Fraudulent Claim? Our Workers' Comp Defense Attorneys Can Help
Workers’ compensation insurance is designed to provide benefits to employees injured on the job. However, not every claim is valid, and employers and insurers have the right to challenge questionable or fraudulent claims.
If you’re facing a disputed or potentially fraudulent claim, our workers’ compensation defense attorneys serving Bucks, Delaware, and Montgomery Counties can help you evaluate the situation and develop a strategic response.
We work with employers and insurance carriers to investigate claims, protect against liability, and pursue appropriate defenses under Pennsylvania law.
Workers' Compensation in Pennsylvania
The Pennsylvania Department of Labor & Industry has determined the maximum compensation for workplace injuries. That maximum is $1,205 in 2022. That figure represents 66 2/3 percent of an employee's average weekly wage when the weekly wage falls between $ 903.76 and $ 1807.50.
That's a lot of money when, as an employer, you have the responsibility to provide workers' compensation coverage to your employees. However, you also have the right to protect your business against claims that are fraudulent, unwarranted, or unrelated to work activities or for work injuries caused by your employee's drug or alcohol use. Employers and insurers are interested in assessing and mitigating risks due to the increase in weekly benefits, medical costs, settlements, and the number of claims. And as Pennsylvania workers' comp defense attorneys, we do, too.
Our workers' compensation defense lawyers develop sound strategies for self-insured, commercially insured, and uninsured employers, as well as your third-party administrators. We support those strategies with our vast understanding of workers' compensation laws as they apply to employers and employees. That gives our workers' comp defense attorneys an edge when advancing an employer's workers ' comp defense case.
Our Workers' Comp Attorneys Know PA's Requirements
Under Pennsylvania law, you must have workers' compensation coverage if:
- You have at least one employee who could suffer an injury or work-related disease in Pennsylvania.
- Employees work in PA, but an employee could suffer an injury in a state other than Pennsylvania.
- Your employee contracts for work in Pennsylvania. But an injury could occur with any of these conditions:
- The injury occurs outside of Pennsylvania
- The employment is not localized in the state
- Workers' compensation laws in the state where the employee gets injured don't apply
- Employment is not within the United States or Canada
You can learn more about workers' comp by visiting the PA Department of Labor & Industry.
Trust Our Workers' Comp Defense Attorneys to Build Your Case
Eligibility for any workers' compensation claim must include these elements:
- The injured party must be an employee, not an independent contractor.
- An injury must have occurred within the "course and scope of employment."
- There must be a connection between the medical condition or disease and the work performed, with occupational diseases.
As an employer, you have some defenses against workers' comp claims. We've covered several below. But talk with one of our workers' comp defense lawyers to review the details of your situation and develop an appropriate defense.
Under the Influence
The Bureau of Workers' Compensation may deny a claim because a worker was intoxicated. It assumes that the work injury happened directly because of the drug or alcohol use and was not an injury that would have occurred without that effect.
Willful Misconduct or Horseplay
Willful misconduct is another common reason for denial and includes violations of work or safety rules that result in injury. In addition, horseplay or lollygagging may be a defense against a workers' comp claim. However, Pennsylvania law requires proof of the behavior. Moreover, the actions would be unacceptable in the scope of the employee's regular work duties.
Statute of Limitations
In PA, employees must notify their employer within 21 days of the injury unless they are aware of it. Plus, they must notify their employer no later than 120 days after their injury to file for workers' compensation benefits -- failure to do so voids their ability to receive compensation for their injury. Other procedural failings may also disqualify an employee from filing a claim.
Self-Inflicted Injuries
Workers' compensation doesn't apply to self-inflicted injuries. So, if an employee starts a fight, gets hurt, and seeks to file a claim, you have a plausible workers' comp defense.
Link to Employment
The worker's injury must be directly related to their job. For example, if a worker fails to treat a wound properly and becomes infected as a result, they may not be eligible for workers' comp because there is no causal link.
Failing to Attend Doctor Appointments
In Pennsylvania, injured workers must meet with the employer's approved physicians or medical provider within the first 90 days. Failing to do so may result in the dismissal of the workers' compensation claim.
It's critical to talk with a workers' comp defense attorney who knows Pennsylvania laws. Our law firm has four PA offices —Doylestown, Feasterville, Norristown, and Wayne. We're experts in the Commonwealth's legal system.
How Our Workers' Comp Defense Attorneys Can Help
Our local law firm focuses on providing advice and counsel for employers in every aspect of risk assessment, claims mitigation strategy, negotiation, mediation, and litigation. The goal of our workers' comp attorneys is to reduce your organization's liability on claims. In addition to legal representation, we offer in-service seminars and consultations to our clients on a range of workers' compensation topics.
We can also assist you with a range of other business-related services, including employment, business, and IP law. U.S. News cited our firm as one of the Best Law Firms for 2022. Give us a call today. Or contact an attorney directly here.
