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Reporting vs filing a claim Pennsylvania

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  • Reporting vs filing a claim Pennsylvania

    I notice that different states have different laws regarding when an injured employee should must notify his employer of the injury, and how much time can pass before he can't file a WC claim at all.

    I'm having a hard time understanding what the point is of having reporting deadlines (i.e. 14 days from time of injury) when the employee can file a claim up to 2 years later? Does it really matter what my company policy is regarding reporting an injury?

    Thanks.

  • #2
    Yes, and employer can have reporting requirement for any number of reasons. For one, most claims that require you to file a claim also need to be reported for OSHA purposes. There your employer does not have a 2 year window. Most employers also look at the claims data to find trends and address training and safety matters.

    Realize as well, while you have 2 years to file with the state, a claim that comes in two years after the fact is going to be scrutinized by the carrier and more than likely contested. A lot can happen in 2 years and intervening incidents can affect your ability to claim benefits.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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    • #3
      Thanks for the response.

      ONe more question: what if my company has a 7 day reporting deadline and I miss it. What can they really do about it?

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      • #4
        If you miss the deadline, the company could discipline you or even terminate you, although a recent decision by the Worker's Comp Board in Maine has some potential to negate that option for employers in the state.

        The Workers Comp Board here heard a case in which an employee (well over 20 years with the company) was fired for not immediately reporting an injury. In this particular case, the employee bumped his knee and thought nothing of it, as I am sure happens quite often. The next day, the knee was swollen and the employee reported it. Fired on the spot for violating company policy. The Board found that this was unreasonable on the part of the employer and, given the circumstances of the injury, I agree. Not all injuries are immediately recognizable as reportable.

        Still, you should report an injury as soon as possible.
        Senior Professional in Human Resources and Certified Staffing Professional with over 30 years experience. Any advice provided is based upon experience and education, but does not constitute legal advice.

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        • #5
          Good information, thanks.

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          • #6
            Agree with Scott. Though I have to say that case was just begging to be found in the employee's favor. I wouldn't take it to mean that you can't be fired anywhere for not reporting a claim in a timely manner.

            The other downside to not reporting it is that your insurance may reject the claim if it is found to be the result of a work accident. The WC carrier isn't going to pay on a claim you haven't filed and that sticks you with the bill. Same with getting treatment or tests authorized. Even something as simple as PT or an MRI must be approved by the carrier. No claim, no authorization, no treatment.

            Claims that are reported after the fact also tend to be scrutinized and rejected more often than those that are timely filed.

            Bottom line- if you hurt yourself, report it. There is absolutely no benefit in waiting.
            I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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            • #7
              Originally posted by ElleMD
              Though I have to say that case was just begging to be found in the employee's favor. I wouldn't take it to mean that you can't be fired anywhere for not reporting a claim in a timely manner.
              True, the employer was quite unreasonable -- the employee reported the problem as soon as he was aware of it, which was less than 24 hours after the injury took place -- but the wording of the decision effectively gives all employees in this state 90 days to file a claim and prevents any employer from having policies that require earlier reporting.

              Shafer v. Poland Spring

              I dislike the decision, of course, and can only hope that future case law or new legislation will allow employers to get accidents reported in a more timely fashion. The whole idea of us having to go back 90 days to figure out what happened, who witnessed it, etc. just boggles my mind. Fraudulent claims will become an even bigger problem than they have been in the past.
              Senior Professional in Human Resources and Certified Staffing Professional with over 30 years experience. Any advice provided is based upon experience and education, but does not constitute legal advice.

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              • #8
                Could be worse, here it is one year, two for occupational illnesses. I'm also not aware of any other state that restricts the employer from having a more stringent policy. Even if the employee has a certain amount of time to file, the employer may require they be informed of the accident sooner. However, I know in my own state if we terminated for not reporting it, unless it was a major incident, we'd be crucified for it. Disciplining them is one thing but terming is looked at quite differently.
                I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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                • #9
                  I may go ballistic when we have an employee report, say, on Monday, that he was injured at work on Thursday and visited his doctor (translation, Emergency Room) over the weekend, but I would never for a moment consider firing them. That would be a simply golden opportunity for the employee to be unemployable due to the injuries and cost me big bucks in unneccessary WC premiums.
                  Senior Professional in Human Resources and Certified Staffing Professional with over 30 years experience. Any advice provided is based upon experience and education, but does not constitute legal advice.

                  Comment

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