Orthopedic Injuries & Workers’ Compensation in Pennsylvania

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KEY TAKEAWAYS

  • Workplace orthopedic injuries, often stemming from falls and repetitive motion, can result in significant pain and limited mobility.

  • Musculoskeletal system and connective tissue disorders (MSDs), characterized by bodily reactions, exclude slips and falls and encompass conditions like carpal tunnel syndrome and back injuries.

  • Pennsylvania’s workers’ compensation system supports employees with work-related injuries, offering options for choosing an orthopedic doctor based on employer-provided lists, authorized doctors, or employer selection.

  • Initiating a workers’ compensation claim for orthopedic injuries involves proving work-relatedness, obtaining verification from a doctor, and navigating a process that includes specific forms and regular updates.

  • The 90-day rule in Pennsylvania workers’ comp mandates initial visits to approved doctors, offering injured workers control over their medical care choices after this period, emphasizing transparency, accessibility, and compliance.

On This Page

Orthopedic Injuries in the Workplace

Injuries are a common occurrence in workplaces, often resulting from falls, overexertion, or repetitive motion. These orthopedic injuries affect bones, joints, and muscles and can lead to significant pain, limited mobility, and time away from work. 

The U.S. Bureau of Labor Statistics characterizes musculoskeletal system and connective tissue diseases and disorders (MSDs) as conditions resulting from bodily reactions such as bending, climbing, crawling, reaching, twisting, overexertion, or repetitive motion. 

MSDs exclude disorders caused by slips, trips, falls, or similar incidents. Some examples of common work-related MSDs are:

  • Back injury and back pain
  • Carpal tunnel syndrome
  • Hernia
  • Arthritis 
  • Sprains, strains, and tears

Source: CDC

Employees need to understand their rights and options when facing orthopedic injuries at work.

Finding a Workers’ Comp Orthopedic Doctor in Pennsylvania

Selecting the best orthopedic doctor for a workers’ compensation case is crucial for receiving proper care and ensuring the success of the claim. While Pennsylvania’s workers’ compensation law allows injured workers to choose their doctor after the initial 90-day period, it’s important to consider several factors when making this choice:

  • The doctor’s experience and understanding of the specific medical condition.
  • Willingness to accept the workers’ comp medical fee schedule.
  • Knowledge of the workers’ compensation claim process.
  • Willingness to provide detailed reports to support the workers’ comp claim.
  • Availability for medical appointments.

Understanding Workers’ Compensation in Pennsylvania

Workers’ compensation is a vital system in Pennsylvania, designed to support employees who suffer from work-related injuries, including orthopedic injuries. This system ensures that workers receive the necessary medical treatment, which covers doctor’s appointments, surgeries, physical therapy, medications, injections, and more.

Generally, employees have three options for choosing an orthopedic doctor:

  1. Selecting a doctor from a list or medical network provided by their employer.
  2. Choosing any authorized doctor.
  3. Having their employer choose the treating doctor for them.

Initiating the Workers’ Compensation Claim Process

Filing a workers’ compensation claim for orthopedic injuries, though intimidating due to extensive paperwork and insurance dealings, is crucial, especially for severe injuries requiring immediate medical attention.

Proving the work-related nature of the injury is essential, and this involves a doctor or orthopedic surgeon verifying the injury’s relation to work, the extent of work-relatedness, any resulting restrictions, the patient’s recovery prospects, and the expected recovery period.

Below is a step-by-step guide for processing workers’ compensation claims in Pennsylvania:

  1. Notice of Injury: Employers must inform employees about their workers’ compensation contact details.
  2. Injury Reporting: Employees should report injuries within 21 days; beyond 120 days, compensation may not be allowed.
  3. First Report of Injury: Employers must report injuries to their insurer or management and file a First Report of Injury with the Bureau of Workers’ Compensation within specified timeframes.
  4. Various Notices:
    • Notice of WC Denial: Issued if liability is denied, closing the claim, but employees can seek legal advice.
    • Notice of Temporary Compensation Payable: Extends the investigation period to 90 days.
    • Notice Stopping Temporary Compensation: Must be issued if temporary compensation is stopped, followed by a decision on the claim.
    • Notice of Compensation Payable: Indicates acceptance of liability.
    • Agreement for Compensation: Another form of accepting liability.
  5. Statement of Wages: Used to calculate wages; must be submitted to the bureau.
  6. Notice of Suspension or Modification: Filed when an injured worker returns to work, indicating changes to compensation.
  7. Final Statement of Account of Compensation Paid: Provided to the worker after final payment.
  8. Supplemental Agreement for Compensation: To alter benefits, with necessary submissions to the bureau.
  9. Final Receipt: Filed when benefits terminate, with a three-year window for the worker to contest termination.

For litigated claims, the process includes filing a claim petition, assignment to a judge, hearings, alternative dispute resolution sessions, and potential appeals to higher courts.

Source: Department of Labor, Pennsylvania

The 90-Day Rule for Workers’ Comp in PA

Pennsylvania’s workers’ compensation system includes the 90-day rule, which mandates that injured workers must see a doctor from their employer’s approved list for the first 90 days post-injury. This rule aims to ensure that medical bills are covered. After this initial period, injured workers can choose their own doctor, giving them more control over their medical care.

According to Pennsylvania’s Department of Labor & Industry, there are specific guidelines related to the 90-day rule, including:

  • Employee rights and choices
  • Transparency and accessibility
  • Medical specialization
  • Compliance and regulations

Employee Rights and Choices

The employer is obligated to provide written notice to the employee regarding their rights and responsibilities. This notice must be signed by the employee during the hiring process, whenever modifications are made to the list of healthcare providers, and at the time of injury.

The employer is not permitted to mandate that the employee exclusively see a particular provider from the list. The employee has the option to switch from one designated provider to another, allowing for flexibility in choosing their healthcare provider.

Transparency and Accessibility

Designated providers should be easily accessible geographically and possess specialties that are relevant to potential work-related medical issues that employees may face.

Medical Specialization

The list of providers should include a minimum of six options, with at least three of them being physicians. It’s important to note that the term “providers,” as defined in the Act, encompasses a broader range of healthcare professionals than just physicians.

Each provider’s name, address, telephone number, and specialty must be clearly listed on the provided document. If a specific medical specialty necessary for treating a work-related injury is not included in the list, the employee has the freedom to select a healthcare provider who can offer the required specialty care.

Compliance and Regulations

In cases where the employer’s list of designated providers does not align with the Act and its accompanying regulations, the employee retains the right to seek treatment from a provider of their choice.

Choosing an Orthopedic Doctor for Workers’ Comp

Selecting an orthopedic doctor who specializes in workers’ compensation cases is crucial for effective treatment. The orthopedic specialists at NJ Spine & Orthopedic are experts in bone and muscle injuries and understand the unique challenges of workplace injuries. 

The Ambulatory Surgery Center of Bala Cynwyd is a leading facility for outpatient surgical procedures. It specializes in spine surgery, orthopedic procedures, and pain management injections, offering quality, affordable, and convenient services. 

Schedule a Consultation Today

NJ Spine & Orthopedic is here to help individuals suffering from work-related injuries. Our team is not only adept at diagnosing and treating spinal conditions but also experienced in handling insurance and workers’ compensation claims. We aim to alleviate the burden of dealing with financial and insurance matters during your recovery.

To start your path towards a pain-free life, call (866) 553-0612 or schedule your consultation today.

Frequently Asked Questions

It’s common for workers’ comp insurance companies to initially recommend specific doctors for injured workers​​. However, employees have the right to choose their doctor after the 90-day rule period​​. This flexibility allows them to seek medical treatment from a doctor they trust and are comfortable with.

Any orthopedic injury sustained while performing job duties, ranging from sprained ankles to more severe conditions like a blown-out knee or injured hip, can qualify. The key factor is proving the injury is work-related.

A doctor or orthopedic surgeon needs to confirm the injury’s relation to your job. This includes verifying the injury occurred at work, assessing the extent of work-relatedness, and detailing any work-related restrictions.

LETS GET IN CONTACT

For immediate assistance, please call 855.586.2615
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