Spring City Workers’ Compensation Lawyers

What Is Workers’ Compensation?

Workers’ compensation insurance coverage provides financial benefits to employees suffering work-related injuries or illnesses. Workers’ compensation coverage ensures injured workers receive medical care and other benefits.

What Are the Most Dangerous Industries?

According to the Occupational Safety and Health Administration (OSHA), the most dangerous professions include:

• Agriculture
• Aircraft
• Construction and roofing
• Trucking
• Logging
• Manufacturing
• Mining
• Warehousing

Are Businesses Required to Carry Workers’ Compensation in Pennsylvania?

In Pennsylvania, the majority of employers are required to carry workers’ compensation insurance to cover expenses in the event of a work injury or occupational illness. Coverage applies to both full and part-time employees, regardless of the number of hours worked.

What Does Workers’ Compensation Cover?

Workers’ compensation benefits typically cover lost wages, medical expenses, and rehabilitation costs associated with injuries or illnesses. Workers who suffer permanent disabling conditions or loss of a limb may also receive disability benefits. In accidents resulting in death, the deceased’s family may be eligible for death benefits, including funeral and burial expenses. The amount and duration of workers’ compensation benefits vary, depending on the circumstances of the accident and the extent of injuries.

In particular, in unique situations, workers may be eligible for additional benefits if a third party is ultimately responsible for the accident, such as a subcontractor or equipment manufacturer. In such cases, you can file a personal injury lawsuit against the responsible party.

How Do I File a Workers’ Compensation Claim?

Workers’ compensation claims are complex, and filing a claim can be a complicated process. You should first consult a lawyer who can help explain your options and the process for filing a claim. The filing process typically includes:

• Notifying your employer: Report the accident and your injuries to your supervisor or employer as soon as possible, both verbally and in writing. Typically, workers’ compensation policies require notification within 14 days, and employers must file an accident report with the insurance company. You are entitled to a copy of the report.
• Seeking medical attention: Seek a doctor’s evaluation immediately following the accident to diagnose your condition, recommend treatment, and complete the necessary workers’ compensation claim forms. Without a doctor’s report, your claim will be denied. You may be required to see an employer-approved doctor.
• Compiling documents: You must complete separate forms for each benefit you request and documentation supporting your claim, such as proof of wages, medical reports, and prior work-injury history. You may also qualify for occupational disease, hearing loss, or dependent benefits. You can request the forms from your employer’s insurance company.

Once filed, the insurance company will review the submitted paperwork and determine whether you qualify for benefits and approve or deny your claim. Sometimes, the insurance company may request additional evidence to determine what benefits you qualify for or whether other alternative solutions are more appropriate, such as structured settlements or compromise agreements specifying a payment schedule instead of a lump-sum payout.

Can My Workers’ Compensation Claim Be Denied?

Insurance companies deny workers’ compensation claims for several reasons, the most common being:

• The injury is not work-related: If you are injured outside of work, your claim will likely be denied, even if you performed a task related to your job.
• The injury is intentional: Workers’ compensation benefits do not cover injuries that are self-inflicted or are the result of other deliberate behavior, such as fighting.
• The injury occurred under the influence: If your injury was caused by alcohol intoxication or under the influence of illegal drugs, the claim will likely be denied.
• The accident was improperly reported: Every state has requirements for reporting a worker’s injury. Claims not reported within the required time frame are typically denied.

Can I Appeal the Denial of My Workers’ Compensation Claim?

The most common reason insurance companies initially reject claims is incomplete paperwork or lack of evidence proving that the injury occurred at work. If your claim is denied, you have a legal right to file an appeal by submitting a formal request for reconsideration. You will also be required to provide additional supporting information or evidence for your claim to be reconsidered and approved.

It is best to seek the assistance of an experienced Spring City workers’ compensation lawyer familiar with the system to ensure your paperwork is accurate and complete and help you navigate the appeals process.