Workers’ compensation benefits protect injured workers in Philadelphia and across the U.S. When your company offers workers’ compensation, you will receive benefits for work-related injuries or illnesses.
Workers’ compensation is also a legal right in Pennsylvania, where you are entitled to support after an injury or illness. You have the right to receive money to help you pay for medical care and to cover lost income.
Unfortunately, your workers’ compensation claim may be disputed by your employer or insurance company. If this happens, you may become stressed or overwhelmed as you worry about how to pay for medical treatment.
You can, however, follow several steps to challenge the dispute on your claim.
What Are the Basics of Workers’ Compensation in Philadelphia?
The Pennsylvania Workers’ Compensation Act governs Philadelphia workers’ compensation. The Act sets out the guidelines and rules for handling work-related injury claims.
Some workers may not know this, but this law covers physical and mental injuries sustained on duty. Because some industries are more hazardous to employees than others, specific sectors must offer workers’ compensation insurance.
Overall, the system is supposed to be fair and pay out benefits fast. But this will not necessarily happen when an employer or insurance company disputes a claim.
For instance, your employer may argue that you did not sustain your injury or illness at work. They may also claim that you are exaggerating your injury.
If there is a disagreement about the extent of the benefits you should receive, it also leads to a dispute.
If a dispute arises, you have the right to challenge unfair decisions.
Steps You Can Follow When Challenging Disputed Claims
The last thing you want to do while ill or injured is fight over money. Instead of retaliating aggressively (which will count against you), follow these steps.
1. Review the Decision
The first thing you need to do is read the decision notice or letter carefully. Make sure you fully understand why there is a dispute on your claim.
The notice should list all the reasons for the decisions, so look for errors there. Sometimes, one mistake can result in a dispute. If you find one, make a note of it or highlight it.
2. Compile Your Evidence
Your work-related injury or illness will inevitably come with evidence. This means you will have documentation and correspondence that proves what happened.
So, you must gather all of this evidence to prove that you need workers’ compensation benefits. The most important documents you need include:
- All medical reports and records related to your condition
- An accident or incident report, if relevant
- Witness statements from colleagues who saw what happened
- All communication with your employer
- All correspondence with the insurance company
3. Re-evaluate Your Medical Condition
If the dispute comes from a disagreement over your medical condition, you can go for a re-evaluation. Doing this will give you an updated report on your injury or illness and its treatment.
A fresh medical opinion that supports your claim should spur your employer to reconsider. The new report should ideally show clearly how your condition affects your work and daily life.
4. Consult a Workers’ Compensation Lawyer
If it seems like you are getting nowhere challenging the dispute, getting a lawyer is a good idea. A workers’ compensation lawyer specializes in related claims and understands all the relevant laws and processes.
The lawyer will review all your documents and evidence and guide you on your next steps. He or she can also represent you at a hearing if necessary.
5. File an Appeal
Your lawyer can also help you file an appeal within a specific timeframe. You can find the deadline for appeals in the dispute notice.
Keep in mind that filing an appeal is a formal process. As such, you will have to work with your lawyer to gather more evidence. You may also have to attend a hearing or mediation session.
6. Attend a Mediation or Hearing
You can often resolve a dispute through mediation or a hearing.
Mediation always involves a neutral third party who works to help both sides reach an agreement. If it does not work, you could arrange for a hearing process. The administrative law judge will oversee the hearings.
You must explain your situation and bring your documents to support your claims during these hearings. Do not exaggerate anything about your injury or illness. You will have the lawyer by your side to guide you on what to say and what not to say.
7. Follow up on Your Appeal
Once your appeal is filed, you can regularly follow up on its progress.
Stay in contact with your lawyer while you wait for a resolution. If the court needs additional requirements, he or she will advise you on how to proceed.
Other Things to Know About the Dispute Process
It is important to keep the following in mind as you go through a dispute process:
- The Pennsylvania Workers’ Compensation Act has strict legal standards for claims. It suggests you and your employer must provide evidence to state your cases. The judge or mediator will consider all the facts presented before deciding.
- In any disputed case, the burden of proof lies on both sides. You have to prove your injury or illness is work-related. Your employer must prove otherwise. Having strong evidence may be enough to tilt the balance in your favor.
- Reaching a settlement agreement before a judge or mediator makes a final decision is possible. In most instances, reaching an agreement early is the most practical solution for both parties. It cannot only save you a lot of time, but it also reduces your stress.
Workers’ Compensation Will Remain a Critical Benefit
If you are exposed to workplace hazards every day, workers’ compensation benefits are a must. You can challenge the dispute if the employer or insurance company disputes your claim or gives unfair compensation.
Ultimately, your goal should be to recover well and to be financially secure while doing so. You should not let a dispute about benefits get in the way of this. With the right approach and the help of a skilled lawyer, you can keep your compensation claim on track.
