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Workers’ Comp: Can You Appeal a Denied Claim?

plank-dennis-workers-comp-attorney-Lancaster-County-PennsylvaniaBy Dennis Plank, Attorney

Work-related injuries often cause more trauma than the mere injuries themselves. Fear of lost work time and wages, mounting medical bills, and the worry of supporting a family can add stress to an already difficult situation. Fortunately, Lancaster County workers who suffer injuries on the job typically qualify for compensation under The Pennsylvania Workers’ Compensation Act. The state law requires most employers to carry insurance that will pay benefits to cover medical bills, lost wages and possibly a lump-sum settlement to employees who are injured or disabled in connection with their job.

Injured employees often find the workers’ compensation claim process complicated and time-consuming. The result is many denied claims, frequently due to simple mistakes. An experienced workers’ compensation attorney can often appeal a denied claim and get it approved. Here’s a look at some common reasons for denied claims and how a workers’ comp lawyer can help.

Missed Deadline for Filing a Workers’ Comp Claim

An employee must report a work-related injury to an employer within 120 days of the date of injury to receive workers’ compensation benefits. If they have a work-related condition or illness that occurred over time, they must report it within 120 days of diagnosis. Reporting an injury as early as possible offers the best chance for maximum compensation for medical bills and lost wages. Whenever possible, put the report in writing and keep a copy. Include a description of the injury and when and where it occurred.

Under some circumstances, injured workers have recourse for claims denied due to missed deadlines. A workers’ comp lawyer can determine if the employee qualifies for an exception in Pennsylvania. That may be the case if the employer was aware of the injury, if the employee was incapacitated and unable to notify the employer on time, or if the employer did not clearly post workers’ comp rules.

Lack of Witnesses to Support Workers’ Compensation Claim

Insurance companies often deny workers’ comp claims that lack eyewitness proof. Without eyewitnesses, the insurance company may suggest that the accident never happened or that it happened outside the workplace.

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In some cases, a workers’ compensation attorney can build a case for a successful appeal if the employee told a co-worker or supervisor about the injury, if there are witnesses who saw the employee before or after the accident, or if the injured employee left work to seek medical attention.

Workers’ Compensation Denied Due to Illegal Drug Use

Some employers require a drug test following a work-related injury. Failing that test increases the likelihood of denied workers’ compensation benefits if the insurance company claims that substance abuse contributed to the accident.

Even if a medical exam shows illegal drug use, there are some cases where an experienced workers’ comp lawyer can show that those test results should not affect benefits – in particular, if the substance abuse was not a contributing factor in the accident. An attorney might also question the integrity of the drug test, the timeliness of the test for accurately proving intoxication at the time of the accident, or whether the employer had a reasonable basis for ordering the test. The Occupational Safety and Health Administration (OSHA) prohibits employers from using drug testing as retaliation against an employee who reports a workplace injury. In such cases, a workers’ comp lawyer may successfully appeal a denied claim if the employer failed to request a drug test from other employees who did not report injuries but who may have contributed to the accident.

Workers’ Comp Claim Filed After Termination

Insurance companies are likely to deny workers’ compensation claims filed after an employee quits, gets fired or laid off, viewing the claim as nothing more than an act of revenge. An experienced workers’ comp attorney can help compile the necessary witness accounts and medical evidence to prove that the claimant suffered a legitimate injury while still on the job. A lawyer may also successfully appeal a denied claim if the employee reported the injury while still employed or if the injury occurred after the employee gave or received notice but before their last day of work. Even with a successful appeal, however, employees who quit may not qualify for benefits covering lost wages since they gave up their wages voluntarily.

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Remember: Although Pennsylvania is an at-will state, meaning an employer can fire an employee at any time and for any reason, it is illegal to terminate an employee for reporting a workplace injury. Any employee who believes they have lost their job because of an injury should contact a workers’ compensation lawyer immediately.

A Doctor Says Your Injuries are not Work-Related

In Pennsylvania, injured employees must seek treatment from a list of employer-approved physicians for the first 90 days. An insurance company may deny a workers’ compensation claim if a doctor determines that the injury occurred outside the work environment or because of a pre-existing condition.

Some injuries outside the workplace do qualify for benefits. A workers’ comp attorney can gather evidence for a successful appeal if the employee sustained the injury while traveling to a remote worksite, working from home, traveling for business, or making deliveries for an employer. In the case of pre-existing conditions, if work-related activities result in a new injury, a lawyer can help prove that the injury qualifies for workers’ comp coverage.

Paperwork Errors in Workers’ Compensation Claim

Filing a workers’ compensation claim requires significant documentation and detailed information. Insurance companies look for reasons to avoid paying benefits and frequently deny claims due to paperwork errors. When this happens, an experienced workers’ comp attorney can help file a claim petition and collect the documentation, medical records, testimony, and evidence necessary to prepare for a hearing before a workers’ compensation judge.

Lancaster County workers who suffer a workplace injury should consult with an experienced workers’ compensation attorney. The Law Offices of Going and Plank in downtown Lancaster can help with meeting state deadlines, securing evidence to file a claim, and navigating the workers’ comp process to ensure maximum benefits. Remember, an initial denial is not final. Contact us today for a free consultation to review all options for an appeal.

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Denied Workers’ Comp Claims Happen, But They Can be Appealed

plank-dennis-Lancaster-County-Pennsylvania-denied-workers-comp-attorneyBy Dennis L. Plank, Attorney

Some jobs are more dangerous than others, but injuries can happen in the workplace, no matter what type of work you do. Sometimes workers get workers’ compensation to help them get through the recovery period, but in some cases the result is a denied workers’ comp claim.

Most often, when we think of workplace injuries, we think of accidents on the job, but you can also develop injuries over time or illnesses related to your work environment. Workers’ compensation, a type of insurance that offers benefits to those who suffer workplace injuries, whether those injuries are immediately, or they occur over time.

Each state has different workers’ comp laws. If you’re employed in Lancaster County, you are protected under the Pennsylvania Workers’ Compensation Act, which requires most employers to carry insurance that will pay benefits to cover medical bills, lost wages, and possibly a lump-sum settlement to employees who are injured or disabled in connection with their job.

In 2018, 8,660 workers’ compensation claim petitions were filed in Pennsylvania. However, every year there are many denied workers’ comp claims in Pennsylvania. An experienced workers’ comp lawyer can guide you through the claims process and help you avoid the common pitfalls that can result in a denied claim.

Denied Workers’ Comp Claim Because You Didn’t Report the Injury Immediately

Pennsylvania requires you to report a work-related injury within 120 days of the date of injury to receive workers’ compensation benefits. To ensure you receive the maximum compensation for medical bills and lost income, it’s best to report an injury immediately. Reporting an injury as soon as it occurs establishes a foundation for your case. Waiting any amount of time to report a workplace injury could give your employer reason to doubt that the injury happened at work. More importantly, waiting to report an injury could have serious medical consequences.

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What seems like an innocent bump on the head or simple sore back could develop into something more significant and costly down the road, when proving how it occurred becomes more difficult. There is more leeway in reporting if a work-related condition develops over time, such as arthritis or a lung condition. Such cases should be reported within 120 days of the date your doctor diagnoses your condition and its connection to your work.

Even if you fail to meet the reporting deadline, you may still be able to collect workers’ compensation if you have witnesses, if your employer was aware of your injury, if you were incapacitated and unable to file a report, or if your employer didn’t post notices about workers’ comp rules.

Denied Workers’ Comp Claim  Because Inconsistent Accounts

An insurer may deny your claim if your statements about the injury are inconsistent or if your version of what happened differs from accounts given by witnesses, co-workers, supervisors, or medical professionals.

Always make sure you are consistent when discussing the details of your injury, whether you are talking to your employer or your doctor. If you feel others are deliberately misrepresenting your injury or that you are being treated unfairly consider seeking the advice of an experienced workers’ compensation attorney. Contact the Law Offices of Going and Plank for a free consultation.

Denied Because You Filed the Claim After Termination

Another reason to report a work-related injury immediately is to avoid the possibility that you will be fired or laid off before filing your claim. Insurance companies often deny claims filed after termination because they view them as an attempt at revenge. Of course, some employers may try to avoid a claim by firing you because you were hurt on the job.

While some employers legitimately terminate employees for reasons unrelated to their work injury, it is illegal to fire an employee because they were injured at work or because they filed a worker’s comp claim. Seek the advice of a workers’ comp lawyer if you feel you were fired due to your injury.

Denied Workers Comp Claim Because You Lacked Witnesses

It’s much easier for an insurance company to question the location of your accident if no one else saw it happen. That’s why an insurer will often deny a worker’s comp claim when there are no witnesses. If you had an accident on the job when no one is around, you can still build a workers’ compensation case if you tell your supervisor and co-workers immediately, if you have witnesses who saw you before and after the injury, or if you had to leave work to seek medical attention.

Denied Claim Because You Refused to Issue a Recorded Statement

When you suffer a workplace injury, your employer may ask you to make a recorded statement for the insurance company. While these statements are often simple, straightforward accounts of how the injury occurred, they are sometimes a means for the insurance company to avoid paying benefits. During a recorded statement, an insurer may ask leading questions designed to elicit inconsistencies about the nature or cause of the injury or details about past medical problems, all in an effort to deny your claim.

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Although you are under no legal obligation to make a recorded statement or answer invasive or leading

questions, insurance companies can use your refusal as a basis for denying your claim. It may seem like a no-win situation, but an experienced workers’ comp attorney can help. A request for a recorded statement may indicate that the insurer is looking for a reason to deny your claim. Never agree to a recorded statement without first consulting a lawyer.

Denied Claim Because Illegal Drugs Were Detected in a Medical Exam

Some employers may require a drug test for illegal substances when a workplace injury occurs. An insurance company may deny your claim on the grounds that drug use led to an increased chance of an accident. Under Pennsylvania law, if an employee’s intoxication or illegal drug use is the sole cause of a workplace injury, then the employee is not eligible for workers’ compensation benefits. However, an employer must have reasonable cause to request a drug test following a work-related accident. If your claim was denied due to illegal drug use, you may still have options, especially if the injury would have occurred regardless of impairment.

If your workers’ comp claim has been denied, don’t lose hope. In many cases, a qualified attorney can get you the compensation you deserve. Going and Plank has decades of experience handling workers’ comp cases. Contact us today for a free consultation to review your case. It could be your first step toward a settlement that protects you from financial hardship.

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5 Common Reasons Workers’ Comp Claims are Denied (and What you can do to Challenge Them.)

plank-dennis-Lancaster-County-Pennsylvania-workers-comp-claims-in-Lancaster

By Dennis Plank, Attorney

Workers’ comp claims in Lancaster are not always straighforward. If you work in Lancaster County and you are injured on the job, you are usually entitled to compensation under The Pennsylvania Workers’ Compensation Act. Our state laws require most employers to carry insurance that will pay benefits to cover medical bills, lost wages and possibly a lump-sum settlement to employees who are injured or disabled in connection with their job.

However, not all workers’ comp claims in Lancaster County are approved upon the first submission. Some businesses and their insurance companies look for ways to save money and will sometimes deny claims based technicalities. Fortunately, a good workers’ comp attorney can often help you fight a denied claim to get the payments you deserve.

There are many reasons for denying a claim, but here are 5 common reasons. Take a look and let our team know if any of these apply to your case.

Did Not Report the Work-Related Injury in a Timely Manner

Even the most minor work injury, such as a bump on the head or a sore back, should be reported immediately in the event it turns out to be something more significant. In Pennsylvania, you must report your injury within 120 days of the date of injury to receive workers’ compensation benefits. However, it’s much better to report the injury within 21 days to ensure you get the maximum compensation for medical bills and lost income.

There is more leeway if a work-related condition develops over time, such as arthritis or a lung condition. Such cases should be reported within 120 days of the date your doctor diagnoses your condition and its connection to your work. Even if you miss the deadline for reporting, you may still be able to collect workers’ compensation if there were witnesses to your injury or your employer was aware of it, if you were incapacitated and unable to file a report, or if your employer didn’t post notices about workers’ comp rules. Contact Going and Plank to review your case and pursue your legal options.

Forms Errors for Denied Workers’ Compensation Claims in Lancaster

Filing a workers’ compensation claim can require significant documentation and detailed information. Many workers’ compensation claims are initially denied because they were not properly or completely documented, or because there was a paperwork error. Remember, the insurance company’s goal is to avoid paying claims if possible.

insurance-Lancaster-County-Pennsylvania-Workers-comp-claims-in-Lancaster-PA

An experienced workers’ compensation attorney can make sure your initial claim is filed correctly and give you the best chance of receiving the benefits you deserve. However, if your claim has already been denied due to a paperwork error, contact the Law Offices of Going and Plank. We can guide you through filing a claim petition and collecting the necessary documentation, medical records, testimony, and evidence necessary to prepare for a hearing before a workers’ compensation judge.

Missing Medical Information or No Accident Report for Denied Workers’ Compensation Claims in Lancaster County

It’s important to include medical information and an accident report as evidence in workers’ compensation claims in Pennsylvania. Even if an injury seems minor, you should seek medical attention promptly. If your claim is missing the details of how the injury occurred, or a medical evaluation verifying the injury and its cause, it may be denied. Your doctor’s records should include physical limitations and work restrictions that will affect your benefits. Always indicate to medical professionals that the injury occurred at work to ensure that information becomes part of your medical records.

Did Not Complete the Required Medical Exam

As part of the investigation process for a workers’ compensation claim, an employee may be asked to take part in an independent medical examination by a doctor of the insurer’s choice. The insurer’s physician will perform a physical exam and may also order additional tests to determine the degree of injury, if the injury is consistent with the work-related accident reported, and if the treatment prescribed by the employee’s physician is appropriate.

Injured employees may be required to receive an independent medical examination once every six months to evaluate their progress and their ability to return to work. Failure to take part in these medical examinations can result in an initial denial of a claim or an end to benefits down the road. If you’ve received a request for an independent medical examination, contact the Law Offices of Going and Plank and let us ensure that your benefits are protected.

A Doctor Says Your Injuries are Not Work-Related

In Pennsylvania, injured employees must seek treatment from a list of employer-approved physicians for the first 90 days. Should a doctor decide that your injuries occurred outside the work environment or that they are the result of a pre-existing condition, your workers’ compensation claim may be denied. However, there are instances in which an injury can be considered work-related, even if it did not occur in the workplace. For example, if you were injured while traveling for work or while working from home, your injuries may still be covered under workers’ compensation. Additionally, having a pre-existing condition does not exempt an employee from filing a workers’ comp claim, especially if work-related activities resulted in a new injury.

injured-traveling-Lancaster-County-Pennsylvania-workers-comp-claim-in-Lancaster-PA

If You’ve Been Denied, Contact an Attorney

Getting a fair workers’ compensation settlement isn’t always automatic or easy. A claim can be denied for many reasons. If you feel there has been an error, or that your employer or their insurance company has submitted false information that may have hurt your claim, contact the Law Offices of Going and Plank in downtown Lancaster for a free consultation.

We can review your case and determine if you have additional options for pursuing your claim. Contact us today for a free consultation if you’ve been injured on the job. We can review your case and help you receive a settlement that protects you from long-term financial hardship.

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Your Workers’ Comp Claim has Been Denied. What do You do Next?

plank-dennis-Lancaster-County-PennsylvaniaBy Dennis L. Plank, Attorney

Many of us work hard at our jobs. We show up day after day, giving our employers our best efforts. But even dedicated, experienced employees may get hurt on the job. That’s why denied workers’ compensations claims are so frustrating.

In 1915, Pennsylvania enacted the Pennsylvania Workers’ Compensation Act to provide medical benefits and to compensate workers for lost wages when they were hurt on the job. Over 100 years later, The Pennsylvania Workers Compensation Act is still in effect and has grown to cover most types of full-time and part-time employees.

How Does the Workers’ Comp Act Work?

The Pennsylvania Workers’ Compensation Act requires most Pennsylvania employers to carry workers’ compensation insurance. This insurance is in place to pay out claims that cover the costs of medical treatment and compensation to PA employees for lost wages arising from their work-related injuries and medical conditions.

The Act specifically states that the insurance is in effect regardless of fault. That means that if, for example, you fall on the job, even in a workplace that is safe, and the fall was not caused by the employer’s negligence, you are eligible for workers’ compensation. The Act provides protection to employees under many circumstances where the employee suffers an injury while in the course of performing his work duties.

However, workers’ compensation does not cover deliberate or reckless behavior. So, if you are hurt on the job because of horseplay, drug use, or you intentionally hurt yourself, the Act will not cover your injuries.

Workers’ Compensation may provide an opportunity to negotiate a lump sum settlement of your claim to cover future wage loss or future medical expenses. In addition to total or partial wage loss and payment of medical expenses, the Act provides for compensation for specific loss of body parts, scarring and disfigurement, and death of an employee arising from the performance of work duties.

Petitioning a Denied Worker’s Comp Claim is a Complicated Process

Getting your workers’ compensation claim approved and paid is not always simple or straightforward. Claims often require detailed documentation and obtaining detailed medical records and reports. Insurance companies and their lawyers often dispute claims. As a result, many workers’ compensation claims are unfairly denied. If your workers’ compensation claim has been denied, you still have rights. In Pennsylvania, you can further pursue a workers’ compensation claim by filing a petition with the Bureau of Workers’ Compensation.

In filing this petition, you will be asked to provide evidence and documentation of your injury at a hearing before a workers’ compensation judge and the insurance company’s attorney will also be asked to defend their rationale for denying the claim.  If you need help evaluating your denied claim, contact Going and Plank to schedule a free consultation.

If your claim was denied, you need to know what to do, and how to do it quickly. Here are some tips to help you through the process.

Step One: Know Why Your Workers’ Compensation Claim Was Denied

There are many reasons a workers’ compensation claim is denied. Read your denial letter carefully to determine the issue(s).

In some cases, denials may be due to a technicality such as a paperwork error or that you reported the injury late. In other cases, the insurance carrier may allege that your injury did not meet the legal requirements for compensation. An example might be that your injury did not occur in the course of your employment or was not related to your work activity.  In some cases, the attorney for the workers’ compensation insurance company may dispute the truth or the validity of your claim.

The good news is that initial denial is not final. If your claim was denied, if you think the denial was reached in error, if you want to dispute a technical error, or if you feel that your employer or the insurance company has submitted untrue or unfair information that has hurt your claim, you may take additional steps to further pursue your claim. Schedule a free appointment to discuss your options.

There are many reasons claims are denied. Here are some of the most common:

No Witness

Without a witness, it’s easier for insurance companies to claim your accident never happened, or to claim it happened elsewhere. If you make a claim without the proof of an eyewitness, insurance companies will question your claim, and many such claims get denied. If you’re hurt at work, but no one saw your injury, Going and Plank may be able to build a case, especially if you told co-workers or supervisors about your injury when it happened, if there are witnesses who saw you before or after the accident, or if you left work that day to seek medical attention. Contact us at 717-392-4131 for a free workers’ comp consultation.

Missed Deadline for Reporting Injury

Sometimes employees get hurt at work and consider it a minor injury. You may have put off reporting your injury until you realized it was a more significant issue.

To eliminate these types of issues, an employee should report any minor injury at work, such as a bumped head or a sore joint, even if you feel it’s a minor mishap. However, even if you waited to report your injury, you may still be entitled to workers’ comp. Contact us at Going and Plank for a free consultation.

Inconsistent Accounts

It’s not uncommon to find that the injured person’s account of the incident differs from the accounts given by witnesses, co-workers, supervisors or medical professionals. Such differences may result in your workers’ comp claim being denied. An experienced workers’ compensation attorney can help you evaluate the issues, and help you determine ways to explore the discrepancies and resolve them when possible. If you feel others are misrepresenting your injury, or that you are being treated unfairly, contact us at Going and Plank to schedule a free consultation.

Made Claim After You Were Fired or Let Go

Even small injuries at work can escalate into circumstances resulting in disability. That’s why it’s important to report work injuries immediately. You may have found that when you took a few days off after your injury to obtain medical treatment or to rest, your employer decided to fire you in the interim. In fact, some employers will fire you because you were hurt on the job, to avoid a claim for workers’ compensation benefits.  If this is your situation, contact us at Going and Plank to discuss your choices.

Alcohol or Drug Use

After a work-related accident, some employers require a test for illegal substances. Your workers’ comp claim can be denied if drug use led to an increased chance of an accident. However, certain exceptions may apply. Schedule a free consultation with a workers’ comp attorney to weigh your options.

Refused a Recorded Statement

Employees may be asked to make a recorded statement for the insurance company, but you are not legally required to make this statement. Since recorded statements can be used against you, it’s smart to consult a workers’ comp lawyer at this point. If you were asked to make a recorded statement, and your agreement or denial resulted in a denial of your claim, contact Going and Plank to discuss your options.

Step Two: Find an Experienced Attorney to Represent You in the Workers’ Comp Hearing and Appeal Process

Filing a petition to further pursue your workers’ compensation claim after the insurance carrier has issued a denial can be an intimidating process.  Many claims are initially denied because the claim was not properly or completely documented.  That’s why it is so important to hire an experienced workers’ compensation attorney to represent you through the hearing and appeals process.

You may find that further pursuing your denied claim is a daunting task. The filing of a claim petition requires obtaining significant documentation, medical records, and detailed information regarding your claim in preparation for a hearing which will be scheduled before a workers’ compensation judge, who after taking the testimony of both parties and considering all pertinent documentation including medical records and testimony, will issue a decision as to whether you are entitled to payment for your work injury.

As part of the hearing process, you will be required to provide documentation inclusive of relevant medical records, documentation of your work status and earnings at the time of the injury and any other documentation required by the workers’ compensation judge or requested by the insurance company’s attorneys.  You may also be required to undergo an additional medical examination at the insurance company’s request.

It’s smart to have an experienced workers’ compensation attorney on your side.  Going and Plank has decades of experience handling workers’ compensation issues for injured workers throughout Lancaster, Chester, York, Dauphin, and Lebanon Counties.  We will provide expert and experienced representation to make sure that you receive all of the benefits available to you under the law.  Make sure you schedule a free consultation with Dennis Plank, an attorney with over 35 years of workers’ compensation experience in Lancaster, Pennsylvania.  Schedule your free consultation now.

Step Three: Filing a Workers’ Compensation Claim Petition

Don’t let a denial of your workers’ compensation claim stop you from receiving the benefits you deserve.  You are legally entitled to challenge a denial of your claim by the workers’ compensation insurance company by filing a petition with the Bureau of Workers’ Compensation which will entitle you to a hearing on your claim before a workers’ compensation judge.  An effective presentation to the judge could result in payments of benefits to cover lost wages, medical expenses, or provide the basis for a potential lump sum settlement of your claim.

Pennsylvania law requires an employee to give notice of his work injury to the employer within 120 days of the date of injury.  The law also places a 3-year statute of limitations on the filing of a claim petition to pursue benefits, with this time limit commencing on the date of your injury.  If you believe your workers’ compensation claim was unfairly denied, it is important to meet with an experienced workers’ compensation attorney as soon as possible to ensure that these time limitations are met.

Unfortunately, an injury on the job can have long-lasting financial effects.  Whether you’re full time, part time, or salaried, Going and Plank works with clients to make sure your injury does not hurt your long-term financial security.

These procedures are challenging for most employees. That’s why Dennis Plank and Going and Plank offers a free consultation to help you determine your best course of action. We move fast to help you meet all required deadlines. Our representation of you does not require an initial payment of legal fees, and in most cases, we only receive payment if your claim has been successfully resolved resulting in payment to you.

Don’t Wait. Schedule Your Free Appointment Now.

Dennis L. Plank is a Lancaster County attorney specializing in representing injured workers. He has spent more than 35 years fighting for the fair and legal treatment of every employee. If you’ve been hurt on the job, an attorney from Going and Plank will work to ensure that your settlement covers the resulting long-term financial hardships. A variety of injuries are covered, including:

  • Neck and back pain

  • Nerve damage or spinal cord damage

  • Bone fractures

  • Arm or leg injuries

  • Hand or foot injuries

  • Loss of use of a body part

  • Loss of body parts

  • Brain damage

  • Cranial or skull damage

  • Chronic pain

  • Physical disfigurement and scarring

  • Damage to hearing

  • Damage to eyesight

  •  Dental damage

  • Impaired mobility or loss of dexterity

  • Death

If you feel you’re being treated unfairly or illegally, contact us today to discuss your legal options. Consultations are free, and we only get paid if we win your claim.

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Workers’ Comp: Get the Benefits You Deserve

9 Important Facts Abo­­­ut Workers’ Compensation

dennis-plank-Lancaster-County-Pennsylvania

By Dennis Plank, Workers’ Compensation Attorney

Whether you work in an office, a factory, or a construction site, in a warehouse, outdoors, or elsewhere, your employer is responsible under Pennsylvania Law for providing insurance benefits to compensate injured workers for lost wages and medical expenses under the terms of The Pennsylvania Workers Compensation Act. The workers’ compensation program was started over 100 years ago to provide employees with compensation for lost wages and payment of medical expenses arising from work-related injuries and work-related medical conditions, regardless of fault. The Act also protects employers from direct lawsuits by employees.

Although the vast majority of employers in Pennsylvania are required by law to carry workers’ compensation insurance coverage for their employees, there are a few exceptions. However, the majority of employed Pennsylvanians are covered under the law and have well-defined rights and recourse under the Act.  Most people don’t think much about workers’ compensation until they find themselves injured.  The law can be confusing.  That’s why we are offering this list of nine important facts you need to know about workers’ compensation in Pennsylvania.

Fact: Not all Types of Injuries are Covered by Worker’s Compensation

While it’s true that Pennsylvania law covers most types of injuries and illnesses encountered as a part of your employment, not all injuries are included.

  • Self-Inflicted Injuries: If your injuries are intentionally self-inflicted, you are not covered for benefits under the terms of the Act. Any attempt by an employee to intentionally harm himself in order to obtain workers’ compensation benefits is both fraudulent and not covered under the Act.
  • Physical Attacks: If you are physically attacked by a co-worker for personal reasons, or if you are physically attacked by a person not associated with your workplace, you are not covered under Workers’ Compensation. However, such physical attacks are illegal and should be reported to your employer and the police immediately.
  • Alcohol and Drug Abuse: If your injuries were caused as a result of alcohol or drug use, you are not covered. It is your responsibility to conduct your work soberly and without drug use.
  • Breaking the Law: If you are injured while breaking the law, or as a result of breaking the law, you are not covered.
  • Commuting: Generally, if you are injured commuting to and from work, you are not covered. However, if you are in the course of traveling as part of the performance of your work duties such as driving to a remote work site after reporting to work, making deliveries for your employer, traveling for business, or you are injured while driving or making deliveries for your employer, you may be covered.

Fact: Workers’ Compensation Covers Injuries That Occur Over Time

Not all work injuries happen in a moment. Some occur slowly over time from repetitive motion, like back pain or carpal tunnel syndrome.  Your employer should not require you to repeatedly work in awkward or uncomfortable positions or require you to work repetitively without breaks or variety, nor should your employer subject you repeatedly to physical force, weight, impact, or vibration.

Additionally, your employer should make sure they are using the right tools and equipment optimally placed for your physical requirements. Extreme temperatures and poor work organization are also factors in repetitive injuries. If you’re not sure if your injury is covered, please set up a free consultation at Going and Plank, and we’ll help you determine your rights.

Fact: Part-time Employees are Covered by Workers’ Compensation in Lancaster County, and Throughout Pennsylvania

Workers’ Compensation is not reserved for full-time and salaried employees. In Pennsylvania, both full-time and part-time employees are covered under the Workers’ Compensation Act.

Fact: Your Injury may be Covered, Even if it Didn’t Happen on Employer Property

PA law does not require that your injury occurs on the work premises to be covered under the Act. If you were injured while doing work requested by your employer, you may be covered. While commuting is usually not covered, if you were injured in an accident while running an errand for your employer, you may be covered.  While commuting is not covered, you may be covered if you fell in your employer’s parking lot. If you travel for work or drive for a living, accidents that occur while you are working, regardless of location, are covered. Request a free consultation at Going and Plank to find out if your injury is covered.

Fact: There are Time Limits on a Workers’ Compensation Claim

If you are injured on the job or realize that you have acquired a work-related medical condition over time, report it to your employer as soon as possible. Your report should include when and where the injury occurred, and you should describe the type of injury. While verbal reports are acceptable, written reports are preferred. You should make a copy of your written report and keep it for your records.

Additionally, you must report your injury within 120 of the date or injury to receive Workers’ Compensation benefit, or, in the case of conditions incurred over time, with 120 days of the date of your diagnosis. However, it’s much better to report the injury within 21 days to ensure you get the maximum compensation for medical bills and lost income. If you’re not sure you’ve met the time limits, contact us at Going and Plank for a free consultation.

Fact: If you Have Contracted a Condition or Disease as a Result of the Environment at Your Workplace, You may be Eligible for Workers’ Compensation

If you have contracted a medical condition or disease as a result of exposure to unsafe working conditions or unsafe activities, you may be eligible for Workers’ Compensation. Occupational diseases can be caused by repeated exposure to asbestos, dust and air-borne particles, fungicides, gas, infectious agents, metals, noise, pesticides, herbicides, pressure, radiation, solvents, temperature, and vibrations. Many conditions and diseases can be classified as occupational diseases, including:

  • cardiovascular system disease
  • central nervous system disease
  • hearing loss
  • heart disease
  • liver disease
  • lung disease
  • mental health issues
  • mesothelioma
  • musculoskeletal disease
  • psychiatric diseases
  • renal disease
  • reproductive system disease
  • skin disease
  • vision loss

Fact: Workers’ Compensation is Usually Paid in Addition to Sick Pay

Worker’s Compensation claims are rarely paid quickly. If you need to take time off work because of a work injury, use your sick time and make sure your employer is notified in writing that you are taking sick time to recover from a work-related injury. (And keep a copy of that written notification.) In most cases, your Worker’s Compensation will be paid in addition to sick time taken. Union members may have alternate agreements in places, so if you’re part of a union, check with your union boss for details. If your employer is forcing you to take sick time instead of filing for Workers’ Compensation, contact the team at Going and Plank to ensure your rights are being protected.

Fact: Your Employer has a Worker’s Compensation Attorney Working for Them. You Should Too.

When Workers’ Compensation claims are filed, your employer’s insurance company uses an experienced Workers’ Compensation attorney to protect the company’s rights and their financial interests. To make sure you aren’t deprived of your rights, and to ensure receipt of all wage loss and medical expense benefits you deserve, you should also hire a Workers’ Compensation attorney.

Workers’ Compensation cases can be complex, and the insurance company’s goal is to avoid payment of claims if possible. With an experienced workers’ compensation attorney on your side, you’ll be able to fight for the maximum compensation you deserve.

Going and Plank has over 35 years of experience representing Workers’ Compensation clients. Contact us today to schedule a free consultation on your case.

Fact: The Law Offices of Going and Plank Only Gets Paid if You do

Many people are scared to incur additional costs when they’re dealing with Workers’ Compensation issues. However, Going and Plank won’t charge you upfront fees for a Workers Compensation case. In fact, we don’t charge you anything unless you receive your benefits, compensation, or settlement. That means we’re interested in getting you the best settlement possible. Contact us to schedule your free consultation today.

Want to find out more about Dennis Plank? Read these articles and blogs:

Why are Workers’ Comp Claims Denied in PA?

5 Common Reasons Workers’ Comp Claims are Denied

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Why are Workers’ Comp Claims Denied in Pennsylvania?

Or click here to discover an even wider range of legal topics in our legal blog.

Why are Workers’ Compensation Claims Denied in Pennsylvania?

What is Workers’ Compensation?

Workers’ compensation is actually a type of insurance. Employers are required by Pennsylvania law to carry workers’ compensation insurance, often called workers’ comp. When employees are hurt on the job, they may incur medical expenses, miss work, or suffer long-term consequences. Employees who are injured or disabled in connection with their job are usually eligible to receive workers’ compensation benefits which may include recovering lost income, payment of medical bills and, in some cases, a lump sum settlement.

Workers’ Compensation in Pennsylvania

Each state has a slightly different plan. In our state, The Pennsylvania Workers’ Compensation Act requires most employers to compensate employees for lost income and medical expenses. If you’ve been hurt on the job, you may also qualify for potential lump sum settlements. Until 2011, small businesses were exempt from carrying workers’ compensation insurance. In 2011, a measure was signed that expanded the availability of workers’ compensation coverage to all types of small businesses, including sole proprietors, partners in partnerships, and members of limited liability corporations.

However, many workers’ compensation claims in Pennsylvania are denied. While not all denials can be successfully overturned, scheduling a free consultation with an attorney from Going and Plank may be your first step towards getting the compensation you deserve.

Why are Workers’ Compensation Claims Denied?

There are many reasons workers’ compensation claims are denied in Pennsylvania. Each case is different, and no one policy covers all situations. However, there are some circumstances that are especially problematic for employees and insurance companies. In these cases, insurance companies are more likely to deny your claim. An experienced workers’ compensation attorney can help you navigate complicated situations. Here’s a list of some of the common reasons workers’ comp claims are denied.

Denied Because of Lack of Witnesses

Without a witness, it’s easier for insurance companies to claim your accident never happened, or to claim it happened elsewhere. If you make a claim without the proof of an eyewitness, insurance companies will question your claim, and many such claims get denied. If you’ve been hurt at work, but no one saw your injury, Going and Plank may be able to build a case, especially if you told co-workers or supervisors about your injury when it happened, if there are witnesses who saw you before or after the accident, or if you left work that day to seek medical attention. Contact us for a free workers’ comp consultation.

Denied Because You Didn’t Report Your Injury Immediately

Sometimes employees get hurt at work and consider it a minor injury. You may put off reporting your injury until you realize it’s a larger issue. Whenever you experience any type of seemingly minor injury at work, such as a bumped head or a sore joint, report it immediately even if you feel it’s a minor mishap. Often small injuries develop into major medical issues, so cover your bases and report all incidents, big or small. Even if you waited to report your injury, you may still be entitled to workers’ comp. Contact us at Going and Plank for a free consultation.

Denied Because of Inconsistent Accounts

If your version of your injury if different from the accounts given by witnesses, co-workers, supervisors or medical professionals, your workers’ comp claim may be denied. If you feel others are deliberately misrepresenting your injury, or that you are being treated unfairly, contact us at Going and Plank to schedule a free consultation.

Workers-comp-compensation-File-claim-PA-Pennsylvania-Lawyer

Denied Because You Filed a Claim After You Were let go or Fired

Even small injuries at work can quickly escalate into bad situations. It’s important to report work injuries immediately. If you miss working for a few days after your injury to rest up, even if you take sick days, your employer may decide to fire you in the interim. In fact, some employers will fire you because you were hurt on the job, to avoid a claim. Insurance companies often think that if you waited to file a claim until after the termination, it’s an attempt at revenge. If this is your situation, contact us at Going and Plank to discuss your choices.

Denied Because a Medical Exam Detects Illegal Drug use in Your System

After a work-related accident, some employers require a test for illegal substances. Your workers’ comp claim can be denied if drug use led to an increased chance of an accident. However, certain exceptions may apply. Schedule a free consultation with a workers’ comp attorney to weigh your options.

Denied Because You Refuse to Issue a Recorded Statement

Employees may be asked to make a recorded statement for the insurance company, but you are not legally required to make this statement. Since recorded statements can be used against you, it’s smart to consult a workers’ comp lawyer at this point.

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When you retain Going and Plank to represent your interests, we will take the time to thoroughly analyze your claim in order to ensure that lost income is recovered, medical bills are paid, and a lump sum settlement is fully and expertly considered. Click here to schedule a free consultation. 

The Law Offices of Going and Plank are located in downtown Lancaster, PA. We are proud to participate in the Hyatt Legal Plan.

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