What Does Workers’ Compensation Not Cover in Pennsylvania?

Workers’ compensation in Pennsylvania is intended to cover any injury or illness sustained by employees while performing their employment duties. The majority of employers in the state are required to carry this type of insurance to protect their employees. Workers’ compensation provides benefits for medical expenses and lost income while the employee cannot work. However, workers’ compensation does not cover all workplace injuries, and not everyone is eligible. Our Carbon County workers’ compensation lawyer can help determine if you qualify.

Activities Unrelated to Employment 

Generally speaking, workers’ compensation will not provide benefits for injuries arising from activities unrelated to employment. The Workers’ Compensation Act in Pennsylvania specifies that only injuries and illnesses sustained during the scope and course of employment are covered under workers’ compensation insurance. Therefore, if you suffered injuries outside of regular business hours or outside of the workplace, you may not qualify for benefits.

However, if you are in this situation, it is critical that you speak to an attorney. For example, if you were working overtime, this could be regarded as an injury that occurred outside of regular working hours. If your employer asked you to work overtime, though, you likely still qualify for workers’ compensation benefits.

Reckless Behavior 

Workers’ compensation insurance companies may also deny a claim if the employee was engaging in reckless behavior at the time. For example, if your employer provided you with safety equipment but you did not use it and became hurt, this could be a reason for a denial. These cases rely heavily on the specific facts of a situation.

Additionally, the law allows employers to deny workers’ compensation benefits if the employee was impaired by drugs or alcohol at the time of injury. Sometimes, employers may argue an employee was impaired even though they were not, so it is always important to speak to an attorney.

Unreasonable Medical Treatment 

Workers’ compensation will pay for medical treatment as long as it is considered reasonable. If your employer believes that your treatment is unreasonable, unusual, or medically unnecessary, they can file a Utilization Review. If the Utilization Review also deems that your medical treatment was unreasonable or unnecessary, your employer then has the right to deny you coverage.

Certain Workers Do Not Qualify

 Only employees are eligible for workers’ compensation. Workers who are not classified as employees are not eligible. As such, if you are an independent contractor, you do not qualify. Additionally, certain agricultural workers, federal employees, and executives are also ineligible for workers’ compensation benefits.

Call Our Workers’ Compensation Lawyer in Carbon County Today 

If you have been injured while on the job, you may be eligible for workers’ compensation benefits. Unfortunately, many employers and insurance companies wrongfully deny employees the benefits they need. At The Law Office of Kim M. Gillen, P.C., our Carbon County workers’ compensation lawyer can review the facts of your case, determine if you qualify, and help you obtain the full benefits you deserve. Call us now at 484-613-0011 or contact us online to schedule a consultation and to get the legal help you need.

Source:

pa.gov/en/agencies/dli/programs-services/workers-compensation.html