What You Should Know About the PA Workers’ Compensation Claim Process So Your Claim Is Not Denied

Date Published 7/21/2021
Date Updated 3/1/2023

RG Injury Law Firm has TOP WORKERS COMP LAWYERS who win Workers Compensation cases when you have been injured at work and need skilled, experienced, tough legal counsel to fight for your fair compensation from the insurance companies and employers.

Talk for free with Lancaster Workers Comp Attorney Bill Gregory about your potential case today. 717.656.5000

Hopefully, you will never be injured at work, but if you are hurt at your workplace, you need to follow these recommended steps from a Workers’ Compensation lawyer to ensure you have a properly perfected Workers’ Compensation claim:

How to file a Pennsylvania Workers Compensation Claim

REPORT YOUR WORK INJURY TO YOUR EMPLOYER

If you have just been injured, you must report your work injury or illness to your employer, and you must do so within 120 days of the work injury or illness occurring. If you just learned that your injury or illness is related to your work activity, then you must report the injury or illness within 120 days of your discovery that the injury or illness is related to your work activity.

Failure to report your injury within 120 days will preclude your ability to recover Workers’ Compensation benefits.

Also, to receive medical payments and wage loss payments for your Workers’ Compensation injury from the date you were injured, you must report the injury to your employer within 21 days of it occurring. Failure to report the Workers’ Compensation injury within 21 days of it occurring, may result in benefits not being paid from the date of the injury until you reported it.

SEEK MEDICAL TREATMENT FROM YOUR EMPLOYER’S LIST OF PANEL PHYSICIANS

After you report your work injury to your employer, you should be provided with a list or directed to a posted list of panel physicians with which you must seek treatment for the first 90 days of your injury. The list of panel physicians must contain several different physicians or physician practice groups with different specialties. Assuming you were provided with a proper Workers’ Compensation panel list (ask our experienced Workers’ Compensation lawyers), you must treat with a doctor on that list for the first 90 days of your injury. After 90 days, if your claim is accepted, you can treat with a doctor of your choosing and the carrier must pay for the treatment. If you do not treat with a panel list doctor within the first 90 days of your injury, that medical treatment may not be covered by the Workers’ Compensation insurance company. Also, if your employer does not provide you with a Workers’ Compensation panel list, you may seek treatment from any doctor for your injury. You may treat with a doctor in another state, but the out of state doctor must be willing to accept Pennsylvania Workers’ Compensation reimbursement rates for the treatment you receive.

KNOW YOUR CLAIM STATUS

Your employer should report your injury to the insurance company and file the first report of injury with the Bureau of Workers’ Compensation. Within 21 days of your report of your injury, the insurance company must accept your injury, deny your injury or temporarily accept your Workers’ Compensation injury for 90 days. If your claim is denied, you should seek assistance from a Workers’ Compensation lawyer, like Rankin & Gregory to file a claim petition to pursue the Workers’ Compensation benefits you deserve. If your claim was temporarily accepted, the insurance company may terminate your Workers’ Compensation benefits any time before 90 days.

If you are receiving Workers’ Compensation benefits you should make sure that you are receiving the correct amount of money. Your weekly benefits are based on an average of what you made before you were injured. A Workers’ Compensation lawyer can confirm you are receiving the correct benefits.

OTHER ISSUES THAT ARISE DURING A WORKERS’ COMPENSATION INJURY

FMLA and Workers’ Compensation Benefits

The Family Medical Leave Act and Workers’ Compensation Act are two io separate and distinct laws which may be applicable to your case. When you are injured at work your employer may require you to also fill out paperwork for FMLA. FMLA allows certain employees to take up to 12 weeks of unpaid, job-protected leave per year – with a few exceptions. You can take the leave if you have a family or personal medical-related need, including a work injury. FMLA may also protect your employer-sponsored health insurance benefits while you are off work.

Your Workers’ Compensation benefits will be responsible to pay you while you are off and pay for your medical treatment which is related to your work injury.

Health Insurance and Workers’ Compensation Benefits

The Workers’ Compensation insurance carrier should be paying for reasonable, related and necessary medical bills related to your accepted work injury. However, you may have health insurance through your employer which pays for medical bills you incur that are not related to your Workers’ Compensation injury. Unfortunately, the Workers’ Compensation Act does not cover the cost of your health insurance if you are out of work due to a work injury. Your employer may maintain your coverage at their cost or pass the cost of your health insurance on to you. This can be especially troubling with the rising cost of health insurance.

Contact lawyers who know the Workers’ Compensation law and how it interacts with your employers’ benefits can give you the peace of mind you deserve while recovering from your work injury. Call us for a no pressure, free consultation at 717.656.5000.