What to Do While on Workers’ Compensation in Pennsylvania

Receiving workers’ comp benefits in Pennsylvania limits an injured worker’s activities. If your workers’ comp claim is in progress or has been approved, you may have questions about what you can and can’t do while receiving benefits. Your claim benefits can be reduced or revoked if the insurance company or your employer can show that you don’t require them.

Workers’ compensation rules can feel overwhelming. Medical treatment, returning to work, and even personal activities can impact your recovery and benefits. Physical recovery should always be your first priority. When you are focused on that and following your doctor’s orders, your workers’ compensation claim process should proceed more smoothly.

Unfortunately, your employer or insurance company paying for your benefits will watch for any opportunity to revoke or reduce your compensation payments. For this reason, having an experienced Pennsylvania workers’ compensation lawyer you can rely on is a good idea.

At Munley Law, our Pennsylvania workers’ compensation attorneys have helped thousands of injured workers understand their rights and secure the full benefits they deserve. Contact Munley Law today for a free consultation with our experienced workers’ compensation team.

Time-Sensitive Actions After a Pennsylvania Work Injury

Pennsylvania employers reported more than 115,000 work-related injuries in 2023. Reporting your injury to your supervisor is the first step in your compensation claim. You should report your injury within 21 days of the occurrence. Most successful claims start with immediate reporting – ideally within 24 hours of the incident. This quick action helps establish a clear link between your work and your injury.

Timely medical attention further establishes the link. Pennsylvania requires the first 90 days of treatment to be administered by your employer’s approved provider list. The insurance company will review your initial medical records carefully when deciding whether to accept or deny your claim. You should tell the treating doctor that your injury occurred at work so they can document the injury properly.

If your injury requires emergency treatment, the approved provider list is waived. You should seek medical care from the nearest emergency room.

Remember to document everything:

• Take photos of your injury and the accident scene
• Get names and contact information of any witnesses
• Keep copies of all medical records and work restrictions
• Save any correspondence with your employer or their insurance company

It can be overwhelming to keep on top of the time-sensitive aspects of your workers’ comp claim while you deal with your physical injury. If your employer is fighting a fair payout, you may not have the energy to engage in a legal battle. Munley Law can help. Our experienced workers’ comp lawyers can handle the legal process so you can heal.

Understanding Your Pennsylvania Workers’ Compensation Benefits

The Pennsylvania workers’ compensation system provides several types of benefits for injured workers. Income loss benefits typically equal up to two-thirds of your average weekly wage, with the current maximum weekly rate set at $1,347. These payments help replace your lost wages while you recover.

Pennsylvania workers’ compensation law requires comprehensive medical coverage. Your employer’s insurance must pay for reasonable and necessary medical expenses related to your workplace injury. This includes doctor visits, hospital stays, surgeries, medications, physical therapy, and medical devices.

Mental health conditions are also covered under workers’ compensation in Pennsylvania. Work-related stress and trauma or the difficulty of a physical injury can cause significant mental health challenges. However, these claims often require strong medical evidence and expert testimony to prove.

Death benefits provide financial support to families who have lost a loved one due to a work-related injury or illness. Surviving spouses and dependent children may receive weekly benefits equal to a percentage of the deceased worker’s wages.

Unfortunately, many injured workers receive less than they deserve. For the best results, you should have an experienced attorney review any compensation offer before you accept. If you’ve already accepted an offer, it’s not too late. Munley Law will review your pre-injury wages and current benefits to ensure you’re getting the full amount allowed under Pennsylvania law.

Receiving Workers’ Comp Benefits

While you are entitled to workers’ comp benefits, these benefits are intended to compensate you for losses you suffer because of a workplace injury. Your employer or their insurance provider may be watching you to try to prove that you don’t qualify for benefits. To secure your compensation, you should:

• Keep all your medical appointments and follow your doctor’s advice
• Don’t take a second job or continue any side jobs you may have
• Don’t treat your injury or illness like a vacation

Missing medical appointments, ignoring your treatment plan, or otherwise living as though your injury does not affect you will be evidence for an insurance adjuster to question whether you should receive benefits.

Medical Treatment Under Pennsylvania Workers’ Comp

Your medical care plays a vital role in both your recovery and your workers’ compensation claim. For the first 90 days after your injury, Pennsylvania law requires you to choose doctors from your employer’s approved provider list. After this 90-day period, you can switch to any licensed healthcare provider for your treatment.

You also have a right to a second opinion, even during the initial 90-day period. Workers’ comp medical benefits must cover a second opinion visit, even from a provider not on the employers list.

The insurance company might require you to attend an Independent Medical Examination (IME) with their chosen doctor. While you must attend this exam to maintain your benefits, remember that this doctor works for the insurance company. Their role is to minimize your benefits and save the insurance carrier money.

The insurance company may also question whether certain treatments are necessary or related to your work injury. Common treatment denials involve:

• Physical therapy, beyond a certain number of sessions
• Pain management treatments
• Specialized diagnostic tests
• Alternative therapies
• Certain medications

Your treatment plan, outlined by your medical provider, should be included in your workers’ comp benefits. If you are being denied care or coverage, you should seek legal advice immediately.

Returning to Work After a Pennsylvania Workers’ Comp Claim

Pennsylvania workers’ compensation law sets specific rules about returning to work. You should not accept work that could worsen your injury or exceeds your medical limitations. Doing work that violates your doctor’s orders could result in diminished or denied compensation.

An employer can offer a light-duty position that meets your doctor’s restrictions. You typically must try the position. Refusing suitable work can result in a reduction or loss of your wage loss benefits. Suitable work must:

• Pay a fair wage
• Be within your physical capabilities
• Match your medical restrictions
• Include reasonable hours and location

Many employers use vocational assessments to evaluate your ability to work. A vocational expert will review your skills, education, and work restrictions to identify potential jobs you could perform. If the job pays less than your pre-injury wages, you may receive partial disability benefits to make up the difference.

Pennsylvania law protects your right to physical recovery. If your employer pressures you to return to work before your workers’ comp doctor recommends, if they minimize your injury, or imply that your job is at risk, you should get legal advice as soon as possible. Munley Law can help protect your health and rights, whether it’s reviewing a return-to-work offer or fighting pressure to get back to work. Contact us for a free consultation.

Claim Denials and Appeals in Pennsylvania Workers’ Compensation

Workers’ comp claims are denied for many reasons– often from missed deadlines or disputes over whether the injury happened at work. You should never take a denial at face value. Pennsylvania employees can appeal a denial with a hearing before a workers’ compensation judge.

Your employer’s insurance company must send you a written Notice of Denial explaining why they denied your claim. You have three years from the date of your injury to file an appeal. For a successful appeal, you should start the process as soon as possible.

The workers comp judge will hear testimony and evidence from both sides, including:

• Medical records and doctor testimony
• Witness statements about your injury
• Your own testimony about how the injury occurred
• Evidence about your work duties and limitations
• Wage records for calculating benefits

Appeals can take between 6-12 months. During this time you will continue to receive medical care and compile medical reports on how your injury affects your ability to work. If your appeal is denied, you can appeal to the Workers’ Compensation Appeal Board and potentially to Pennsylvania’s appellate courts.

Many insurance companies will deny a workers’ comp case in hopes that the injured employee will just give up. Munley Law can help build a strong appeal to receive the benefits you deserve.

Third-Party Claims in Pennsylvania Work Injury Cases

While workers’ compensation provides benefits for workplace illnesses and injuries, you may have additional rights to compensation through a third-party claim. These claims arise when someone other than your employer contributed to your injury. Workers’ comp covers economic damages, such as lost wages and medical bills. Third-party claims cover economic and non-economic damages, including pain and suffering.

Pennsylvania workers often have valid third-party claims in situations involving:

• Construction accidents where another contractor’s negligence caused your injury
• Delivery drivers hurt by other motorists
• Injuries from defective equipment or machinery
• Slips and falls on properties owned by someone other than your employer
• Accidents caused by vendors or visitors at your workplace

Filing a third-party claim doesn’t affect your right to workers’ compensation benefits. However, if you recover money from the third party, you may be required to reimburse some of your workers’ compensation benefits. Pennsylvania gives you two years from the date of your injury to file a personal injury lawsuit against the liable party.

If your workplace injury involves a third-party claim, you should hire a personal injury lawyer right away. Munley Law’s attorneys have recovered millions of dollars for employees injured by a third party. Schedule a consultation today.

 

When to Contact a Pennsylvania Workers’ Compensation Attorney

You are entitled to workers’ compensation benefits. Unfortunately, many insurance companies will do everything they can to keep you from receiving workers’ compensation benefits. Hiring a workers’ comp attorney early in your case is your best chance for success.

You should contact an attorney if:

• Your claim was denied
• Your benefits stopped unexpectedly
• The insurance company disputes your medical treatment
• You’ve been asked to see an insurance company doctor
• Your employer offers light duty work
• You’re receiving other disability benefits like Social Security
• Your injury prevents you from returning to your old job
• You feel pressured to return to work before you’re ready

Munley Law’s Pennsylvania workers’ compensation lawyers work on a contingency fee basis. We don’t take any payment until we’ve made a recovery in your favor. Our firm has 65 years of experience representing injured workers across Pennsylvania. We understand how a work injury affects your entire family, and we fight to get you every benefit you deserve under the law.

Don’t risk your benefits by trying to handle your claim alone. Contact Munley Law today  for a free consultation about your workers’ compensation case.