How Does Workers’ Compensation Work?

Workers’ compensation is a state-mandated, federally-regulated type of insurance that provides medical treatment and wage loss compensation for employees injured in a work-related accident or who become sick while working or as a result of working.

Under workers’ compensation laws, injured employees do not have to prove their employer’s liability or negligence to receive benefits. In exchange, employers pay for insurance coverage and obtain protection from direct lawsuits from employees. This “no fault” system pays employee claims regardless of who is found to be liable for the injury.

Whether the first day on the job or after years of service, employees are covered by workers’ compensation for their entire time of employment. So, even if your work-related injury or illness is not the result of a single incident, such as a repetitive use injury or an illness due to repeated exposure to chemicals, it should still be covered by workers’ compensation.

Most employers are required to carry workers’ compensation insurance -- with a few exceptions. Additionally, workers’ compensation does vary by state, so it is important speak with your HR department and learn about your benefits.

The Process

If you are injured at work, doing a work-related task or become ill because of your job, then it is best to immediately alert your supervisor or HR department. If time allows, choose an employer-approved medical provider who handles workers’ comp and, at the medical facility, inform your provider that this was an on-the-job injury. Ensure your provider documents the injury in your medical records with as much detail as possible – dates, affected areas, limitations and how the injury happened.

In the meantime, your supervisor will file an injury report and your HR department will begin an investigation. Your employer and its insurance company have 21 days after they receive your notice of injury to agree that your injury was work-related or deny your claim, according to the Workers’ Compensation Act.

If approved, your HR department will submit a claim to the Commonwealth’s claims adjustor at the Bureau of Workers’ Compensation who will either approve or deny the claim. Every claim is investigated, so be honest. Once approved, your claim will be managed jointly by your employer and the claims adjustor and you will receive benefits. If your claim is denied, you have three years from the date of the injury to file a claim petition.

Obtaining Benefits

Benefits of workers’ compensation vary by state, by policy and by the nature of the injury or illness. Before receiving benefits such as wage compensation, your employer will likely require medical proof of your injuries from a physician, along with documentation about if you can return to work and if you have restrictions on job duties or types of work.

Under workers’ compensation, employees can receive compensation for medical expenses (including surgeries, hospital stays, medicine, supplies, and more) and replacement wages. Workers’ comp policies may also include: vocational rehabilitation, specific loss benefits, temporary disability payments, permanent injury compensation and survivor benefits.

Do I Need an Attorney’s Help with my Workers’ Comp Claim?

Yes. You can represent yourself, but the insurance company will have an experienced lawyer and workers’ compensation law is complex. It is very difficult to win a case without the help of an attorney who focuses on workers’ compensation.

We especially recommend contacting an attorney if:

• your case requires surgery.
• your injury impacts your future job performance.
• your injury prevents you from working at all.
• you had pre-existing problems in the same part of your body or pre-existing disabilities.
• your case is denied.
• you feel you are being short changed.
• your doctor releases you to work before you feel ready.
• you need additional medical treatment.

Next Step

If you have been injured on the job, while doing a work-related task, or become sick as a result of your job, contact Lepley, Engelman, Yaw & Wilk to discuss your options.