by Karl VoigtThe lawyers of the Workers’ Compensation Law Clinic have prepared this booklet to answer the questions posed to us most often by our clients. While we are always happy to discuss workers’ compensation cases, we felt that a comprehensive resource would be helpful to injured workers and their families. This booklet, however, is not intended to be a substitute for legal advice. We are always happy to provide a free consultation for those with questions beyond these.
Please note that this booklet addresses work injuries suffered after June 24, 1996.
What is workers’ compensation?
The Pennsylvania Workers’ Compensation Act requires that your employer either: 1) maintain insurance to cover injuries suffered by its employees; or 2) apply for and become self-insured. The insurance policy is “no fault,” which means that an injured worker is covered whether or not the employer feels the injury was his or her fault.
While claims are administered by private insurers, the Bureau of Workers’ Compensation oversees adjudication of contested claims.
What is a work injury?
Actual injury, repetitive trauma, in rare cases, mental trauma
If you have had a work injury, it is important to that you tell your employer about it within 21 days, and critical that you give notice within 120 days. One of the most common causes of claims being denied is that the employee “stuck it out” and thought the problem would go away, then only told the employer months later. If you do not give your employer timely notice, you may lose all of your rights to benefits.
Insurer has 21 days to investigate
What benefits are payable to an injured worker?
There is no time limit to receipt of TTD benefits.
Disfigurement 275 weeks
If a widow or widower remarries, they are entitled to 104 weeks of compensation.
At what rate are weekly workers’ compensation benefits paid?
Generally, you are paid 66% of your preinjury average weekly wage. There are several ways to determine this figure, the most common being an average of your 3 highest earning quarters. These benefits are subject to caps, which change every year. A person injured in 2003 can receive no more workers’ compensation than $xxx a week; for 2004, that number is $xxx. The statewide minimum is exactly half of these figures, unless earned less than these amounts before your injury In that case, your benefit is 90% of your average weekly wage.
Weekly or biweekly
Overtime, other employers, room, board
I’m getting workers’ compensation. Do I need an attorney?
No, not unless the insurer is preparing to challenge your rights. Trust your instincts: if you suspect the insurer is trying to affect your rights, they probably are.
Generally, lawyers fees are limited to 20% of your wage loss benefits.
Can I collect unemployment compensation, social security, retirement, short- or long-term disability, or sickness & accident benefits while getting workers’ compensation?
Does my employer have to keep my job open if I get hurt?
The Workers; Compensation Act does not address this. The only law that may procect your job is the Family and Medical Leave Act. If your employer is large enough, this Act may require it to keep your position open for 12 weeks, without pay.
What if my employer or the insurer goes bankrupt?
Can I sue my employer for pain and suffering?
No. This stems from a conflict that started at the Industrial Revolution. As the Commonwealth transitioned from an agricultural economy to one of industry, more residents suffered work-related injuries. With this increase came
There is one exception to this immunity: if your employer did not have insurance at the time of injury, you may sue them in a Court of Common Pleas.
You may have the right to sue a third party if you were injured by unsafe equipment or an automobile accident. As an example, a worker injured by a table saw shipped without a guard may be able to sue the manufacturer. You will need an attorney with experience in these matters to pursue such a claim.
I received a Denial of Workers’ Compensation from the insurance company. What do I do next?
I got a Notice of Temporary Compensation Payable in the mail. What is this?
I got a Notice of Compensation Payable in the mail. What is this?
This is good news. Without issuing this document, the carrier is not bound to pay any benefits associated with your work injury.
I got a Verification Form in the mail. What is this?
You must return the signed and completed form back to the carrier. Otherwise, your benefits will be suspended until the forms are received. We recommend that you return the forms via USPS certified mail, with a return receipt, so you can prove that you sent the forms back.
I got a Notice of Ability to Return to Work. What do I have to do?
Do I have to treat with the company doctor?
Good question. Chances are you do not. While the law allows your employer a “captive period” in which you must treat with their choice of doctor for 90 days, in most cases this can not be enforced. The only way they can impose a doctor on you is if: 1) your employer posts a list of 6 physicians to choose from in a public place; 2) your employer gets your signature on an Acknowledgement before and after you are injured.
The insurance company wants to send me to an “Independent” Medical Examination (IME). What is this?
We put quotation marks around the word “independent” because they are not independent. The insurer has chosen the IME doctor because he or she has The doctor often gets paid hundred if not thousands of dollars for every injured worker examined.
The insurance company wants to send me to an Impairment Rating Evaluation (IRE). What is this?
What if workers’ compensation hires a vocational counselor to interview me?
A vocational counselor is xxxxxxxx, usually after an IME or treating doctor releases you to return to work in some capacity. This is the insurer’s first effort to reduce your workers’ compensation benefits.
The assignment of a vocational counselor is often the first sign that you need an attorney.
What if my employer offers me a modified job?
It is often wise to ask your treating doctor if the offered job is acceptable.
Supplemental Agreement. It is advisable to consult an attorney to review this form.
Can the insurance company hire a private investigator to follow me?
Yes. If you are radiating your image to the public, you can be observed and videotaped.
Do I get reimbursed for my travel expenses?
Generally not. If you have to travel outside of your locale to get medical care that you can’t get in your area, your travel costs may be reimbursable. Bethenergy Mines
IME travel, yes.
If your doctor prescribes modifications to your car as a result of your work injury, the insurance company should pay for those modifications.
Do I have to settle my case?
Absolutely not. There is no petition the insurance company can file against you to force a settlement. Likewise, there is no petition that you can file against an insurer to force them to settle your case.
In some cases, it is acceptable to settle your case. However, whether or not you should may be one of the most important decisions you ever make.
Choose your lawyer carefully. One who advertises that your case can be settled, or who only receives a fee if you settle may be motivated to settle your case even if it’s not truly in your best interests.
What if I want to settle my case? What’s a Compromise and Release?
You can indeed settle your case.
C&Rs are increasingly technical and the Agreement must be crafted very particularly to protect your rights.
What happens when a case goes to court?
The party who files the petition must meet its “burden of proof”. This is done by presenting evidence in the form of testimony and documents.
Is there one hearing where the Judge makes up his or her mind?
No. All of the parties will get a copy of the Judge’s Order in the mail after the case has closed.
Can I appeal a Judge’s Order if I disagree with it?
Yes, but the chances of success on appeal are generally slim. We often meet clients for the first time only after a Workers’ Compensation Judge has ruled against them. The unfortunate news we often have to deliver is that the Judge is the final finder of fact; the Order cannot be overturned unless the Judge made a serious mistake in the law. The Judge’s choice of believing one witness over another will not be overturned. Even worse, appellate courts have recently held that an injured worker who appeals a decision can be held liable for the insurance company’s attorney fees if the appeal is without merit.