Fraudulent Claim? Our Workers Compensation Defense Attorneys Can Help

The Pennsylvania Department of Labor & Industry has determined the maximum compensation for work injuries occurring on and after Jan. 1, 2020 will be $1081.00 per week amounting to a weekly wage increase of 3.1 percent. The weekly compensation rate is 66 2/3 percent of the employee’s average weekly wage if the wage falls between $1,621.50 and $810.76. The weekly compensation rate is $540.50 if the employee’s average weekly wage is between $810.75 and $600.56, and 90 percent of the employee’s average weekly wage if it is $600.55 or less.

That's a lot of money when, as an employer, you have the responsibility to provide workers’ compensation coverage to your employees. But keep this in mind, 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. Given the increase in weekly benefits, medical costs, settlements and number of claims, employers and your insurers have an interest in assessing and mitigating risks. And as Pennsylvania workers’ compensation defense attorneys, so do we.

Our workers' comp lawyers develop sound strategies for self-insured, commercially insured and uninsured employers and your third-party administrators. Those strategies are supported by the fact we understand workers comp laws as they apply both to employers and employees. That gives our workers’ compensation defense attorneys an upper hand when advancing an employer’s workers comp defense case.

What is an employer’s workers’ compensation responsibility?

Under Pennsylvania law, you are required to have workers’ compensation coverage if:

  • You have at least one employee who could suffer an injury or work-related disease in Pennsylvania.
  • Employment is localized in Pennsylvania, but your employee could be injured in a state other than Pennsylvania.
  • Your employee is under a contract of hire made in Pennsylvania but could be injured outside the state of Pennsylvania, the employment is not localized in the state, the workers’ compensation laws in the state in which employment is localized do not apply, or employment is not within the United States or Canada.

Defenses for a workers comp claim

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.”
  • In cases of occupational diseases, there must be a connection between the medical condition or disease and the work performed.

Claims may be denied because a worker was intoxicated, assuming that the work injury happened because of the drug or alcohol use and was not an injury that would have occurred whether the employee was intoxicated or not.

Willful misconduct is another common reason for denial and includes violations of work or safety rules that lead to an injury. Horseplay or goofing off during work may be a defense against a workers’ compensation claim, but under Pennsylvania law, it must be proven that this behavior is not considered to be unacceptable in the scope of the employee’s duties.

No employee is eligible for workers’ compensation benefits for a self-inflicted work injury.

How our workers’ compensation defense attorneys can help

Our workers comp 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 lawyers in our Doylestown and Norristown law offices is to effectively reduce your organization’s claims liability. To that end, we are proactive and also offer in-service seminars and consultations to our clients about a range of workers’ compensation topics.

Our experience is a key ingredient in successful workers’ compensation defense matters. You can trust our workers’ compensation defense attorneys to help you, as a Pennsylvania employer, defend against fraudulent or unwarranted workers’ compensation claims. Give us a call today to put our workers comp lawyers to work for you.

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