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Have you or someone you love suffered an injury while at work? Has your employer tried to undervalue your claim? Has your employer’s insurance company denied your claim or benefits?

If you answered yes to any of the above questions, it’s time to contact the trusted workers’ compensation attorneys at the law firm of Schmidt Kramer.

Our lawyers have over 25 years of experience and have successfully represented workers just like you. We can help. Talk to us today.

Call (888) 476-0807 or fill out our online form for a FREE CASE REVIEW

Pennsylvania Workers’ Comp Eligibility: Do You Qualify?

bricklayer at workBefore filing for workers’ compensation, it is important to determine if you are covered by Pennsylvania’s Workers’ Compensation Act, and therefore eligible to receive benefits.

While most employees are covered by Pennsylvania’s Workers’ Compensation Act, certain employees are covered by a federal plan instead, which makes them ineligible to receive Pennsylvania benefits.

Additionally, workers who are self-employed or employed by a private citizen cannot receive benefits on behalf of Pennsylvania.

Employees who are NOT eligible for benefits include:

  • All Federal Employees
  • Railroad Workers, Freight Handlers and Engineers
  • Longshore Workers and Other Harbor Workers
  • Volunteers of any Kind
  • Independent Contractors
  • Domestic Workers, Housekeepers or Maintenance Workers for a Private Household

However, part-time and seasonal workers are covered under workers’ compensation, as well as employees who work for non-profit corporations or unincorporated businesses.

Workers’ compensation for self-employed individuals (known as workers’ compensation self-insurance) is available, but the cost of this insurance is not covered by Pennsylvania. Such insurance must be paid for by the self-employed individual.

Does Your Injury or Disease Qualify?

Once you have determined your eligibility, you must then determine if your injury qualifies for a workers’ compensation claim. Certain diseases that arise from unsafe working conditions may also be covered by a claim.

To qualify, the injury or disease must be severe enough to require medical treatment beyond simple first aid. It must have presented itself while you were working at your employer’s place of business during normal working hours, or at a time when you had prior permission to be on the property for work-related reasons.

Examples of on-the-job injuries that may qualify for a claim include:

For a disease to qualify, it must have been caused by, or sufficiently aggravated by, your work environment. Examples of work-related diseases that may qualify for compensation include:

For more information on eligibility and qualifying injuries or diseases, contact the knowledgeable Pennsylvania workers’ compensation lawyers at Schmidt Kramer today.

Call (888) 476-0807 or fill out our FREE Case Evaluation Form

Filing for Workers’ Compensation in Pennsylvania

Workers' Comp FormWhen filing for worker’s compensation, you must first advise your employer of your injury. You must also inform your employer of the type of injury you received, where the injury happened, and the date the injury occurred.

It is best to do this as soon as possible after your accident, as there are specific deadlines you must meet in order to recover benefits. Such deadlines are established by a workers’ compensation advisory committee. This committee is responsible for implementing all workers' compensation timelines and statutes of limitations in Pennsylvania.

Your Employer’s Responsibilities

After you inform your employer of your incident, he or she should complete all required forms and report your claim to the Bureau of Workers’ Compensation. Completed forms should also be promptly submitted to your employer’s insurance company.

If your employer refuses to complete an accident report on your behalf, you may file a petition for workers' compensation payments. You will also need to attend a series of hearings with a workers' compensation judge. While you are not required to have a lawyer present during these hearings, we strongly recommend consulting one.

It is important to note that your employer cannot fire you or retaliate against you in any way after you have reported your workplace injury. Your employer may, however, fire you for other reasons or stop providing health insurance or other benefits.

The Responsibilities of Your Employer’s Insurance Company

Your employer’s insurance company has 21 days to either accept or deny your claim. With that said, it is not uncommon for injured employees to wait up to three weeks before receiving an answer regarding the status of their claim.

However, be aware that your employer’s insurance company may begin paying your medical expenses during this three week waiting period, even though they have yet to make an official decision regarding you claim.

Certain deceitful insurance companies have their own set of priorities, and paying the full value of your claim is not one of them. By covering the cost of one or two of your initial medical appointments, the insurance company is trying to persuade you to recover quickly and return to work as soon as possible.

Once you resume working as usual, the insurance company will most likely drop your claim, never having made a final decision regarding its acceptance or denial.

If complications relating to your injury reappear after you have returned to work, your employer’s insurance company will likely deny any responsibility for additional lost wages or medical expenses, citing your claim is lacking an official determination.

Therefore, it is important for all injured workers to obtain a definitive answer as to whether their claim was accepted or denied. It is also important to contact a reputable lawyer whom you can trust during the filing process.

Filing a claim can be tedious and confusing. There are many circumstances to consider and a multitude of forms to complete. Also, it is not uncommon for injured employees to make critical mistakes or miss crucial steps in the filing process, which can cause unnecessary set-backs or delays.

To increase the likelihood of your claim’s approval, contact an experienced lawyer from the law firm of Schmidt Kramer. Our lawyers can help you navigate the filing process and help ensure you receive the benefits you deserve.

For a FREE review of your case, call the law firm of Schmidt Kramer at (888) 476-0807 or fill out a FREE CASE REVIEW FORM today.

Appealing a Denied Claim for Workers' Compensation

gavel and law bookIf your employer’s insurance company has denied your claim, you will not receive compensation for lost wages, and any medical expenses related to your illness or injury will not be covered.

Should you chose to reject—or appeal—the insurance company’s decision, it is important to understand that you cannot return to work during the appeals process. This means you may be without any income at this time.

Also, keep in mind that it can take up to one year (and in some cases, even longer) for a workers’ compensation appeals board to make a final decision regarding your appeal.

Lack of income for an extended period of time can easily cause undo financial hardship, and you may feel obligated to return to your job—or to seek another job—even though you are still injured.  

However, returning to work is exactly what the insurance company would like you to do, as this will terminate any responsibility they have for paying your medical bills or compensating you for lost wages.

Even though it is not advisable to return to work, there are other income options available while your claim is being reviewed.

Unemployment Benefits

If your injury prevents you from performing you regular job, but it does not prevent you from performing light duty tasks at a different job, you may be eligible for unemployment benefits.

If your appealed claim is ultimately approved by the board, the amount of unemployment benefits you received while waiting for the final decision would be deducted from the total amount of workers’ compensation benefits you were awarded. In this sense, your unemployment benefits are similar to workers’ compensation benefits that were paid in advance.

Short-Term Disability Benefits

If your employer offers a short-term disability plan, or if you purchased your own short-term disability plan prior to your injury, you may receive short-term disability benefits while you are waiting for a decision on your claim appeal.

And, like the unemployment benefits discussed above, the short-term disability benefits you receive while waiting on your claim appeal will be deducted from the total amount of awarded compensation.

Welfare Benefits

If none of the above options are available, you may be eligible to receive welfare benefits, although these benefits often amount to much less financially than what you were receiving prior to your workplace injury.

However, if your claim is approved while on welfare, and you receive a workers’ compensation settlement, the benefits you received during the appeals process will not be deducted from your settlement. Also, you will be compensated for all lost wages, plus 10 percent interest on each year of lost wages. 

Get Help From Trusted Workers’ Compensation Attorneys in Harrisburg

Schmidt Kramer LawyersThe team of lawyers at Schmidt Kramer understand how difficult it can be to deal with an injury that has left you unable to work for a long period of time.

Although Pennsylvania workers’ compensation laws are put in place to avoid lawsuits, it is still important to have someone on your side who knows how the system works, and who can ensure your rights are protected throughout the entire process.

If you or a loved one have been injured on the job, speaking with an experienced attorney can help you obtain the MAXIMUM amount of compensation you deserve.

Talk to our Pennsylvania workers' compensation attorneys today. We will investigate your claim and get you the help you need.

Call (888) 476-0807 or fill out our Free Case Evaluation Form for a free review of your case today or Click Here To Chat Live with a representative now.

Schmidt Kramer

209 State Street
Harrisburg, PA 17101