How to File a Workers’ Compensation Claim

Helpful Advice from an Honest, Experienced Attorney in Philadelphia

After you’ve been injured at work, the last thing you probably want to think about is filling out paperwork and meeting deadlines. But it’s a critical part of the process of filing a Workers’ Compensation claim. If you miss any one of the many steps or time limitations in this process, you may lose the ability to obtain compensation for your injuries.

The Law Offices of Richard A. Jaffe, LLC is dedicated to helping injured workers throughout the entire claims process. We aggressively fight for workers injured throughout Philadelphia.

Your recovery from a work accident can be difficult. Getting benefits shouldn’t have to be. That’s where we can help. Let us handle the paperwork and all the details. Contact us today to learn more: call 866-800-3332 for a free case evaluation.

Do you have a workers’ compensation claim?

In Pennsylvania, every employer with at least one employee is required to participate in the workers’ compensation program. Workers’ comp covers every employee – part-time, full-time, and seasonal – beginning on the first day of work. Unless you’re in a field that is specifically covered by a separate program, such as a railroad worker or government employees, you can get workers’ compensation if you are hurt on the job.

You have a workers’ compensation claim if you sustained any injury or occupational disease in the course and scope of your employment. Fault doesn’t matter; if you tripped over your own feet in the office, you can still get workers’ compensation for your injuries. With a few highly limited exceptions – for instance, if you started a fight or intentionally injured yourself – all that matters is that you were at work when the injury happened.

The steps to file a workers’ compensation claim in Pennsylvania

In general, the workers’ comp claim process is as follows:

Step 1: Report the injury to your employer

In Pennsylvania, you have up to 21 days to report the injury to your employer to get the full amount of workers’ compensation you’re entitled to receive. If you report the injury more than 21 days but within 120 days of the injury, you can still file a claim, but that claim will only pay for your lost wages and medical expenses from the day you made the report, not retroactive to the day of the injury. After 120 days, you may not be able to get workers’ comp at all (unless the employer was already aware of the injury).

Reporting the injury to your employer means notifying your supervisor or manager, human resources, or someone else in charge at your organization. Just telling a coworker doesn’t count. Follow your employer’s protocol for reporting a work injury. Legally, you can make this report verbally, but we strongly recommend doing so in writing, since that creates a record of the report to support your claim in case it’s disputed.

We also recommend reporting the injury as soon as possible. Again, you have up to 21 days to do so without compromising your legal rights, but the longer you wait, the easier it is for your employer or the insurance company to dispute your claim. They may argue that something happened in the intervening time to cause or aggravate the injury. The sooner you report the injury, the better.

Step 2: Get medical attention

You need to see a doctor as soon as possible, both to protect your health and to create documentation of your injury to support your claim. Medical records are a key piece of the evidence presented in the workers’ compensation claim process in Pennsylvania.

Note that Pennsylvania law allows employers to designate a list of approved doctors to treat work injuries. If your employer has provided a list that complies with the legal requirements, you must choose a doctor from that list for non-emergency treatment within the first 90 days. After 90 days have passed, you are generally free to see any doctor of your choice for your work injury.

Step 3: A claim is filed with the Pennsylvania Bureau of Workers’ Compensation

Once you have reported the injury, your employer will generally take care of what happens next. They will file a form with the Bureau called a First Report of Injury, and either the employer or the workers’ comp insurance company may file additional forms with the Bureau, as well.

The workers’ comp insurance company has 21 days from the day of notification to take action on the claim. By the end of that 21-day window, they must issue a notice that your claim is approved, denied, or temporarily approved while they extend the investigation period for an additional 90 days.

Step 4: Appealing a denied or disputed claim

If the insurance company denies your claim, you have up to three years to file a Claim Petition for Workers’ Compensation with the Bureau. If you do not file the Claim Petition within 3 years of your injury, you may be barred from receiving workers’ comp even if you were legitimately injured at work.

Once the claim petition is filed, your claim will be assigned to a workers’ compensation judge, usually in the county where you live. You and the insurance company will go to a hearing before the judge where both sides can present evidence. Usually, the judge will schedule the case for mediation, or the case will be resolved in an informal conference or settlement conference. If the case is not settled, the judge will issue a decision to resolve the claim.

The judge’s decision can be further appealed to the Workers’ Compensation Appeal Board within 20 days of the decision being communicated to the parties. Beyond the Appeal Board, you can appeal to the Commonwealth Court of Pennsylvania, and then to the Supreme Court of Pennsylvania.

Do I Need a Lawyer?

Many injured Pennsylvanians wonder if they really need a lawyer to apply for benefits. You may think your case is clear cut. After all, you’re entitled to receive Workers’ Compensation benefits after being injured at work.

Unfortunately, the claims process can become complicated very quickly, and it can be tough to go it alone. If you need workers’ compensation help in Philadelphia, you’ve come to the right place. Attorney Richard A. Jaffe used to represent insurance companies and knows these companies will use any number of tactics to keep payments out of injured workers’ pockets. They often start by scrutinizing paperwork to find mistakes or missed deadlines.

The Law Offices of Richard A. Jaffe, LLC can help you better understand how to correctly fill out any forms and file the proper paperwork. Attorney Jaffe can represent you in any settlement conferences or determine the best way to appeal a denied claim. For a free consultation, call 866-800-3332 today.