What Employees Should Know About Workers’ Compensation?
Workers’ Compensation claims should be filed as soon as possible after an employee is injured on the job. These employees go to work expecting to go home at the end of the day without incident, but that is not always the case. Someone who is hurt at work must know how to file a report, receive the medical care they need, file an insurance claim, follow up, and receive the Workers’ Compensation coverage that is needed.
Although Workers’ Compensation insurance should be provided to employees under Pennsylvania state law, there could be exceptions. The employer avoids liability in almost all cases, but cases can be complicated by the insurance company and any investigations that may be initiated. Injured employees can receive a wide range of coverage that will help them recover, get back to work, or even learn a new vocation. Injured employees should speak to a Workers’ Compensation lawyer as soon as possible to start the legal process or for assistance filing an injury report.
What are Common Workplace Injuries?
Workplace injuries occur from the corner offices of executives to the factory floor where workers are using powerful tools in tight quarters. Someone who has been hurt on the job needs to know that they are covered for their injuries. The list below does not show every possible workplace injury, but it gives workers an idea of what is covered under Workers’ Compensation insurance or a related lawsuit.
Construction accidents. Construction accidents include electrical, crane, forklift, and scaffolding accidents; welding accidents; trench collapses; and other related accidents. Construction workers may be struck by falling objects, or they may be crushed or stuck between two large objects. Construction workers, subcontractors, independent contractors, and others may be involved. Construction sites also include vehicles that may be involved in what would otherwise be labeled as a traditional vehicle accident.
Factory/warehouse accidents. Factory and/or warehouse accidents include trips or slips, defective equipment accidents, heavy machinery accidents, forklift accidents, conveyor belt accidents, injuries caused by improper or faulty protective gear, heavy lifting injuries, and other incidents. Factories and warehouses have trucks or vehicles entering and exiting the premises every day. These facilities may be the place where accidents occur, and even more accidents might occur as workers load and unload vehicles.
Fatal work accidents. Common causes of workplace fatalities include falls from heights, vehicle accidents, electrocutions, being hit by falling or moving objects, non-road vehicle rollovers, being trapped by moving machinery, and workplace violence. In short, an accident that may have resulted in a personal injury claim can be covered under a wrongful death claim or result in the payment of death benefits through Workers’ Compensation.
Industrial accidents. Industrial accidents often include repetitive strain injuries, chemical exposure, air embolisms, decompression sickness, and other related injuries. Chemical exposure may not be discovered until long after the worker left the company or the industry. Repetitive strain injuries are often more severe than people think and overlooked issues such as air embolisms and oil injections can be fatal. Air embolisms can be caused when compressed air penetrates the skin, blocking blood vessels. The same is true of oil injections that can penetrate the skin and cause symptoms similar to those of a stroke.
Motor vehicle accidents. Commercial truck drivers, delivery drivers, and others in the transportation industry are at high risk of being injured in a work-related motor vehicle accident. Drivers could be hurt during accidents on the roadway, or they might be injured when loading or unloading their vehicles. The driver may experience toxic exposure as a result of the loads they are carrying, or they might be injured when performing administrative tasks inside a factory or warehouse.
Occupational disease. Occupational diseases include respiratory disorders, such as occupational asthma or pneumoconiosis; phossy jaw; hand-arm vibration syndrome (HAVS); neurological disorders, such as peripheral polyneuropathy; cancer, including mesothelioma; heart disease; hepatitis; and stress-related illnesses.
These diseases range in severity from occupational asthma that requires a rescue inhaler and other treatments to neuropathy that causes nerves to tingle, muscles to weaken, and a lack of coordination. Heart disease can reduce the victim’s quality of life, and pneumoconiosis may cause fibrosis of the lungs. Phossy jaw occurs when workers are continually exposed to white phosphorus, causing necrosis of the bone, and HAVS occurs in those who use vibrating tools such as jackhammers.
Cancers may be caused by exposure to a range of substances. For example, mesothelioma is caused by exposure to asbestos, which has long been a topic of conversation in the personal injury and Workers’ Compensation areas.
Black lung is caused by the inhalation of coal dust in coal mines. Chronic beryllium disease is caused by prolonged exposure to beryllium dust during the production of electronics and nuclear power equipment, and chronic obstructive pulmonary disease (COPD) is caused by exposure to smoke and toxic fumes in a factory or refinery setting. Coughing, wheezing, shortness of breath, and fatigue should be treated by a doctor.
Anyone who believes they have been affected by an occupational illness should report their illness, seek treatment, and contact a lawyer if necessary. Additionally, preexisting conditions that are worsened by the employee’s job are also compensable. For example, someone with mild to moderate asthma could develop much more severe symptoms as a result of their exposure to smoke, fumes, or toxic substances.
Machine accidents. Injuries from machine accidents include cuts, burns, amputations, degloving injuries, broken bones, eye injuries, crushing injuries, and other injuries. Workers who are using powerful machines should be trained properly, use the appropriate protective gear, and work with partners to reduce the risk of injury.
Office injuries. Office injuries may include pain related to lifting heavy objects, injuries from flying or stationary objects, and musculoskeletal disorders, such as carpal tunnel syndrome. Something as simple as a trip and fall across a carpeted room is compensable. Although the employee got up and went back to work, that nagging knee pain they feel later in the day may be related to their accident.
Someone who stares at a screen all day may have damaged their vision. Employees who experience an electrical shock or are injured by computer or server parts should report their injuries, and someone who falls from a stepladder while hanging a banner outside the office should be covered under Workers’ Compensation.
Slip and fall accidents. These injuries may be due to poor lighting, uneven floor surfaces, poor housekeeping, faulty cabling, inadequate floor coverings, wet floors, changes in levels, faulty scaffolding, and other unsafe conditions. Although these injuries most often affect full-time employees, a consultant who is visiting the office for the first time could slip on an unmarked wet floor, sustain a head injury, and require medical attention along with wage loss benefits.
Toxic exposure. Depending on the workplace, workers can be exposed to dangerous toxins such as arsenic, asbestos, benzene, beryllium, ammonia, chloroform, zinc, lead, iodine, mercury, formaldehyde, silica, uranium, and other toxic substances. Each substance can cause a range of complications or symptoms. Workers should take the time to report their symptoms and go to the doctor as soon as possible.
Injured workers should contact a Workers’ Compensation lawyer as soon as possible to receive assistance with claims related to these injuries.
How can I Report an Injury?
Injuries should be reported to an immediate supervisor as soon as possible. The supervisor is responsible for completing the report and following up with the department that files insurance claims. At this point, the employee can visit an approved doctor for treatment.
The insurance company will cover all required treatment, but there are rules that govern how treatment is provided. Injury reports start the compensation process for employees, as they must be out of work for seven days before benefits begin. It is important to report these accidents as soon as possible. Someone who has missed 14 days of work will receive benefits retroactive to the date of their injury.
The employee has 21 days to report the injury so that they can receive benefits retroactive to the date of their accident. The employee has 120 days to report an injury so that they can receive any wage loss benefits and medical compensation.
If the report is not processed or the employee believes they cannot file a report, they should reach out to a Workers’ Compensation lawyer for assistance. Workers should try to document who took their report, when the report was filed, and use medical records to show when they first received treatment.
Which Workers are Not Covered by State Workers’ Compensation Insurance?
Workers not typically covered under state Workers’ Compensation insurance include the following individuals:
Housekeepers and domestic workers
Longshoremen and harbor workers
Independent contractors are not covered under Workers’ Compensation because they do not have a traditional employer/employee relationship with the business. Housekeepers and domestic employees are optional.
Because domestic workers are optional for Workers’ Compensation, they should be informed of their rights when they are hired. Agricultural workers do not need to be covered because of the Farm Labor Exemption if they work less than 30 days a year or make less than $1200 a year. Not all farms qualify for this exemption, and injured workers should consult with a lawyer to review how they may be covered.
Those covered under related federal laws such as railroad workers, sailors, longshoremen, harbor workers, and defense contractors receive benefits under federal statutes that supersede anything at the state level. An experienced Workers’ Compensation lawyer can explain how these injuries are covered and advise on what course of action to take if the victim is exempt.
How can Victims Receive Treatment?
Employers in Pennsylvania must provide employees with a notice of their rights when they are hired. The employee signs the notice showing that they understand that they are covered by Workers’ Compensation insurance. The employer must provide a list of at least six providers that can treat their employees. Under Pennsylvania law, three of these providers must be physicians.
The injured employee can choose any provider from the list, and they can change to another provider at any time so long as that provider is on the employer’s list.
Some injured employees require emergency or specialty care. When that treatment is deemed reasonable, the employee can go outside the list of approved providers for care. All bills from the doctor’s office or medical clinic are forwarded to the Workers’ Compensation insurance provider.
It is important to remember that the insurance provider may choose to stop coverage, and it may be necessary to involve a Workers’ Compensation lawyer to protect the rights of the employee and their family.
How Do Injured Employees Receive Workers’ Compensation Benefits?
Workers’ Compensation benefits will provide a source of income while helping to pay for medical bills resulting from any work-related injuries. This compensation is a guaranteed limited coverage that is provided in exchange for the employee agreeing not to sue their employer for damages. Each level of Workers’ Compensation coverage is progressively more comprehensive until the worker is provided with total disability benefits if they cannot go back to work again.
It is important to remember that the insurance company pays these benefits after the employer has filed a report. A report from the employer signals to the insurance company that a claim must be paid. Without a report, the employee cannot receive the coverage they need. Workers’ Compensation benefits continue until the injured employee has recovered or has been deemed permanently disabled. A Workers’ Compensation lawyer will review the case and help victims understand their rights if coverage is not paid appropriately.
What if a Worker is Temporarily Disabled?
Temporary disability payments are divided into two categories:
Temporary partial disability
Temporary total disability
Temporary payments for partial disability are capped at $1081 a week under Pennsylvania law. These workers receive two-thirds of their weekly earnings unless they earn below $600.55 a week. At that level and below, the worker earns 90 percent of their weekly pay.
Temporary disability benefits last for up to 500 weeks in the state of Pennsylvania. When the benefits have been exhausted, the insurance company may request a medical examination. Insurance companies use these medical examinations to show that the worker can return to work or receive only part of the benefits for which they are entitled.
Injured employees should contact a Workers’ Compensation lawyer when a medical examination is requested or when these benefits have not been paid by the insurance provider.
What if a Worker is Totally Disabled?
Workers who are on partial disability benefits will eventually have their claims reviewed. If the worker is more than 35 percent disabled, they can receive total disability benefits. Total disability benefits are split into two categories:
Permanent partial disability
Permanent total disability
Total partial disability implies that the employee can obtain gainful employment, but they likely cannot do the job they performed when the accident occurred. If these workers can obtain a new job, they often receive a portion of their benefits to make up for the difference in pay. Job training is provided under Pennsylvania law to allow these workers to get another job regardless of the field they choose.
When someone cannot work at all, they are given permanent total disability status and their payments continue as normal.
Are There Options for Special Payments?
Specific-loss payments are available through Pennsylvania’s Workers’ Compensation laws to help workers who have experienced amputations, the loss of senses, scarring, or disfigurement. Although the state has created a chart to explain all these specific losses, the calculations are simple. Each specific loss will use the percentage of the workers’ pay that they would receive every week.
That figure is multiplied by the number of weeks assigned to the injury. For example, someone who has lost an eye will receive 275 times their weekly wage as calculated under Workers’ Compensation rules.
These payments are offered to help injured workers move forward when there is only so much rehabilitation they can do after such an injury or accident.
Negotiating a Lump-Sum Settlement
A lump-sum settlement can be reached when the employee believes that waiting for weekly payments will not help them financially. They can hire a Workers’ Compensation lawyer to negotiate a settlement with the insurance company.
The insurance company and worker will engage in what is known as a Compromise and Release. This document says that the insurance company will make a lump-sum payment, and the employee agrees to bring no further legal action in the case.
Injured employees can accept a lump-sum settlement, or they can take a structured settlement that includes larger monthly payments over a shorter period. A lawyer can determine which settlement is better for the situation.
Once the two sides have agreed on a settlement, a Workers’ Compensation judge must approve the settlement. The employee will receive their payment under the contract, and all other litigation in the case will cease.
What if a Loved One Died Because of Their Work-Related Injuries?
Death benefits are provided under Workers’ Compensation laws in Pennsylvania. A benefit of $3000 for burial and final expenses is required when a worker dies on the job or due to injuries suffered on the job.
Spouses are paid 51 percent of the deceased worker’s wages. A spouse with one child is paid 60 percent of the worker’s wages, and a spouse with two or more children receives about 67 percent of the worker’s wages. The children are counted toward these benefits until they turn 18. If the child is enrolled in college, they remain part of the death benefits package until they turn 23.
In addition to the spouse and children, dependent parents or siblings may also receive death benefits. Partially dependent parents are eligible for 32 percent of the worker’s wages, and totally dependent parents receive 52 percent of the worker’s wages. Partially dependent siblings receive 22 percent of the worker’s wages, and totally dependent siblings receive 32 percent.
Families should contact a Workers’ Compensation lawyer when it is clear that death benefits have been disallowed or they have not been properly paid. In some cases, the lawyer may need to prove that a dependent should be covered under Workers’ Compensation death benefits.
The families of deceased workers may also need a lawyer’s help when they do not know how their loved one should be covered. For example, a civilian defense contractor may have died overseas. The family needs help learning how to recover damages under the Defense Base Act, as the employer may be difficult to contact.
Can an Injured Employee Sue Their Employer?
Workers’ Compensation coverage is a no-fault system. The employer provides insurance, and the employee agrees not to sue the employer. However, employees can sue third parties or the insurance company to recover compensation. The insurance company may not perform its due diligence, or it may deny claims without any foundation or evidence.
Employees also cannot sue their negligent coworkers after an accident. Under Pennsylvania law, negligent coworkers are free from liability. Workers’ Compensation insurance covers all medical and recovery expenses along with lost wages for the victim. Victims should speak to a lawyer to learn if exceptions to these rules may apply.
One significant exception is asbestos exposure. Some of the largest companies that once used asbestos in their daily work no longer exist or have been sued into bankruptcy. These companies were often required to establish asbestos trusts to pay for illnesses that occur, in some cases, up to 30 or 40 years after the worker left their position. A lawyer can file a claim against the asbestos trust to recover monetary damages for mesothelioma diagnoses or related conditions.
When employees sue the insurance company, they most often file a bad-faith insurance lawsuit. A lawyer will review the case and provide the victim with information that may help them recover compensation. These cases hinge on the timeliness of the report, a potential state insurance division investigation, and any documentation the insurance company has provided.
An exempt worker such as a housekeeper or independent contractor may sue for damages because they are not covered under Workers’ Compensation insurance. There is no trade-off because the worker did not receive standard coverage, and they have the right under Pennsylvania law to sue for their medical expenses, recovery, lost wages, and possible disability.
Why Do Injured Workers Need a Lawyer?
Injured workers need a lawyer because they can be sure that their employer and the employer’s insurance carrier has lawyers. These lawyers are meant to reduce the monetary losses of either the company or the insurance provider. Injured workers may find themselves talking to lawyers, third-party advocates, and others who may try to settle as quickly as possible for the lowest amount possible.
A Workers’ Compensation lawyer will assist the victim when they believe they cannot file an insurance claim or report their injuries. Some businesses are explicit in their desire to avoid all accident reports. Some workers might have been told they are not eligible, or the supervisor who took the report tried to assign blame outside of standing Pennsylvania Workers’ Compensation rules.
Workers who have issues with the insurance company might have been subjected to unnecessary medical examinations, or they might have been given an examination by a biased doctor. Moreover, the insurance company might harass the worker, try to trick them into taking a small settlement, or send letters to the victim to sign that act as de facto settlements.
A third-party lawsuit may also be available to sue the manufacturer of a faulty tool, part, or vehicle. Victims should allow the lawyer to review the case and determine who is liable for the accident even if Workers’ Compensation has been paid.
Pittsburgh Workers’ Compensation Lawyers at AlpernSchubert P.C. Assist Injured Employees
If you are dealing with the aftermath of a workplace injury or Workers’ Compensation claim, contact the Pittsburgh Workers’ Compensation lawyers at AlpernSchubert P.C.We have over 75 years of combined experience with Workers’ Compensation and assisting injury victims. As experienced legal advisers, we can help you with every aspect of your claim. Call us at 412-765-1888or contact us online for a free consultation. Located in Pittsburgh, we serve injured workers in Allegheny County, Lawrence County, Washington County, and across Western Pennsylvania.
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Moving on after an injury, whether it came from another’s negligence or a workplace accident, is a daunting task. Indifferent insurance companies seldom offer any consolation, and growing medical bills and time spent out of work can seriously impact the lives of you and your loved ones.
Pittsburgh's heritage is in its people. When an individual suffers a workplace injury or illness, or an injury due to the negligence of another, it can compromise their livelihood. Know that our attorneys can work to secure the compensation you and your family need.
The attorneys at AlpernSchubert P.C. can be the compassionate advocates you need after suffering a personal injury or work injury. Based in Pittsburgh, we serve clients throughout Western Pennsylvania, including Washington, New Castle, and all of Allegheny County, Washington County, and Lawrence County.