Workers’ Compensation Handbook
III. What Should I Do If I Am Injured?
When injured at work, there are requirements that injured workers must meet in order to protect their potential rights and benefits under the Workers’ Compensation Act. Likewise, employers must follow certain procedures when informed that an employee has been injured on the job. If an employer fails to follow the necessary procedures, the employer would be in violation of the Workers’ Compensation Act and subject to penalties of up to 50% of benefits due to the injured worker.
One of the most important obligations an injured worker must abide by when injured on the job is to give notice. An employee must tell his or her employer about the work-related injury within 21 days, but no later than 120 days from the date the employee sustains the injury. An injured worker will be barred from benefits if he or she fails to give notice of the injury to the employer within 120 days*. However, it is not enough to just report the injury. The injured worker must report the injury as work-related. It is important to fill out an incident report as soon as possible. It may be advisable to have your union representative present when this report is filled out. This report provides the necessary information about the accident and puts the employer on notice, but it should not be confused with filing a claim for workers’ compensation benefits, which will be discussed later in this booklet. Remember that you have up to 120 days to give notice pursuant to state law and under no circumstance is this time period shortened. For example, many employers have policies that a work injury must be reported within 48 hours or some other time frame. Therefore, many workers think that they cannot report an injury beyond that time period. This is simply not true.
Some injuries are obviously related to work while others are not and may develop over months or years. In these cases, the employee must report this type of work injury to the employer within 120 days of the date that a medical doctor relates the injury to work.
Do not let a supervisor or other representative of your employer deter you from reporting your injury and filling out a report. Often, employers will try to convince employees not to fill out an accident report because they may be concerned about their insurance premium with their workers’ compensation insurance carrier. Be advised that once you have filled out an accident report, the employer or insurance carrier must let you know within 21 days whether they are considering the injury to be a work-related injury. Often, employers will not do this for the above reason and as a result, the injured employee’s claim is never properly documented with the Bureau of Workers’ Compensation. This can affect the employee’s rights and benefits into the future.
Your obligation, as an injured employee, to give notice of your injury and its relation to work, is the most important prerequisite to protecting your rights. If you do not give notice within 120 days, you will, in most circumstances, have waived your right to workers’ compensation benefits.
*If day 120 falls on a weekend or a holiday you may have additional days but do not delay.
An Uninsured Employer
If an employer is uninsured then the injured worker must file a Notice of Claim Against Uninsured Employer with the Bureau of Workers’ Compensation and the Pennsylvania Uninsured Employer Guaranty Fund within 45 days of the date the worker discovers that the employer is not insured. Once this notice is filed, the injured worker may have recourse for his lost wages and medical benefits from the Uninsured Employer Guaranty Fund, a fund specifically established for injured workers of uninsured employers. There is also the possibility that the employer will be criminally prosecuted for its failure to maintain workers’ compensation insurance benefits. If a Notice of Claim is not filed with the Bureau of Workers’ Compensation within the requisite 45 days, the injured worker may be precluded from obtaining workers’ compensation benefits.
Filing a Claim
As stated above, after you have reported your injury, your employer must either accept or deny your claim within 21 days from the date you gave notice that you sustained a work-related injury. The acceptance or denial of your claim must be on one of four very specific documents. Your employer or its insurance carrier can accept your injury by issuing documents developed by the Bureau of Workers’ Compensation entitled either “Notice of Temporary Compensation Payable,” “Notice of Compensation Payable,” “Medical Only Notice of Compensation Payable,” or “Agreement for Compensation,” all of which will be discussed later in more detail in this booklet. Please note that if you do not receive any one of these documents within 21 days from the date you reported your injury, it is as if your employer has denied your injury. Your employer denies your injury by issuing a “Notice of Workers’ Compensation Denial” or by not issuing any document whatsoever. If your employer does not issue any document, your employer may be subject to penalties if you file a successful Claim Petition with the Bureau of Workers’ Compensation.
If your employer or its insurance carrier denies your injury as work-related, you can file a Claim Petition and have your case decided by a Workers’ Compensation Judge. You must file your claim within three (3) years from the date of the injury. This is the Statute of Limitations. For occupational disease claims, the three-year time limit starts when you learn that your disease may be related to your work, and the disease has caused a wage loss or you no longer work for that employer.
Many workers mistakenly think that reporting an injury is the same as filing a claim. It is important not to confuse these two events. A claim must be filed with the Bureau of Workers’ Compensation on a Claim Petition. After a Claim Petition is filed the claim is assigned to a Workers’ Compensation Judge. Many workers also mistakenly think that if the employer is paying for the medical expenses related to the work injury, the employer has accepted responsibility for the injury. Be advised that payment of medical bills by an employer or its insurance carrier is not an acceptance for the injury unless they have given you one of the above mentioned documents developed by the Bureau of Workers’ Compensation. Often, an injured employee will assume that the employer’s payment of medical expenses means acceptance of the claim, only to find out, once the 3 year time limit passes, that the employer never accepted the claim. At this point, it is potentially too late for the employee to file a claim, however, there may be some exceptions to this rule so you may wish to consult an attorney.
Seeking Medical Treatment
The Workers’ Compensation Act permits your employer or its insurance carrier to dictate the treatment for your work-related injury for a period of 90 days. In order to have this right, the employer must post a list of 6 healthcare providers for you to choose from. You can choose from ANY of the 6 healthcare providers on the list. This is your right. After 90 days have passed, you can receive treatment from any healthcare provider of your choice. Remember, if your employer never indicates that they have accepted your claim within the requisite 21 days from the day you report your injury, then you can treat with medical provider of your choice that may not be on the Employer’s list after the 21 days. If your employer has not posted a list of six healthcare providers to be seen in the event of a work-related injury, you may see any doctor of your choice right away.
The employer must provide written notification to the employee explaining these rights and duties. Notification to the employee must be evidenced by an acknowledgment signed by the employee that the employer provided the information. Failure of the employer to provide the information relieves the employee of responsibility to treat with the employer’s medical provider and the employer remains responsible for all medical treatment rendered.
If an invasive procedure is necessary during the initial 90-day period, the employee is entitled to secure a second opinion from a doctor of the employee’s choice and follow that course of treatment. However, the Workers’ Compensation Act indicates that the course of treatment and medical procedures designated in the second opinion shall be performed by one of the employer’s doctors. In addition, the employee must comply with an additional 90 days of treatment with the employer’s doctor or the employer will be relieved from liability for payment of medical bills incurred as a result of the alternative course of treatment.
After the 90-day period, the employee can choose any healthcare provider but must notify the employer within 5 days of the first visit of the healthcare provider’s name and address. An employee’s failure to notify the employer relieves the employer from payment of medical bills. Your doctor will have to provide your employer with periodic reports about your treatment. The first report must be sent to your employer within 10 days of the first treatment. Reports then must be provided on a monthly basis for as long as you treat with that doctor for the work injury.
If you suffer from a condition or disease that you believe is related to your work, it is very important to tell your doctor about your job, the type of physical activities you are required to perform and any toxic exposures or substances to which you may have been exposed. If possible, obtain the Material Safety Data Sheets (MSDS) from your employer or your union for your doctor to review. Your doctor can then advise you if your problem is work-related.
TIP: Remember you should schedule your own appointments with medical providers regardless of who chooses the medical provider. Even when you are treating with the panel medical providers, you want to maintain control over your medical treatment. Cases are won and lost based on the medical evidence. If you permit the insurance company or your employer free access to discuss your case and treatment, often you may not receive the benefits you are entitled to.