The insurance company must pay you no more than 30 days after the judge issues the written approval.
Contact Our Philadelphia Workers’ Compensation Attorneys for Help
At Lowenthal Abrams, PC, Jim Mogul is the head of our Philadelphia workers’ compensation lawyer team. He is a certified specialist and personally directs every workers’ comp case that passes through our offices. With Jim at the helm, our team can simplify the process, walk you through your case, and address any confusion or concerns you might have. So contact us today. It won’t cost you a thing for a consultation, and you will only have to pay a fee if we are able to help you.
Learn More by Watching Jim Mogul’s Videos.