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Employees are covered under Workers’ Compensation insurance for injuries sustained on or off the employer’s premises if the employee is acting in the furtherance of the employer’s interests. If an employee is injured, they should immediately seek medical attention and indicate to the medical provider that the injury is related to their job. They should also immediately notify their employer as to the injury, how the injury happened, when the injury occurred, and where the injury happened.
If you or a family member is seeking legal assistance with your current Workers’ compensation benefits or needs help applying for disability benefits after an injury at work, don’t hesitate to call. Experienced Pittsburg, PA Work Injury Lawyer Robert E. Mielnicki can help you. Call 412-288-0300 or contact us online for your free and confidential consultation.
Workers’ Compensation Process in Pittburgh, Pennsylvania
Once the employer is notified of the injury, the must conduct an investigation as to what happened and whether the employee actually sustained an injury during the course of their employment. If the employer determines that a work injury occurred, their Workers Compensation insurance carrier will begin paying for any medical treatment related to the work injury and two thirds (2/3) of any wage loss caused by the worker injury.
If the employer denies the employee’s claim that they sustained a work injury, the employee may file a claim petition with the Bureau of Workers Compensation. The employee should retain an attorney to represent them in filing a claim petition. The attorney will conduct an investigation as to how the injury happened, what injuries were actually sustained, what witnesses and evidence will corroborate how the injury occurred, and what medical doctors will provide reports and testimony to prove that an injury was actually sustained. The attorney will start the process whereby hearings are scheduled for the employee, and any other witnesses, to testify before a judge and for the employer’s doctors to provide testimony by way of depositions.
Pre-Existing Medical Conditions and Workers’ Comp Claims
An experienced attorney is required to review the employee’s medical records to determine what questions are required to be asked both of the employee to fully explain the nature of their injury, and also of the doctors to elaborate on all of the medical criteria that support the fact that the employee’s injury was caused by what happened at work, as opposed to a pre-existing condition or degenerative process.
The employer and their Workers Compensation insurance company will commonly defend against claim petitions by citing pre-existing conditions or age-related concerns that they, and their retained doctors, will point to as the cause of the employee’s inability to work. A claimant must have an attorney to effectively counter their defense by way of cross-examining their doctors to point out inconsistencies in their opinions in the context of standard medical understanding and common sense “cause and effect.”
Pennsylvania Disability Benefits Denials, Modifications, and Appeals
Whether the employer and its insurance company accept the claim and begin paying Workers Compensation benefits or whether they issue a denial, the employee will have to submit to “Independent Medical Examinations “ (IMEs) to be conducted by a physician chosen by the employer. The IME physician’s report can be used to defend against the recognition of a new Workers Compensation claim. It can also be used to show that the injured employee’s “disability,” i.e., impairment has changed, potentially resulting in a modification of benefits.
A modification of benefits may result from the employee’s “disability,” i.e., impairment, being found to be less than fifty percent (50%) of total body impairment. Such a determination results in the employee’s benefits being converted from total “disability” to partial “disability” for a period of five hundred (500) weeks. The employee has the right to challenge such a determination. An experienced attorney may gather and present medical reports and have the employee’s doctors provide testimony that the employee continues to suffer from total, as opposed to partial, “disability.”
The employer and its insurance company may also use an (IME), or a utilization review, to challenge what medical treatment they are responsible to pay. The employer’s Workers Compensation carrier is responsible for the payment of all “reasonable and necessary” medical expenses that are related to the work injury. However, if a utilization review, by a non-treating physician, determines that treatment is not “reasonable and necessary,” the employer will not have to pay for that treatment. An employee can challenge such a determination by filing an appeal and requesting a hearing before a judge to review the determination. The employee may testify as to why the treatment is required and present reports and testimony from the treating physician supporting their appeal.
Pittsburgh Workers’ Comp Lawyer Offering Free Consultations
An attorney can provide the necessary expertise to properly file the appeal and present the required medical evidence to ensure that medical benefits continue.
If you were injured in a workplace accident and need help filing for Workers’ Compensation in Pennsylvania, call 412-288-0300 or contact us online today to speak with dedicated Pittsburgh Workers’ Compensation Attorney Robert E. Mielnicki. We offer a free and confidential consultation to help you begin the workers’ comp. benefits process.