This a question that attorneys are often asked from someone who just had the misfortune of getting injured while at work. It is a question that this author often hears from someone who KNOWS someone who got hurt at work. Well, the short answer is no. Generally, if you fall down at work and break your leg, most likely, you will receive workers’ compensation benefits for time missed for work and your medical bills will be paid by your employer’s workers’ compensation insurance company. However, not all injuries are quite as obvious as a broken leg. For instance, some injuries happen over time – a repetitive trauma. Carpal tunnel, aggravation of pre-existing asthma, or thoracic outlet syndrome are a few examples of work injuries whose causation may not be so obvious. If someone uses her hands at work all day, perhaps the repetitive use caused carpal tunnel over time, perhaps not. These are the cases where legal help is a must, because these are the cases that insurance companies can easily deny as being not work-related.
Any attorney who practices in the area of workers’ compensation will tell you that there are many times when an injured person does NOT need a lawyer. Often times an injured worker will suffer an injury, stay out of work for a few weeks, collect workers’ compensation benefits, and simply return to work. This person may not need a lawyer because everything happened the way it was supposed to. However, and unfortunately, this story is not the norm.
The best advice to anyone injured at work would be to see a lawyer just to learn your rights. At least in Pennsylvania, a consultation with an attorney who practices in this specific area is usually free. There are many things that average people do not know about their rights under the Workers’ Compensation Act of Pennsylvania. How quickly must the injured worker report his injury? What amount will the injured worker get paid while he or she is out of work, and how is this amount determined? If the injured worker is out of work for an extended time, how long will the benefits continue?
The answers to these questions are often simply unknown to the injured worker. Someone injured at work has 120 days to report the injury. You heard that right, one hundred twenty days. Employers often tell their injured workers that since they did not report the injury immediately, their claim will be denied. A knowledgeable attorney will tell you there is nothing in the law to justify such action. When does this situation come up? An employee hurts his back lifting something at work, but he has done this before. In fact he has done this many times before, and usually the pain goes away in a few days. However, this time, his pain does not go away. In fact, this time, after the weekend, he can not even get out of bed. He calls out sick for a few days and then tries to work the rest of the week. He manages to make it through the week, and thinks that all he needs is a weekend of rest to get better. But, he does not get better. In fact, on the next Monday, now a week after his injury, he is feeling worse than he did the previous week. This is exactly the type of claim that employers and workers’ compensation carriers deny because of the simple fact that the injured worker never said anything when the injury happened. Is this the type of claim with which an attorney can help? The short answer is absolutely “yes.”
These are the very situations that naturally happen when a hard worker does not want to look like a crybaby or seek medical treatment, or is afraid of missing work or being fired for pursuing his workers’ compensation rights. There are often these types of situations where the injured worker thinks that he has no rights, and that he might as well just go back to work or quit his job. As an attorney who practices this type of law exclusively, I have seen this scenario far too many times, and, unfortunately, these injured workers often do not consult an attorney because of the fear that it will simply cost them too much.
Attorneys who represent injured workers in Pennsylvania work exclusively on a contingency basis – in other words, if the attorney does not get the injured worker any benefits, the attorney simply does not get paid. Most attorneys will charge a contingent fee of 20% of any wage loss benefits they obtain for their clients, because that percentage is considered to be reasonable in the Workers’ Compensation Act of Pennsylvania. Simply put, if the attorney does not obtain any benefits for the injured worker, he or she will not be paid any fee. This author is amazed at how often injured workers do not even consult with an attorney because of the fear of a consultation fee, or that they “simply can’t afford it.”
There are many, many rights that injured workers in Pennsylvania simply do not know that they have. After an employee is injured, the employer must either accept or deny an injury within 21 days. Once an injury is accepted as work related, the insurance carrier is liable for medical bills and/or wage loss benefits as long as that employee continues to be disabled under the PA Workers’ Compensation Act. Workers’ Compensation insurance carriers often tell medical providers that “we closed that claim,” or that, “the claim is too old, we are not paying.” However, in Pennsylvania, once an injury is accepted by a workers’ compensation carrier, generally benefits (both medical and possibly wage loss) cannot be stopped without a Judge’s order or the specific agreement of the parties.
Injured workers often think that their claim has been accepted by the insurance carrier or employer simply because their medical bills have been paid. However, the payment of medical bills is not an acceptance of liability. In fact, insurance companies will often simply pay for some of the medical bills and simply never accept or deny the claim at all. The injured worker goes back to work and that is the end of the claim. However, what happens when that lower back injury that did not seem very serious comes back a few weeks later? What then? Unfortunately, many injured workers do not consult with an attorney and think they have no rights. “I called the insurance company and they told me my claim has been denied,” is what they often hear. These same injured souls often think they are on their own, or must run their escalating medical bills through their personal insurance, paying endless and often costly co-pays. This is exactly where an attorney can help.
Any attorney who works in this field will tell you that there are many times where the client should be told that she simply does not need an attorney with the type of claim she has. This author has often told injured workers that they do not need legal representation yet, but that they may need it some time in the future. Many attorneys can be retained for legal representation before they are needed, without taking an attorney fee, until they must file or answer a petition filed with the Workers’ Compensation Bureau. In this sense, the attorney works in a type of consultant role, until there is some petition that requires more formal action. Often, if an injured worker does not return to work in what the employer or insurance carrier deems to be a reasonable time, the carrier will file a petition to stop or modify his benefits. If the injured worker already has representation before this happens the lawyer can be in a position to assist and enjoy a significant tactical advantage.
The above samples of the rights of someone injured at work are only a sample of many. The best advice for an injured worker is to consult with an attorney to know your rights, even if the employer and insurance carrier seem to be doing everything correctly, because there are simply too many things the injured worker needs to know, but cannot be expected to know without expert assistance.
The lawyers of Wolf, Baldwin & Associates, P.C. have over seventy years combined experience litigating workers' compensation claims in Southeastern Pennsylvania. We welcome you to browse our website, and to contact us with any question you may have.