Tuesday, October 2, 2012

15 Common Mistakes That Will Sink Your Pennsylvania Work Comp Claim

After more than 17 years of helping victims of workplace injuries collect workers' compensation benefits, I have seen claimants make serious mistakes that hurt their claim and made it more difficult for them to collect full payment.  To help you avoid these mistakes, I have categorized the 15 most common mistakes and present them to you.  I am confident that after reading this article, you will have a better chance of collecting full payment for your workman's compensation claim.

1. Failure to Report the Accident to Your Employer.

Pennsylvania law requires that a claim be reported to your employer within 120 days from the date of the injury.  The best practice is to report an incident immediately, even if you don't go to the hospital right away.  The best way to report an injury is to talk to you supervisor and make sure a report about the discussion is made.

2. Failure to File a Claim Petition within the 3 year statue of limitations period.

Reporting an injury to your employer is merely a first step.  If you are owed benefits and your employer or its insurance company refuses to pay for your medical bills or wage loss, Pennsylvania law requires that a claim be filed with the Bureau of Workers' Compensation 3 years from the date of the accident. If you wait to contact a lawyer and file a claim beyond the 3 years, you might be precluded from receiving the benefits you deserve.

3. Failure to Inform the Doctor of the Details of Your Accident.

If your medical records do not reflect the fact that you have been in an accident, your claim may be suspect. Insurance companies use any excuse they can find to deny your claim. The absence of any information in your medical records about your accident may give them the excuse they want

4. Failure to Keep a Job Search Log.

The worker has the burden of proving that they are unable to work as a result of a workers' compensation injury or occupational disease. One of the best ways to prove that you cannot work is to show that you have honestly tried to work but were unable to find and maintain a job.

5. Failure to Fully Inform Your Lawyer of All Facts.

Workers' compensation cases are difficult enough to handle successfully, even when a lawyer has all the facts. If you do not fully inform your lawyer concerning all facts, the good, the bad and the ugly, you severely handicap your lawyer's ability to win the case for you. Many facts which you may feel to be adverse can be successfully handled. Do not short change yourself by keeping your lawyer in the dark.

6. Failure to Fully Cooperate with All Vocational Rehabilitation Efforts.

The point at which the insurance company hires a vocational rehabilitation specialist to actively become involved in trying to find a job for you is probably the most critical point in the claims process. You should not attempt to deal with the rehabilitation process without the assistance of an experienced workers' compensation lawyer. Vocational rehabilitation counselors, in the vast majority of cases, are not on your side. It is their job to terminate your benefits, either by your becoming employed or by taking advantage of your failure to cooperate, thereby have your benefits terminated. It is in your best interests to return to work at suitable employment. You should, therefore, fully cooperate with all reasonable vocational rehabilitation efforts.

7. Failure to Accept Suitable Employment.

It is in your best interest to accept suitable employment whether at your prior job or at a new job that may be presented to you. The law does not (and should not) allow a worker to collect workers' compensation benefits if they can work. On the other hand, you are not required to accept any job that your employer or their vocational rehabilitation worker finds for you. The work must be "suitable" to you based upon your physical limitations, age, education, training, and experience. It is important to work closely with an experienced workers' compensation lawyer to help you determine whether any job offered to you is suitable

8. Failure to Anticipate That You Will Be Followed and Videotaped.

It is a mistake to assume that you will not be followed and videotaped by private investigators. Insurance companies would rather pay money to private investigators and lawyers than pay it to you. You should assume that a private investigator will be watching your every move outside of your home. In some cases, they even look inside your home.

9. Working outside Restrictions When You Return to Work.

If a doctor allows you to return to work but conditions your return to work on certain restrictions such as not lifting above a certain weight, or raising your arms above your head, you should follow these restrictions explicitly. When you return to work, there is a temptation to follow your supervisor's instructions even if those instructions would have you working in excess of the limitations your doctor imposes upon you. This is a serious mistake. Carry the doctor's written restrictions with you when you return to work and, if your supervisor tries to coerce you into working outside of those restrictions, give another copy of those restrictions to your immediate supervisor and politely tell that supervisor that your doctor will not allow you to work outside those restrictions

10. Settling Your Claim without the Benefit of an Experienced Workers' Compensation Lawyer.

It is a serious mistake to assume that your employer and its insurance company will treat you fairly. You should understand that in the vast majority of the cases, they will take advantage of you if you let them. The professionals who work for your employer and the insurance company know workers' compensation law inside out. They are looking after themselves, not you. Always seek the advice of an experienced workers' compensation lawyer before you sign any agreements.

11. To Assume That Nurse Case Managers Are Your Friend.

Nurse Case Managers are working for your employer and the insurance company. They are not working for you.  They should not be allowed to talk to your doctors nor be present during examinations.  They will do everything in their power to attempt to get you back to work, whether you are physically ready to return to work or not.

12. Allowing the Employer to "Doctor Shop".

If your employer accepts your claim and agrees to pay, they do have a right to direct your medical care for the first 90 days, assuming they have posted a list of various doctors at your place of employment.  You can choose whom you wish to treat from this list.  
If you treat outside of that list, then you run of risk of the employer not paying for your medical care.  However, there are things the employer must do before they can enforce this rule.  If there is no list then you can treat with whoever you want.  Further, iff you weren't provided with a copy of that list when you were hired AND right after your injury, then you can choose whoever you want.  However, once your medical providers have been established, they cannot switch you to another doctor without your permission. Insurance companies like to have you seen by doctors who they can count on to "sing their song". Do not allow them to do this. If your employer or its insurance carrier attempts to switch you to another doctor, consult an experienced workers' compensation lawyer immediately.

13. Failure to Consider a Second Opinion.

The law allows an injured worker to obtain a second opinion if the worker is not satisfied with the opinion of the doctor concerning the nature and extent of your disability. You should consider asking for a second opinion. However, it is not always wise to ask for a second opinion. This decision is case specific. You should consult with an experienced workers' compensation lawyer to help you decide whether you should ask for a second opinion.

14. Assuming That the Compensation Rate Set by the Employer is Correct.

Most of the benefits you are entitled to receive from your workers' compensation claim are based upon your average weekly wage. The average weekly wage includes the gross amount of your pay before any deductions. Average weekly wage may also be increased because of certain allowances your employer may provide such as a housing allowance. Do not be short changed by settling for an incorrect compensation rate.

15. Failure to Seek Medical Care.

Many injured workers, especially males, try to "shake it off" after they are injured at work and fail to seek appropriate medical attention. It is not unusual for a person to have significant injuries without realizing it. If an injured worker waits several days or weeks before seeking medical attention, the claim is suspect. This delay in treatment gives the employer still another excuse to deny the claim.

1 comment:

Doris Belt said...

Thanks a lot, for giving us a very important that will help a lot of people who doesn't have much knowledge how to claim their benefits in an Insurance company.