Have you been hurt at work? Everyone who is injured at work needs to know how the Workers Compensation laws protect them. Handling a Workers Compensation claim is not easy. The Workers Compensation insurance companies are not there to help you. Their job is to find a way to deny or limit your claim. There are many laws and obligations that require your timely attention. If you have been injured at work, we can help. INJURED WORKERS’ HELPLINE 888-947-4848.
WORK RELATED INJURIES
The Pennsylvania Department of Labor and Industry tells us that 85,000 people are injured each year in work related accidents in Pennsylvania alone. Fortunately those people have the Pennsylvania Workers Compensation Act to protect them while they are injured on the job.
Everyone who is injured at work needs to know how the Workers Compensation laws protect them and how their rights can be attacked by the workers compensation insurance carriers. Handling a workers compensation claim is neither an easy or straightforward matter for the uninitiated. In fact a great deal of our workers compensation clients are referred in from other attorneys who do not handle workers compensation cases because of the technicalities and practical considerations involved. The following is some basic information on Pennsylvania Workers Compensation Claims.
WORKERS’ COMPENSATION IN PENNSYLVANIA
The Pennsylvania Workers Compensation Act has broad application to almost all injuries that occur in Pennsylvania, to injuries that occur out of state to Pennsylvania Employees, and to Employees who are from out of state but are injured in Pennsylvania. Therefore, if you work in Pennsylvania or if you are injured in Pennsylvania you are entitled to receive benefits under the Pennsylvania Workers Compensation Laws.
In Pennsylvania, Workers’ Compensation is available when you: (1) sustain an injury, (2) in the course and scope of your employment. These two factors will entitle you to payment of reasonable, necessary and causally related medical expenses. This is the Medical Benefit of our Workers Compensation system.
If, in addition to having medical expenses, you are unable to make your pre-injury average weekly paycheck because of the work injury, you are entitled to a workers’ compensation wage loss payment. This is called the Indemnity Benefit or Wage Loss Benefit in our Workers’ Compensation system.
Under the Pennsylvania Workers’ Compensation Act there many additional benefits including, but not limited to, payment for the amputation or loss of, or for the loss of use of, certain body parts and for scarring of the face and neck. These benefits are called Specific Loss Benefits. There are additional benefits for occupational diseases such as asbestosis and coal miners disease; fatal claim benefits; Heart & Lung benefits; benefits for widows and children. There are other benefits available as well.
You are not permitted to recover for pain and suffering under the workers’ compensation law. Workers’ Compensation is the exclusive remedy of an employee against his or her employer in most, but not all, situations. The Pennsylvania Workers’ Compensation Act is complex. If you have been injured in a work related accident or event, you need to speak with a lawyer. You will be required to deal with people who are much more familiar with the process, and whose interests will not likely be consistent with yours. Do not go it alone. Call our skilled team for help.
WORKERS COMPENSATION FREQUENTLY ASKED QUESTIONS (F.A.Q.):
TOTAL DISABILITY AND PARTIAL DISABILITY
In Pennsylvania, the term “total disability” in workers’ compensation language means that you are unable to earn any money. This is often called “TTD” on your workers’ compensation check. Technically speaking there is no specific time limitation on your receipt of total disability. However, your workers compensation insurance carrier has many ways of fighting your total disability status, and they will use them against you.
“Partial disability” means that you are able to earn some money, but not as much money as you made at the time of the injury. Partial disability is limited to 500 weeks of payments; or about 9.6 years time.
HOW LONG WILL MY WORKERS’ COMPENSATION LAST?
There is no specific time limitation to your eligibility for collecting “total disability.” However, from a practical perspective, your employer, its workers’ compensation carrier or its third party administrator will not likely allow you to collect compensation without end; at least not without a fight. They will find a method to challenge your entitlement to Workers’ Comp.
When you receive “partial disability” payments there is a 500 week period at the end of which your eligibility for wage loss payments can expire.
As a general rule in Pennsylvania, once your claim has been accepted by your employer or awarded by a workers’ compensation judge, your benefits will continue until you agree to change them, or until a workers’ compensation judge enters an award permitting the employer to terminate, modify, or suspend your benefits.
CAN THEY TAKE MY WORKERS’ COMPENSATION?
The employer’s workers’ compensation insurance carrier has a variety of methods for challenging your entitlement to compensation. The three most common methods are by filing Petitions to Terminate, Modify, and/or Suspend your compensation. If you have had one of these Petitions filed against you, please immediately call a Workers’ Compensation lawyer.
A Termination Petition requests that a workers’ compensation judge determine that your workers’ compensation case is over because you are “fully recovered” from your work injuries. An Order of Termination would completely stop both your wage loss and medical benefits. We often see opinions from defense doctors who perform “IMEs” that state that a Claimant is “fully recovered” from whatever happened on the date of injury, and that whatever medical problems continue are attributable to another cause.
Modification Petitions and Suspension Petitions will only change your entitlement to continuing wage loss payments and do not change entitlement to medical benefits. A Suspension is appropriate where you have no loss of earning capacity. For example, if you return to a job that pays you as much as you made at the time that you got hurt, a Suspension is appropriate.
A Modification is appropriate where you have some earning capacity, but not as much as you had at the time of your work injury. For example, if you returned to a job but your earnings were $100.00 short per week, you would be entitled to collect $66.67 per week in the form of “partial disability.” Remember that there is a 500 week time limitation on “partial disability.”
Be especially aware if you receive a Notice of Suspension or Modification Pursuant to §§ 413 (C) & (D) because time is of the essence for you to act to keep your benefits! Call a Workers’ Compensation attorney right away if you receive this document.
Utilization Review is one of the tools used by the workers compensation insurance industry to limit the amount of your Medical Benefits. Remember, the standard for the payment of medical benefits in Pennsylvania Workers Compensation is that the treatment must be: (1) Reasonable; (2) Necessary; and (3) Causally Related to the work injury. This is a rather liberal standard in favor of the employee. If a medical provider sends a bill to the workers compensation carrier in the proper form, the burden is on the insurance carrier to pay the bill within thirty (30) days or to submit the bill to a Utilization Review Organization, also called a “URO”. A URO can only address the reasonableness and necessity of the treatment. A URO can not address the causal relation to the work injury. If a URO has been performed and results in an unfavorable decision, in whole or in part, it must promptly be appealed to a Workers Compensation Judge. Time is of the essence in all of these matters.
INDEPENDENT MEDICAL EXAMINATION (IME).
Insurance companies and employers have the right to have you submit to an examination by a physician of their own choosing at reasonable intervals. Although “reasonable intervals” are not defined in the Pennsyvlania Workers’ Compensation Act, the general consensus is that six (6) months is a reasonable interval.
However the term “Independent” is a misnomer as pertains to these examinations. These doctors are typically hired guns for the defense and are not typically selected by the Judges. These doctors have no responsibility to you. No doctor-patient relationship will result from the examination. These doctors are typically paid hefty sums of money to see you one time; far more money than they receive for actually treating patients. Therefore there is no such thing as an “Independent” medical exam. Rather, they are truly “Defense” medical examinations.
IMPAIRMENT RATING EVALUATION (IRE).
Under the Pennsylvanie Workers’ Compensation Law, those defending against your claim can request that you be seen by the same defense medical examiners for the purpose of establishing your whole person impairment rating under the American Medical Association Guides to the Evaluation of Permanent Impairment. If your injury does not result in an Impairment Rating of 50% or greater, your benefits can change from “Total Disability” to “Partial Disability” and consequently the 500 week time limitation can begin.
However, there are very strict technical rules about when an IRE has to be requested, how an IRE is requested, and what the defense does with the IRE after the examination. If you have received a Request for Designation of a Physician to Perform an Impairment Rating Evaluation, you should immediately contact a lawyer.
THE BOTTOM LINE
Ultimately, if the case is properly handled in a timely fashion, once the employer or its carrier accepts your claim, the workers’ compensation insurance carrier has to convince a workers’ compensation judge that facts exist that entitle them to stop or change your benefits. Just because the carrier says it is entitled to change your benefits does not mean that it will automatically be successful in so doing. There is ample opportunity for us to litigate the matter and present your side of the facts.
Whether you call it Workers’ Compensation, Workmen’s Comp, Work Comp, or Work Compensation, in order for the law to work for you, you should contact an attorney who handles these matters on a regular basis to best protect your rights. This is what we do on a regular basis and we do it well.
This is intended to be a very general overview of Pennsylvania Workers’ Compensation Law. The law is much more comprehensive and specific. There are many other types of Petitions and forms in the Workers’ Comp system. If you have any questions whatsoever, please do not hesitate to contact Mr. Fenerty. Remember that the only bad question is the question that you did not ask.
Our Workers Compensation Law Offices are conveniently located in suburban Northeast Philadelphia and in Southern New Jersey. We are a Philadelphia Personal Injury Law Firm with suburban convenience.