Pennsylvania Workers’ Compensation Employer Defense

October 4, 2024 | Workers’ Compensation

Pennsylvania Workers Compensation Employer Defense

Workers’ compensation is usually required for all employers in Pennsylvania with one or more employees. Most employers purchase workers’ compensation insurance coverage to satisfy the requirement. However, state law allows employers to apply for self-insurance status.

An injured worker is generally entitled to workers’ compensation benefits if they are injured on the job. Workers’ comp is a no-fault insurance system. Workers do not need to prove that the employer was negligent in causing their injuries to receive benefits. Workers may also receive workers’ compensation if they are responsible for causing their injuries.

However, employers may have valid defenses to workers’ compensation claims. If so, the worker may not receive benefits, including medical care and lost wages. Potential Pennsylvania workers’ compensation employer defenses include:

Intentional Injuries

Workers’ compensation does not cover self-inflicted injuries. If a worker intentionally causes their injuries, the employer may have a valid defense to the claim. This exception could apply in horseplay, fights, and other willful misconduct cases.

Intoxication

A worker may be denied workers’ comp benefits if they were under the influence of alcohol and/or drugs when they were injured. The accident might not have occurred had the employee not been under the influence.

Ordinary Course of Employment

To be covered by workers’ compensation, the injury must be linked to the worker’s job. Therefore, an employer may deny a claim if the worker was not on the clock or was doing something that was not required to do their job, such as running personal errands.

Expiration of the Statute of Limitations

An employee must report an injury to their employer within 21 days. If the employee fails to report an injury within 120 days, it is a defense to a workers’ compensation claim. If the employer denies the claim or disputes benefits, workers have three years to file a formal workers’ compensation claim with the state.

Failing to Attend Medical Appointments

For the first 90 days, a worker must seek treatment from a medical provider approved by the employer. Failing to do so could result in a denial of the workers’ comp claim. Also, refusing to follow the doctor’s treatment plan could result in a denial of a claim.

Insurance Fraud

Employers and insurance companies investigate workplace accidents. If they believe the worker is lying about their injuries or staged the accident, they may deny the claim and pursue insurance fraud charges.

Steps to Take if Your Pennsylvania Workers’ Compensation Claim Is Denied

Many workers assume they will automatically receive compensation and benefits if they are hurt at work. However, the insurance company or your employer may deny your claim. In addition to the above employer defenses, an insurance company may deny your claim for other reasons, such as providing incorrect information on workers’ comp forms.

If you receive a notice denying your workers’ compensation claim, read the notice carefully. It should state why your claim is denied. You might be able to resolve the situation by providing additional information or documentation.

Contact a workers’ compensation lawyer to discuss the denial and your legal options. You only have 20 days to file an appeal with the Pennsylvania Workers’ Compensation Appeal Board.

Therefore, seek legal advice as soon as possible. The appeals process is complicated. Hiring an experienced attorney to handle a workers’ compensation appeal improves your chance of success.

What Happens After I File an Appeal in a Workers’ Compensation Case in Pennsylvania?

The Appeal Board may hold a hearing for your appeal, but it is not required. The Appeal Board usually reviews the case and renders a decision without a hearing. If the Appeal Board denies your appeal, you have just 30 days to appeal your claim to the Pennsylvania Commonwealth Court.

When Should I Hire an Attorney After a Workplace Injury?

Many workers find that hiring an attorney early in their case is beneficial. It can help prevent being disqualified from receiving workers’ compensation. An attorney ensures the paperwork and documents are correct and filed on time. They also address any issues promptly to try to avoid denials of claims.

Contact Marzzacco Niven & Associates to speak with a Harrisburg workers’ compensation lawyer if you have questions about a workers’ compensation claim or appeal. Your consultation is free and confidential.

If you’ve been injured in a workers’ compensation, please contact Marzzacco Niven & Associates at the nearest location to schedule a free consultation today:

Harrisburg Law Office
945 East Park Drive, Suite 103 Harrisburg, PA 17111
(717) 231-1640

York Law Office
2550 Kingston Road, Suite 210A York, PA 17401
(717) 995-8998

Wyomissing Law Office
833 N. Park Road, Suite 103, Room A Wyomissing, PA 19610
(717) 388-2325

Chambersburg Law Office
79 St. Paul Drive, Suite 1 Chambersburg, PA 17201
(717) 388-2378

Carlisle Law Office
354 Alexander Springs Road Carlisle, PA 17015
(717) 995-8732

Carbondale Law Office
30 Lincoln Avenue, Suite 101 Carbondale, PA 18407
(717) 995-8810

Lancaster Law Office
2173 Embassy Drive, Ste 123, Lancaster Pa 17603
(717) 616-2954

Lebanon Law Office
937 Willow Street, Suite D Lebanon, PA 17042-1140
(717) 995-8963