A workers’ compensation claim offers a lifeline after a workplace injury in Pennsylvania. However, the process does not come without its challenges. Even the slightest missteps can jeopardize your benefits, leaving you without financial help.
Avoiding these mistakes can be the difference between a denied claim and a positive outcome. From missing important deadlines to failing to maintain proper records, continue reading to stay informed and navigate the process more easily.
What is Workers’ Comp?
Workers’ compensation, also called workers’ comp, offers benefits to workers who have sustained injuries or become ill due to work-related accidents. This compensation covers:
- Medical costs
- Lost wages
- Healthcare benefits
- Disabilities
While government-mandated, the available workers’ comp benefits vary from state to state. Workers’ compensation is a form of employer insurance that covers workers in the event of an accident.
When employees accept this compensation, they waive their right to file a claim for damages from their employers. Private insurance companies usually offer workers’ comp programs. However, each state has an agency that oversees the program and resolves disputes when they come up.
How Does Workers’ Compensation Work in Pennsylvania?
Workers’ compensation coverage is compulsory for most employers in Pennsylvania. Employers without coverage are subject to legal action from employees and criminal prosecution by the Commonwealth.
Either way, this compensation system protects both employers and employees. Employees receive medical treatment and compensation for lost wages. On the other hand, employers cover these costs and enjoy protection from lawsuits.
The commonwealth exempts some employers from workers’ compensation coverage. This includes people covered under other workers’ compensation acts, such as federal employees, railroad workers, and dockers.
Employers can obtain workers’ compensation insurance in Pennsylvania through the State Workers’ Insurance Fund or other licensed insurance carriers. Employees are covered from their first day on the job.
The workers’ comp settlements in Pennsylvania cover medical benefits and wage loss. Only employees who become ill, get injured, or have an injury worsen on the job are qualified. Workers’ comp usually does not necessarily factor in their medical history or fault.
Under this policy, medical coverage includes reasonable surgical services provided, hospital treatment, prescription medicine and supplies, and orthopedic appliances. Unfortunately, workers’ comp does not cover pain and suffering in Pennsylvania. It also does not offer job security if an injury occurs.
Mistakes You Must Avoid in Your Pennsylvania Workers’ Comp Case
Pennsylvania’s workers’ compensation process is straightforward. However, insurance companies may still deny your claim in certain situations. For instance, they may deny the claim if they prove you neglect or ignore protocols. So, here are the mistakes you should avoid to make your claim fool-proof.
1. Not Reporting the Injury Immediately
Failing to report your injury immediately is one way to harm your workers’ comp claim in the state. While Pennsylvania’s worker’s comp system allows you to report an injury within 120 days, waiting even a few days can raise red flags.
Waiting for extended periods can make your employer or the insurance company question the legitimacy of your claim. Besides protecting your claim, promptly reporting the injury ensures proper documentation starts early enough.
When notifying your employer, provide detailed information about the accident. Follow up on the report in writing to ensure the records are available. Starting the process earlier reduces the risk of denied claims.
2. Failing to Document the Events Properly
You may risk your workers’ comp claim getting denied in Pennsylvania if you do not document the events properly. Detailed and accurate records are important to prove that your injury took place at the workplace and is directly related to your work duties.
The insurance company may dispute your claim without proper documentation, arguing that the injury was less severe or occurred elsewhere. Record the accident’s date, time, location, and circumstances when documenting the events.
Keep copies of the incident reports, your medical records, and any correspondence with your employer. These records will help strengthen your case and draw the compensation you deserve.
3. Not Getting Immediate Medical Attention
Delaying medical attention can jeopardize your workers’ compensation claim in Pennsylvania. Immediate medical care safeguards your health and provides important documentation linking your injury to your job.
Without prompt action, you may give the insurer leverage to argue that your injury is unrelated to work. When consulting a medical provider, thoroughly explain the events. Follow their treatment plans and save records of your hospital visits and diagnoses. Delays weaken your case and jeopardize your recovery.
4. Providing Inconsistent Information
Giving inconsistent information can harm your workers’ comp case significantly. Insurers and employers usually scrutinize your injury, treatment, and work history details. Any inconsistencies can create doubt, giving insurers leverage to deny your claim.
Inconsistencies can include varying accounts of how the injury happened, inaccurate timelines, and unclear reporting of symptoms to healthcare providers. These errors may indicate that your claim is false or exaggerated.
Always be consistent and truthful at each stage of the process. Keep notes of the timelines and records of your medical visits and communications with your employer. Showing credibility helps your claim massively.
5. Not Recording all Injury-Related Expenses
The legal team factors your expenses when calculating your damages for your workers’ comp claim in Pennsylvania. You must record your medical bills, lost wages, prescription costs, travel expenses, and domestic assistance.
Without adequate records, you may not receive full reimbursement. Save receipts, invoices, and mileage logs, but track the expenses as they come in. This way, you’ll be able to demonstrate the full extent of your damages.
6. Trusting the Insurance Company
While insurance companies may seem helpful, their main target is to minimize costs. You must never assume they have your best interests. Relying on their guidance can lead to lower compensation, delayed payment, or denied claims.
In the worst case, insurance companies may downplay your injuries and pressure you into a rushed settlement. Document communications with them and avoid providing unnecessary details that may be used against you. Consider hiring a workers’ comp lawyer in Pennsylvania to help you get the benefits you’re entitled to.
Endnote
While a workers’ comp claim may appear basic, making the wrong moves can be costly. To help your case, do not wait to report the injury, get immediate medical attention, and properly document the events. In addition, offer consistent information, record all the expenses, and be wary of insurers.
Featured Photo by Alex Green
