This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured at work or become diagnosed with a disease or illness that is work-related, you should report the injury or illness as soon as possible. Timeliness is essential to the filing process, as well as documentation and record keeping. Tell your employer when and how you were injured. If, as a result of your work related injury or illness, you miss a day of work, your employer is required to file a first report of injury with the Bureau of Workers' Compensation.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Almost all Pennsylvania workers are covered by the state's workers' compensation law. Each employer must provide workers' compensation coverage (i.e. insurance) for all of their employees, whether full, part-time, or seasonal.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
If you are injured while at work or the work you perform or the conditions of your place of work cause you a disease or illness, you may be entitled to claim workers' compensation benefits in Pennsylvania. However, injuries or illnesses intentionally self-inflicted, caused by a violation of state and/or federal law, or by intoxication will prohibit you from claiming benefits.
4. What benefits might I be eligible to receive?
Depending on the nature of your claim and the extent of your injury or illness, you may be entitled to receive one or more of the following benefits:
- Payments for Loss Wage: Benefits paid to you if you are determined to be totally or partially disabled. You receive a wage similar to your pre-injury or illness wages, although at a fraction lower (roughly two-thirds of your former pay). The standards of pay-benefits and duration of pay-benefits will vary depending on the extent of your injury. For example, if you are deemed totally disabled (completely unable to work) you may only qualify for up to 104 weeks of paid benefits to this extent. Partial disability may be paid to you for a period of up to 500 weeks depending on whether you are able to resume work.
- Death Benefits: If your injury or illness results in your death, benefits may be paid to your surviving dependents.
- Specific Loss Benefits: Benefits paid to you for the permanent loss of use or partial or total disfigurement of body parts and appendages.
- Medical Care: Your employer might be responsible for the payment of all reasonably related medical. This can be the case even if you don't suffer any lost days from work. You are entitled to the choice of physician in the event your employer denies responsibility for your claim. Otherwise, your employer may outline a list of approved physicians you may contact if the employer chooses to accept your claim.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
If your injury or illness reaches the extent of perhaps needing to file a workers' compensation claim, your employer must decide upon the filing of a first report of injury form whether to accept or deny the claim (i.e. whether to accept responsibility for the event). If your employer denies responsibility for the claim, you may petition the denial to the Bureau of Workers' Compensation to be heard before a Workers' Compensation judge.
It is important to remember that these petitions can sometimes be costly and/or lengthy in time. You may even choose to hire an attorney, which could mean greater costs. Alternative dispute resolution, which resembles a mediation, could be a great option for you or the opposing party. In this scenario, a workers' compensation judge will help to work through the issues between you and the opposing party with hopes of reaching a settlement and avoiding the petition stage. To request alternative dispute resolution, you must file a petition with the Office of Adjudication of the Workers' Compensation Bureau.
6. If I am not happy with the determination, how do I appeal?
Decisions made by the Bureau of Workers' Compensation judges may be appealed to the Workers' Compensation Appeals Board. If you or your employer continue to be unsatisfied with the determination, you may subsequently appeal the determination to the Commonwealth Court.