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    Workers’ Compensation FAQ

    I’ve heard of workers’ compensation, but what is it?

    Workers’ compensation is a type of insurance often included within employment benefits. Workers comp insurance covers medical expenses and wages lost in the event of an injury on the job. Most workers in Pennsylvania are covered by workers’ compensation insurance.

    Am I covered by workers’ comp insurance?

    The Pennsylvania Worker’s Compensation Act requires that all employers provide workers’ compensation coverage to their employees, including part-time and seasonal workers.

    What is covered by workers’ compensation?

    All work-related injuries, illnesses, or diseases may entitle you to workers comp. If an injury or death is intentionally self-inflicted, it is not covered by workers compensation insurance. In addition, if an injury was caused by an employee’s violation of the law, it is likely that it won’t be covered.

    What benefits are included in workers’ compensation insurance?

    Most workers’ comp plans offer compensation for all medical costs owed in the treatment of a work-related injury. In addition, if you are unable to work because of your injury, workers comp offers lost-wages replacement. In the unfortunate event of a work-related death, death benefits will be paid to any dependent survivors.

    What is a “Specific Loss Benefit”?

    Work injuries sometimes result in loss of the permanent use of body parts, including fingers, thumbs, hands, arms, legs, feet, toes, or sensory faculties, like sight or hearing. In this case, injured workers may be entitled to what is known as a “specific loss award.” Usually, specific loss benefits are awarded to employees who have lost the use of a particular body part, but are not prevented from working by their disability.

    I was injured at work. Can I see my own doctor?

    Yes, unless your employer has readily accepted your claim for workers’ comp and posted a list of at least six health care providers in your workplace. In that case, you must visit one of the listed providers for your initial treatment. You are required to see that medical professional for a period of 90 days. If your treatment lasts longer than 90 days, you may seek treatment from any medical professional you choose after the initial period is complete. If your employer has provided the required list of physicians, and you still choose to visit a professional not on it during the initial 90 days following your injury, your employer or their workers’ comp insurance carrier are legally allowed to refuse to pay for it.

    What should I do if my employer doesn’t offer workers’ comp insurance?

    In the event that your employer has failed to offer you workers’ compensation, you still have a right to those benefits under Pennsylvania law. Contact a workers’ compensation lawyer to discuss your options; it may be possible to file a claim in this situation. For a detailed look at your choices, see our article “What If My Employer Doesn’t Have Workers Comp Insurance?

    I was injured on the job. What do I do now?

    Any injury by which you are affected at work should immediately be reported to your employer, supervisor, or manager. This report does not need to be in writing, although it can be. Next, your employer must fill out a “First Report of Injury” (FROI) form and file it with the appropriate governmental organization. Filing an FROI is normally the first step in claiming workers’ compensation benefits through an insurance company. If your employer fails to file this report, ask them to do so. If they fail to comply, you should contact an experienced workers comp attorney to review your options.

    Injured workers in Pennsylvania must meet a number of specific obligations to ensure the success of their workers comp claims. To learn more about the deadlines involved in a Pennsylvania workers compensation insurance claim, visit our article “Pennsylvania Workers Comp Claim Deadlines: Time Is Of The Essence.”

    Does workers’ comp insurance cover pre-existing conditions?

    If it can be medically determined that your job has caused a pre-existing condition to get worse, leading to disability, you may be entitled to workers’ compensation.

    My initial claim for workers’ compensation benefits was denied. Do I have any other options?

    You may. If your employer’s workers’ comp insurance carrier is unwilling to reimburse you for the ramifications of your injury, you have the right to file a Claim Petition and be seen before a judge of compensation. This process requires the guidance of a workers’ compensation lawyer.

    I’m not ready to work again yet, but my employer is stopping my workers’ comp benefits. What can I do?

    Many employers, or their workers’ comp insurance carriers, try to decrease payments to an injured worker, or stop them entirely. They may hire medical professionals to declare you recovered, when in fact your injury needs further treatment. Legally, employers must file a Petition before a compensation judge to have your benefits limited or stopped. It is often necessary to consult a workers’ compensation lawyer in this position; swift action is required to combat these attempts to decrease your benefits.

    More questions?

    Have a specific question about workers’ comp that wasn’t answered above? Our attorneys are available 24/7. Call Disability Law Advocates Group at 215.563.0600 or fill out our contact form.