Frequently Asked Questions

Can I trust my workers’ compensation claims adjuster to act in my best interest?

The simple answer is no, but not because your adjuster is a bad person. His or her job is to limit the liability of the insurance company and that will always be his or her primary concern. They are generally overworked and subject to endless layers of supervision and oversight. So although generally they are not acting in your best interest, you should always try to treat them with respect. Remember they are the people who can either accept or reject your claim and the people who may eventually decide whether to settle your claim and for how much. So although you are going to treat them nicely, you are never going to trust them and you are especially not going to sign anything they ask you to sign before talking to an attorney.

Should I have an attorney if I am already receiving my workers’ compensation benefits?

The answer to this question is a resounding, YES. You should get an attorney as soon as you are injured at work. Workers’ Compensation law is complicated and decisions you make early could affect your entire case later. A lawyer is not permitted by law to take a fee from a worker until such a fee is ordered by a Judge in connection with litigation. Therefore, all advice and guidance that you get early in your case is for free. One of a lawyer’s main functions in any area of the law is to take the anxiety of making decisions out of the hands of his clients. Why worry yourself over whether you are doing the right thing, when you can have an attorney confidently guide you through the process.

Do I have to treat with the company doctors after a work injury?

Maybe yes, Maybe no. The law states that an injured worker has to treat with the company doctors for 90 days if two conditions have been met. One, the worker must have signed a document which explains his or her rights and obligations under workers’ compensation law, and two, the employer must have made available to the worker a list of at least six medical providers from which the worker can choose. If either of those requirements are not met, you can treat with a doctor of your choice. However, there is a caveat to this. Although you may legally be free to treat with a doctor of your choice, it is not always a good idea to do so. Your goal is to have your employer voluntarily accept your claim. One of the best ways to accomplish that is to cooperate with your employer early in the process. If the company doctor says that you were injured at work and are disabled, usually your employer will accept your claim, but if you refuse to go to the company doctor from the beginning the chance of your employer voluntarily accepting your claim is greatly reduced.

What do I do if my claim for workers’ compensation benefits is denied?

You will need to have your case heard by a workers’ compensation judge, who can order your employer to pay you your benefits. To have your case heard by a workers’ compensation judge, you need to file a claim petition with the Bureau or Workers‘ Compensation in Harrisburg. It is not advisable that you attempt to do this yourself. Your employer will have very experienced lawyers to defend against your claim petition. Given the complexity of workers’ compensation procedure and law, you will also want an experienced workers’ compensation lawyer on your side.

If my claim is denied, can I still get medical treatment for my work injury?

If your employer denies your claim, your medical treatment for your work injury will not be covered by workers’ compensation, and no doctor will be obligated to treat you unless you have private health insurance coverage. However, there are a number of very good doctors who will treat you without payment while your workers’ compensation claim petition for workers’ compensation benefits is pending. If your lawyer thinks that you have a viable workers’ compensation case, he can refer you to one of these doctors.

What if the company doctor releases me to return to work and I am not ready to go back to work?

You can be released to work by a company doctor in two ways. You can be released to full duty or light duty. If you are released to full duty and you do not think you can go to work, you will need to see your own doctor immediately. If you are receiving workers’ compensation benefits and you and your doctor do not believe you can go back to work, and you do not go back to work, generally your benefits will not abruptly end. However, most likely your employer will file a petition to terminate your benefits. This must be defended. You should have already obtained an attorney by now, but if you have not, get one immediately. You will need an attorney who is experienced in workers’ compensation to effectively litigate your case. If you are released only to light duty work, your employer is obligated to either offer you a light duty job or have you evaluated by a vocational specialist to show there are jobs that are physically, vocationally and geographically available to you. Again if you do not go back to work, generally, your benefits will continue, but your employer will file a suspension/modification petition which again must be aggressively defended. At this point things get complicated. You absolutely need an attorney when your employer files a petition. If your claim has been accepted as compensable by your employer, your employer cannot unilaterally stop your benefits until you go back to work, settle your case, agree to end your benefits or a Judge orders your benefits to cease. So if you get a petition in the mail, do not panic. Get an attorney.

If my claim is denied, can I apply for unemployment benefits?

Yes. However, you are not entitled to receive unemployment benefits if you are totally disabled from all employment. You are only entitled to unemployment benefits if you are ready and able to work. Therefore, if you cannot return to your regular employment because of your work injury, but can perform light duty, you may be eligible for unemployment benefits while your claim petition for workers’ compensation is pending. If you have received unemployment benefits while your claim petition is pending and you are eventually awarded workers’ compensation benefits, you will have to pay back the unemployment benefits. The good news is that generally your workers’ compensation benefits will be paid at higher rate than your unemployment benefits.

Can I settle my claim for a lump sum?

The Workers’ Compensation Act provides that workers’ compensation cases can be settled for a lump sum. However, you do not have a right to a settlement. A workers’ compensation judge cannot order that you be paid a lump sum. A settlement has to be agreed upon between you and your employer. Settlement is the preferred method to arriving at a resolution of your case, because it gives you some control over the outcome. When you leave your case in the hands of a workers’ compensation judge you lose all control of the outcome of your case, and you could risk losing all of your benefits.