You injure yourself at work and cannot do your job. Your employer keeps paying you money for two months and then stops. The employer’s workers’ comp. insurance company then denies your claim, alleging that your injury did not occur in the course of your employment. What gives — is your employer on the hook for your claim because they started to pay you? It depends — our work injury lawyers will describe the circumstances under which they are on the hook for your workers’ comp benefits and are not on the hook.
Let’s begin with the basics. If you sustain an injury on the job in Pennsylvania, you must notify your employer within 120 days. Once it is notified, your employer has 21 days to accept the workers’ comp claim or deny the claim — it can also accept the medical part of your claim and pay your medical benefits but deny the wage loss part of your claim. Normally it is the workers’ comp. insurance company for your employer that makes this determination and issues the necessary documents.
Regardless of what document the insurance company issues, it is possible that your employer will continue to pay you after your injury at work. If it does that – and the insurance company has not issued a document denying your claim, which is called a Notice of Workers’ Compensation Denial – your employer has effectively accepted your claim, as long as the money that it paid you is to compensate you for a work-related injury. So what exactly does that mean? When do payments fall in the category of “compensating you for a work-related injury” and when does it not? Do you need a work injury lawyer?
We’ll give you a couple examples in each category. In one case, which was decided by the Commonwealth Court of Pennsylvania, a man sustained serious injuries when he was brutally assaulted on the job. The owner of the injured man’s company was sympathetic and paid his mortgage payment for a period of time and also made payments to his wife. Later, the workers’ comp. insurance company for the employer wanted to deny the claim on the basis that the man’s injuries occurred due to personal animosity that the person who committed the assault had against the victim of the assault; personal animus is one of the exceptions under Pennsylvania workers’ comp. law. The Court held that by making mortgage payments and payments to the injured man’s wife, the employer admitted liability and the insurance company was estopped — or prevented — from arguing later that the man’s workers’ comp. claim should be denied.
Another example: If an employer is aware that one of its employees sustained injuries at work preventing her from returning to work, pays her salary for a period of time, and the insurance company does not submit a Notice of Workers’ Compensation Denial, the insurance company isn’t going to be able to argue down the road that the injured worker is not entitled to workers’ comp. benefits. Unless there are some extenuating circumstances, under this scenario, the employer and its insurance company are on the hook for this claim based on the employer’s payments to the injured worker.
Suppose, however, that a person sustained an injury two days before pay day and is unable to work. The payroll department wasn’t aware that the employee had gotten injured and issued the usual bi-weekly check to the employee. The payroll department is then alerted that the employee suffered a work injury and is out of work; payroll stops issuing salary payments. Because the one paycheck issued to the employee was not to compensate him for his work injury – it was just a regular paycheck — the employer and insurance company would be able to deny the workers’ comp claim.
Here’s another scenario in which the employer has not admitted it is liable for a work injury and can deny the claim. An employee is injured, goes out of work, and the employer initiates payments to the employee pursuant to its short-term disability program. Because short-term disability payments are normally made for people with non-work-related medical conditions, these payments would not constitute an admission of a work injury, and the employer and insurance company could defend the claim and argue that the employee did not sustain a work injury.
If you injure yourself and your employer starts making payments that are designed to compensate you for a work injury, thereby admitting liability, this will have advantages for you if you continue to remain disabled. Let’s say that six months after your work injury, a doctor for the insurance company examines you and is of the opinion that you can return to light-duty work. Your employer then offers you a light-duty position. If your doctor has not released you to go back to any type of work and you did not accept this offer, your employer and its insurance company will have to file a petition to suspend or modify your benefits, which will go before a Workers’ Compensation Judge. Because your claim has been accepted, though, you will continue to receive workers’ comp. benefits while the petition is being heard by the Judge – this process can take a year.
On the other hand, if your employer made payments that were not designed to compensate you for your work injury and has denied your claim, the burden is on you to file a petition and prove to the Judge that you are entitled to workers’ comp. benefits because you sustained work-related injuries at work which have disabled you from performing your job.
If you have been unfortunate enough to sustain a work injury in Pennsylvania, whether or not your employer or the workers’ comp. carrier has paid you any money, it’s important that you contact a firm that specializes in representing injured workers. At Pearson Koutcher Law, it’s all we do – we only represent injured workers in their PA workers’ comp. cases. We will know exactly what to do whether your employer or insurance company has paid you or not following your injury. So if you have been hurt at work, please call us for a free comprehensive evaluation of your case. One of our experienced and knowledgeable work injury lawyers will answer all your questions and represent you in your case.