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Thomas Wing

About Thomas Wing

https://workerscompadvocates.com/

Tom, as the managing partner of McMenamin & Wing, LLC, brings a wealth of local insight and legal experience to the table. A Delaware County, Pennsylvania native and a long-term Philadelphian, his deep roots in the community are a testament to his commitment to his clients. Tom's academic journey began at West Chester University, where he completed his undergraduate studies, followed by a law degree from Widener University Delaware School of Law. Now, with almost a decade of experience focused in workers’ compensation law, Tom's proficiency in navigating complex cases is unparalleled. His professional affiliations are extensive and include membership in the Pennsylvania Association for Justice, the Philadelphia Bar Association, and the Workers’ Compensation Section of the Pennsylvania Bar Association. Moreover, Tom's success has been recognized consistently since 2020, as evidenced by his selection as a Pennsylvania Super Lawyers® Rising Star in Workers’ Compensation every year since then.

Posts by Thomas Wing:

Two doctors reviewing an x-ray with differing opinions, illustrating the role of expert medical testimony in workers' compensation cases involving the complex judge a WCJ has weighing claims.

Medical Evidence In PA Workers’ Comp Cases

In PA workers’ compensation cases, medical evidence helps to prove a claim. Injured workers rely on medical evidence to show that their work injury directly caused their disability. It shows a causal relationship between the injury and work activity.

Not all claims need detailed medical testimony. In some cases, the Workers’ Compensation Judge (WCJ) may find a direct, obvious link between the injury and disability. The WCJ may allow the worker to file a claim without extensive medical evidence.

Obvious Causal Connection

When obvious causal relationships exist between work injuries and disabilities, claims may not need medical testimony for support. Courts know that some injuries have a clear connection to work activities, making medical expert testimony unnecessary. Morgan v. Giant Markets, Inc. showed that claims can proceed without medical evidence. Providing, a layperson can readily understand the connection.

Mental Trauma

In Vactor v. WCAB, a worker developed emotional trauma after suffering a gunshot wound during a robbery. The court found that the trauma obviously caused the worker’s fear of returning to work. This finding made medical testimony unnecessary.

Immediate Pain

In Northwest Medical Center v. WCAB, a worker suffered pain immediately after a physical exertion. The court found an obvious connection between the pain and the work activity. This negated the need for a medical expert’s opinion.

Delayed Or Cumulative Injuries

By contrast, injuries that develop over time present less clearcut cases. Cumulative trauma injuries require clear medical evidence to prove a work relation.

The ruling in Albert Einstein Healthcare v. WCAB illustrates this. They found symptoms that develop over time require medical expert testimony. The medical expert must verify that the work injury caused the condition.

Lay Testimony

In certain cases, an injured worker’s testimony alone can support a claim. This may occur when a worker returns to the job with restrictions after an injury.

In Latta v. WCAB, the court ruled that a worker’s own testimony was enough to reinstate benefits. This occurred after a lay off from a light-duty role. The court presumed that the worker’s pre-injury state remained compromised. This supported the continuation of benefits.

When Lay Testimony Falls Short

While lay testimony can support specific claims, it does not apply to every claim. For example, an injured worker under a “medical-only” Notice of Compensation Payable (NCP) without wage loss benefits. In this instance, testimony alone will likely not suffice. Credible medical evidence must show that the worker’s injury still affects their earning capacity.

Doctor providing expert medical testimony in a workers' compensation courtroom, illustrating the role of medical professionals in supporting claims for work-related injuries.
Doctors routinely testify in workers’ compensation cases.

Medical Experts In Pennsylvania Workers’ Compensation Cases

In PA workers’ comp cases, not all healthcare providers qualify as expert witnesses. The expert witness must hold the appropriate qualifications and experience to testify in specialized medical areas.

Physicians

The court typically recognizes board-certified physicians as qualified to testify on a wide range of medical issues. This often holds true even if they lack specialization in the specific area of the worker’s injury.

Psychologists

Licensed psychologists can testify in cases that involve an employee’s mental health. They cannot diagnose physical injuries.

Chiropractors

Chiropractors can testify, but their scope remains limited to chiropractic care issues. They cannot provide testimony on conditions outside their field.

Nurses

Experienced nurses may testify on matters of patient care and observations. But, courts usually do not recognize them as competent to diagnose or provide opinions on complex causal relationships.

The “Unequivocal” Standard

When a case requires medical evidence, the testimony must remain clear and unequivocal. This means the expert must express a clear opinion that the injury resulted from a work-related event. Statements like “possibly” or “could be” do not meet this standard.

Courts require a direct connection between the work injury and the resulting disability. The medical expert must assert this to a reasonable degree of medical certainty.

Medical experts who express uncertainty will weaken the worker’s case. This can lead to a denial of benefits. They need to provide consistent, confident testimony that links the injury directly to work activities.

Two doctors reviewing an x-ray with differing opinions, illustrating the role of expert medical testimony in workers' compensation cases involving the complex judge a WCJ has weighing claims.
A WCJ must resolve any conflicts between medical experts

Conflicting Opinions

The WCJ holds the authority to weigh conflicting medical evidence and decide which testimony carries more credibility. A treating doctor’s testimony may carry more weight because of their familiarity with the worker’s condition. In cases where the Independent Medical Examination (IME) challenges the claim, the WCJ can still favor the treating doctor. This may occur when their history shows insight into the worker’s pre-injury and post-injury condition.

New Facts

Medical opinions can change if new evidence comes up during a workers’ comp case. If a medical expert forms an opinion based on incomplete or inaccurate information, this can render their testimony unreliable.

Medical Reports Over Live Testimony

Medical reports and affidavits can replace live testimony when the claim period lasts 52 weeks or less. These documents must meet specific standards for admissibility and accuracy.

Hospital Records

Hospital records that detail treatments for work-related injuries qualify as admissible evidence in workers’ compensation claims. Courts limit admissibility to details directly related to the work injury. These records must provide clear evidence that support the medical claim.

Termination Of Benefits

To terminate workers’ comp benefits, an employer or insurance company must provide compelling medical evidence. They must show that the injured worker has fully recovered by providing detailed and consistent medical testimony.

Wrap Up

Medical evidence plays an important role in PA workers’ comp cases. If the case will require a medical expert or expert witness depends.

This can depend on the nature of the injury. It may depend on the causal relationship between the injury and work. Or, it could depend on the clarity of this connection.

In cases with an obvious causal relationship, injured workers might bypass medical testimony. In more complex workers’ comp claims, clear and unequivocal expert testimony becomes a must.

A workers’ comp lawyer knows the requirements of Pennsylvania workers’ compensation laws. They can advise you on the specific needs for your case.

If you have questions about your claim or think you have a case, give us a call. Reach out to our offices 24/7 at (215) 609-4183 for a free case evaluation. We can help get you the benefits you deserve.

a firefighter, police officer, and EMT – working together at an emergency scene in a Pennsylvania city. This scene reflects the critical support offered to these workers through Pennsylvania Workers' Comp Bill 365, which expands benefits to cover mental health conditions from traumatic events. The image underscores the bill's focus on protecting those who risk their lives daily.

New Workers’ Comp Law Protecting First Responders

Pennsylvania’s New Workers’ Comp Law Protecting First Responders: Senate Bill 365

In a major step forward for mental health support, PA has passed Senate Bill 365. Signed by Governor Shapiro, this bill expands workers’ compensation coverage for first responders.

The new law gives workers’ compensation benefits to first responders. It applies to those diagnosed with a Post-Traumatic Stress Injury (PTSI) from events they experienced while on duty. This adjustment to Pennsylvania’s Workers’ Compensation Act reflects the state’s commitment to mental health. Our first responders often experience high-stress situations, particularly police officers, EMS providers, and firefighters.

Previously, PA’s workers’ compensation system had strict requirements for mental health claims. These typically involved necessitating a physical injury or a constituted abnormal working condition for eligibility. The updated law reduces the burdens of proof for first responders facing PTSI. It accepts the high risk of psychological trauma in their work within the PA workers’ comp system.

a firefighter, police officer, and EMT – working together at an emergency scene in a Pennsylvania city. This scene reflects the critical support offered to these workers through Pennsylvania Workers' Comp Bill 365, which expands benefits to cover mental health conditions from traumatic events. The image underscores the bill's focus on protecting those who risk their lives daily.
First Responders see exposure to many traumatic events

Key Parts of Senate Bill 365

Expanded Eligibility For PTSI Claims

The new law broadens eligibility for workers’ compensation claims related to Post-Traumatic Stress Injury (PTSI) among first responders. This includes:

  • EMS providers and firefighters (both volunteer and paid) who respond to emergency calls.
  • Pennsylvania State Police officers and peace officers engaged in emergency response.

Focusing on police officers, EMS, and firefighters, this law addresses the common risks of traumatic events for these workers. It provides a clearer path for mental health claims within the comp system. This ensures that insurance carriers and the Bureau of Workers’ Compensation can process claims more efficiently and effectively.

Definition Of Qualifying Traumatic Events

The law establishes a clear definition of a “qualifying traumatic event” in workers’ comp. Such events must include:

  • Serious bodily injury or death of an individual;
  • Injury, death, abuse, or exploitation of a minor;
  • An immediate threat to life involving the claimant or another individual;
  • Mass casualty incidents; and
  • Crime scene responses.

By specifying these high-stress and traumatic events, the law removes ambiguity. This ensures that workers’ compensation coverage extends to mental health conditions tied to these well-defined incidents.

This approach removes some of the burdens of proof previously required. It also helps claimants avoid proving that an event constituted an abnormal working condition. This had presented a difficult hurdle in workers’ comp claims.

a person filing a workers' compensation claim in an office, representing the process under Pennsylvania's new Workers' Comp Bill 365. The individual reviews paperwork and uses a laptop, symbolizing the careful documentation required to claim benefits, including mental health coverage for first responders after traumatic events. The scene emphasizes professionalism and accuracy in claim submissions.
PTSI Claims have special requirements for First Responders

Claim Filing Process For PTSI

The new workers’ comp process includes several key procedural requirements for first responders filing PTSI claims. They include:

  • Diagnosis: A licensed psychiatrist or psychologist must diagnose PTSI.
  • Timeliness: Claimants must file PTSI claims within three years of diagnosis.
  • Maximum Benefit Period: Workers can receive benefits for a maximum of 104 weeks from the date of injury.

This approach removes barriers in the PA workers’ compensation system. It allows for more straightforward claims processing by the insurance companies and gives first responders timely support.

Retroactivity And Limitations

The law clarifies that events occurring more than five years before its effective date lack eligibility for coverage. PA’s approach to workers’ compensation typically excludes older incidents. This law is no exception. It focuses on more recent work-related injuries and qualifying traumatic events in workers comp.

Previous Workers’ Comp Requirements

The system had tough requirements, making it hard to claim benefits for mental health injuries or diseases. The standard used to require proving an abnormal working condition in workers’ comp. This often made it tough for police officers, firefighters, and others frequently exposed to trauma.

Senate Bill 365 acknowledges the unique psychological impact of traumatic events on first responders. It eliminates the need to establish an “abnormal working condition” for PTSI claims. This shift reduces the burdens of proof and makes it easier for workers to receive workers’ compensation benefits.

Practical Implications For First Responders And Their Employers

This law greatly advances mental health support for emergency personnel. It helps to support these first responders with post-traumatic stress injuries in workers comp. It also ensures they can seek help without fear of financial or procedural issues.

Employers and insurance carriers should note of these changes. To prepare, employers can work with insurance companies to update support resources for their employees. This provides guidance on the claims process for mental health conditions.

Wrap Up

The enactment of Senate Bill 365 shows PA’s dedication to the well-being of first responders. It enhances the workers’ comp system to better support those who put their lives on the line.

Eligible first responders and organizations should familiarize themselves with the updated claims process, specifically qualifying traumatic events, and the necessary documentation for PTSI claims. This new law gives first responders access to the mental health care they need without the roadblocks of the past.

If you suffer with a post traumatic stress disorder, we can help you get the compensation you deserve. For a free consultation, reach out to our offices 24/7 at (215) 609-4183.

Mandatory Direct Deposit For Workers’ Comp in PA

Pennsylvania Workers’ Compensation Update: New Law Affecting Workers’ Compensation Payment Procedures

Governor Josh Shapiro recently signed Senate Bill 1232 into law. This bill makes key changes to PA’s workers’ compensation system, targeting payment methods for workers’ comp benefits.

This law mandates direct deposit as the default payment method. It aims to streamline payment access for injured workers and improve efficiency in distributing funds. Let’s discuss what employers, insurance carriers, and injured workers need to know.

Illustration of direct deposit representing the mandatory payment method change for workers' compensation benefits under Pennsylvania Senate Bill 1232, showing secure, fast electronic transfers from employers to injured workers' bank accounts as required by the new workers' compensation law.
Direct deposit for workers’ compensation benefits makes receiving benefits on time more likely

Key Highlights

Direct Deposit Becomes The Default Payment Method

Insurance carriers will pay all workers’ compensation benefits through direct deposit unless an injured worker specifically requests paper checks. This shift hopes to lessen payment delays with mailing checks. It also aims to make access to funds easier for those with work-related injuries or occupational diseases. By moving to electronic payments, the system can reduce errors and improve payment reliability for workers’ compensation claims.

Universal Access Requirement

Insurance carriers and self-insured employers must provide a direct deposit option to all people receiving workers’ comp benefits. This change simplifies the claims process. It helps provide timely and consistent access to wage loss benefits. It also helps to provide compensation for medical treatment and payments for medical expenses.

Employee Rights And Options: Opting Out of Direct Deposit

Workers who prefer payments by paper check retain the option to do so by telling their employer. This flexibility ensures access for all workers. Regardless of banking status, the new law offers an option for those with unique financial needs. For example, people without bank accounts.

Account Choice And Control

Injured workers can choose the bank account for their direct deposits and can make up to two account changes per year. This gives injured workers control over their workers’ comp benefits, adding a safeguard against fraud while enhancing flexibility.

New Obligations For Employers And Insurance Carriers

Timely Notifications

Employers and insurance carriers must inform employees when the direct deposit option becomes available or mandatory. They must give clear instructions on setting up direct deposit and submitting bank account information. This ensures accurate guidance for injured workers who rely on these payments.

One-Year Transition Period

Employers and insurers have a one-year period to implement direct deposit as an option. This period gives employers and insurance carriers time to update their systems and educate employees on the new procedures.

Error Management Protocols

Protocols address payment errors that arise. Employers hold no liability if the employee provides incorrect account information that causes an error. But, they must take reasonable measures to recover and reissue misdirected funds promptly.

This maintains a reliable payment system, ensuring that injured workers do not face disruptions in their benefits. This support helps those managing medical expenses or long-term recovery needs.

Blank paper check illustration representing traditional payment methods in workers' compensation, highlighting the shift to mandatory direct deposit under Pennsylvania Senate Bill 1232. This image contrasts old payment practices with the new electronic deposit requirement for faster, reliable access to benefits for injured workers.
Paper checks often present challenges for injured employees receiving timely payments

Previous Payment Procedures

Challenges With Paper Check Payments

Paper checks served as the standard for workers’ compensation payments. Workers often faced delays due to postal service issues or mailing errors. This could greatly impact the people relying on these funds.

Address changes, lost checks, and late payments often caused issues. These issues could be challenging for injured workers who rely on these payments. Delay with any source of income can easily affect overall financial stability.

Benefits Of Direct Deposit

Direct deposit resolves many of these issues by providing a secure, electronic method that ensures faster access to benefits. Injured workers can receive their compensation without delays. They no longer need to worry about lost checks in the mail.

This direct payment system enhances tracking and minimizes risks. Insurance carriers can process payments more efficiently, minimizing errors and delays. This matters greatly to injured workers, especially before they return to work.

Steps For Employers

Payroll System Updates

Employers must update their payroll systems. They must comply with the requirements set by the Department of Labor & Industry and the Bureau of Workers’ Compensation.

They must prepare to handle direct deposit. This includes setting up all software and processes for the new direct payment standard. They must coordinate with insurance company systems to avoid delays in disbursements.

Employee Education And Support

Employers should offer guidance to employees with direct deposit. They should provide resources, such as step-by-step instructions or informational sessions. This will provide a smoother transition for workers as they adjust to the new system.

Compliance Deadlines

Employers must track all deadlines and requirements under the Workers’ Compensation Act to avoid penalties. Employers must meet the deadline to offer direct deposit to all employees to comply with labor and industry regulations.

Steps For Injured Workers

Consider Direct Deposit Benefits

Direct deposit offers faster and more secure access to workers’ comp benefits. Injured workers may find direct deposit an easier option for prompt payments.

Exercise Your Right To Paper Checks If Needed

Workers who prefer paper checks should make their employer aware early. This ensures that they avoid any interruptions in receiving comp benefits. Workers who receive other benefits, like social security, may want to coordinate payments.

Double-Check Account Details

Workers must provide accurate bank account information to prevent payment delays. Injured workers should double-check all information before giving it to their employer. This avoids disruptions in receiving workers’ comp benefits.

Wrap Up

With the new direct deposit mandate, both employees and employers must understand and prepare for the transition. By adopting direct deposit as the primary payment method, PA aims to modernize its workers’ comp system. They hope to ensure faster and more reliable access to funds for injured workers.

Employers and insurance carriers will play a crucial role. They must ensure that injured workers can receive their compensation securely and on time.

If you need help with your workers’ compensation claim, give our offices a call 24/7 at (215) 609-4183. We can help you ensure your average weekly wage and compensation rate are correct and get you the benefits you deserve.

 

Evidentiary Principles In PA Workers’ Comp

Understanding the rules of evidence can greatly impact the success of your Pennsylvania workers’ compensation claim. These principles help injured workers and their lawyers in the workers’ compensation system to secure the benefits they deserve.

Illustration of evidentiary rules in a workers' compensation case, featuring balanced scales of justice with symbols like documents, witness stand, and gavel, set against a courtroom background, highlighting the importance of fair evidence in securing injured workers' rights and benefits.
The traditional Pennsylvania Rules of Evidence do not apply in Workers’ Compensation Cases.

What Applies?

Rules Of Evidence

The rules of evidence in Pennsylvania workers’ comp cases differ from those in traditional courts. Workers’ compensation claims follow more relaxed rules.  Section 422(a) of the Pennsylvania Workers’ Compensation Act allows Workers’ Compensation Judges (WCJs) more discretion in admitting evidence. They may admit evidence that other courts would not permit.

All findings must still rely on sufficient and competent evidence. This standard demands reliable, relevant, and factual evidence, despite the more lenient technical rules. A workers’ compensation attorney will typically follow the traditional rules of evidence. This helps to strengthen the case and minimize the risk of challenges on appeals.

Why The Relaxed Rules Of Evidence?

The relaxed rules create a fairer, more accessible process for injured workers. By easing these rules, the system allows for a broader range of evidence. This helps injured workers and their attorneys build a strong case to secure workers’ compensation benefits.

Even with these relaxed rules, lawyers will often prepare evidence in line with the Pennsylvania Rules of Evidence. This includes relevant, material, and properly authenticated evidence. They use this approach to help protect the case from disputes by the insurance company or opposing counsel.

The Walker Rule

The Walker Rule comes from the case Walker v. Unemployment Compensation Board of Review. This vital principle in PA workers’ comp law dictates how to handle hearsay evidence. The Walker Rule applies to administrative proceedings like workers’ compensation hearings, where WCJs assess the evidence presented.

According To The Walker Rule

  1. If properly objected to, hearsay evidence cannot serve as the sole basis for a finding of fact by the WCJ.
  2. If admitted without objection, hearsay evidence retains probative value but requires corroboration by other competent evidence. A WCJ cannot base a finding solely on hearsay unless supported by other reliable information.
Close-up illustration of one person whispering confidentially to another, symbolizing hearsay in a workers' compensation context. Depicts the exchange of information that may be considered unreliable in legal cases, highlighting the importance of direct evidence over secondhand accounts for injured workers seeking fair compensation.
Absent an exception, parties cannot use Hearsay evidence in Workers’ Compensation Claims

Role Of Hearsay In Workers’ Compensation Cases

In PA, the hearsay rule also applies in workers’ comp cases. Hearsay typically refers to out-of-court statements offered to prove the truth of the matter asserted.

Workers’ comp proceedings often discuss hearsay in the context of medical treatment reports and records. These records help to establish the nature and extent of a work injury. But, if the opposing party objects to their admissibility, other evidence, such as direct testimony or additional medical evaluations, must corroborate them.

When hearsay evidence faces no objection, the WCJ may consider it. But it still requires support from other competent evidence to justify a finding. An experienced workers’ compensation lawyer will recognize when to challenge hearsay. They will also know how to ensure that evidence, like medical reports, meets the standards required for admissibility.

Admissibility Of Surveillance Footage In Workers’ Comp

Surveillance footage can play a large role in PA workers’ comp claims. Employers and insurance companies may use private investigators to gather video footage of an injured worker’s daily activities. They hope to show that the worker’s physical abilities contradict their claimed injury. This can challenge the worker’s credibility and eligibility for benefits.

Surveillance Footage Musts

  1. It requires proper authentication. The individual who recorded the footage or someone with knowledge of the recording must verify its accuracy.
  2. The footage must clearly identify the worker and provide a fair and accurate representation of the events shown.

Can Employers Use Surveillance To Deny Benefits?

Surveillance footage, even when authenticated, cannot automatically result in a termination of benefits. The footage must show that the injured worker’s daily activities contradict their claimed work injury.

Video footage should not serve as the sole piece of evidence. It needs corroborating evidence. For example, medical testimony or expert evaluations.

Tips For Injured Workers

Document Everything

Keep detailed records of all events, medical treatment, and any interactions with employers or the insurance company. These records will help when building your case.

Look Out For Cameras

Know that insurance companies may use private investigators to capture video surveillance. They could use any of this footage in your claim.

Hire A Workers’ Comp Lawyer

An experienced lawyer will know how to navigate the rules of evidence in PA workers’ comp. This ensures admissibility and relevance for all presented evidence. They will also know when to challenge inadmissible or uncorroborated evidence, such as hearsay or improperly authenticated footage.

The Importance Of Cross-Examination

Cross-examination plays a huge role in workers’ comp cases, especially with hearsay evidence or surveillance footage. Cross-examining witnesses or experts who provide evidence helps to verify the accuracy and challenge the validity. A skilled workers’ comp lawyer will strengthen the injured worker’s case and protects their right to benefits.

Wrap Up

Anyone involved in a PA workers’ comp case must know the rules of evidence. These principles empower injured workers and help to build strong cases.

If you’re dealing with a work injury, you need an seasoned workers’ comp lawyer by your side. We will help gather the right evidence, challenge inadmissible materials, and protect your rights. For a free case evaluation, give us a call 24/7 at (215) 609-4183. We can help you get all the benefits you deserve.

Settlements In Pennsylvania Workers’ Compensation

Achieving a workers’ comp settlement in PA can seem tough. It often involves mandatory or voluntary mediation, understanding compromise and release agreements, and filing necessary forms to resolve claims.

Key Forms For Workers Compensation Settlements

LIBC-378 Petition For Compromise And Release (C&R)

This form requests a settlement approval hearing, often resulting in a lump sum payment.

LIBC-753 Notice Of Request For An Informal Conference

This form starts the informal conference process as part of the workers’ comp mediation options.

LIBC-755 Compromise And Release Agreement

This form formalizes the release agreement under Section 449 of the Workers’ Compensation Act. It may secure a lump sum settlement or other agreement for an injured worker.

Each of these forms serves a purpose in filing a claim successfully. Especially, when seeking coverage for ongoing medical treatment or wage loss benefits. Working with a qualified workers’ compensation attorney can help ensure accuracy and timely filing of all documents.

A Workers' compensation mediation session with a mediator guiding an injured worker and an insurance representative, symbolizing the mediation process for resolving work injury claims and reaching fair settlements.
The mediation process helps injured employees resolve work injury claims

Mandatory Mediation In Pennsylvania Workers’ Compensation

How Does Mandatory Mediation Work?

In PA, mandatory mediations must occur before a workers’ compensation judge (WCJ) issues a ruling on the case. A mediating judge conducts the mediation, promoting discussions between the injured worker and the employer. Typically, a judge other than the one assigned to the case conducts the mediation. Both parties aim to reach a fair settlement without formal court proceedings, saving time and resources.

Who Needs To Attend?

Both the injured worker and employer (or their representatives, often including insurance companies) must attend the mediation process. Each party must have the authority to accept, reject, or modify settlement proposals. A successful mediation can resolve disputes about medical expenses, wage loss benefits, and other issues. Some judges do not require the attendance of the injured worker or adjuster. 

Voluntary Mediation: An Alternative Option

How Does Voluntary Mediation Work?

Both parties may choose to participate in voluntary mediation, which remains optional, unlike mandatory mediation. This process allows flexibility, offering a chance to negotiate a settlement without court intervention. Injured workers can use voluntary mediation to secure a lump sum settlement or address concerns about medical expenses.

Benefits Of Voluntary Mediation

Voluntary mediation provides a less formal setting where injured workers can discuss their work injury and medical expenses. This approach helps parties reach a compromise and release, allowing for faster settlements and often lower legal costs. The parties also select the mediator of their choice.

Compromise And Release Agreements In Workers’ Comp

What Does A Compromise And Release Agreement Do?

A compromise and release (C&R) agreement legally binds injured workers and employers in settling workers’ comp claims. It may involve a lump sum payment instead of ongoing workers’ comp benefits. In PA, a WCJ must review and approve every C&R agreement. This ensures the injured worker understands the full terms and implications, especially medical expenses and future wage loss.

Essential Components Of A C&R Agreement

A valid compromise and release agreement in PA must include:

  • Date of the work injury
  • Worker’s average weekly wage before the injury
  • Type and extent of the injury
  • Payment details, including lump sum settlement amounts and coverage of any future medical expenses
  • Conditions surrounding other benefits

After completing the release agreement, the employer or insurance company submits it for approval by a WCJ. The WCJ ensures the injured worker comprehends the agreement and its impact on any remaining workers’ compensation benefits.

Finality Of A Compromise And Release Agreement

Once approved, a compromise and release agreement becomes legally binding. This means the worker cannot reopen the claim. A workers’ comp lawyer can help ensure injured workers fully understand the terms. This includes the agreement’s impact on future medical care or wage benefits.

The Role Of Resolution Hearings In Workers’ Comp Settlements

What Happens At A Resolution Hearing?

In a resolution hearing, a WCJ speeds up the process by reviewing a workers’ compensation settlement. The WCJ may use this hearing for cases where both parties have already reached a C&R agreement. The judge confirms that both parties understand the agreement and makes sure it complies with Pennsylvania workers’ compensation law.

Why Are Resolution Hearings Important?

Resolution hearings help the employee understand the settlement process, particularly when both parties have reached an agreement in mediation. They offer an efficient way to finalize settlements. This ensures that injured workers receive their compensation promptly. It also ensures that the agreement accurately addresses all medical costs and wage benefits.

Setting Aside A Compromise And Release Agreement

Grounds For Setting Aside A C&R Agreement

Once the judge approves a C&R agreement, it typically becomes final. However, injured workers can appeal within 20 days.

To do so, strict guidelines exist. They must show that they did not fully understand the agreement. Or they need to prove that fraud, misrepresentation, or a mutual mistake took place.

Courts On Setting Aside Agreements

Pennsylvania courts may set aside C&R agreements for specific reasons, such as significant errors or fraud. However, courts usually uphold these agreements if they meet all requirements. Misunderstandings over settlement amounts or medical expenses usually do not justify setting aside a compromise and release.

Informal Conferences In Workers’ Comp Claims

What Does An Informal Conference Do?

An informal conference allows injured workers and employers to resolve disputes without formal litigation. An injured worker, employer, or their lawyers can file a request to start this process. The WCJ conducts the conference within 35 days. This provides a private setting where the parties can discuss their case.

Confidentiality And Informal Conferences

The informal conference process remains confidential, keeping any information exchanged during the session out of the official court record. Both parties can present their cases, discussing work injuries, medical expenses, wage losses, and possible return-to-work options. If both parties reach a resolution, they document it in LIBC-754 and file it with the Bureau of Workers’ Compensation.

Illustration of a glowing lightbulb symbolizing helpful workers' compensation tips, insights for injured workers seeking settlements, understanding benefits, and navigating claims in the workers' comp process.
Workers Compensation Settlement Tips

Tips

Document Preparation

Completing forms such as LIBC-378, LIBC-755, and others remains vital. A workers’ comp lawyer can help ensure form accuracy.

Seek Legal Representation

Working with a workers’ compensation attorney can protect the injured worker’s rights. This becomes even more important when the settlement includes medical expenses and ongoing treatment.

Understand Medicare And Social Security Impacts

Using clear language in the agreement can help avoid issues for people approaching Medicare or Social Security.

Child Support And Domestic Obligations

If the injured worker owes child support, the Bureau of Workers’ Compensation or Domestic Relations Office may intervene. They may require the injured worker to settle any outstanding debts before approving the agreement.

Wrap Up

With the right knowledge and support, you can settle a workers’ compensation claim in PA. Mandatory and voluntary mediation, compromise and release agreements, and informal conferences offer paths to settlement. This allows the injured workers to secure compensation for medical expenses, wage losses, and other work injury-related costs. Working with a workers’ compensation attorney helps injured workers secure settlements that meet their needs and protect their future.

For a free evaluation on your case, reach out to our offices 24/7 at (215) 609-4183. We stand ready to help you get the settlement you deserve.

PA Workers’ Comp: Employee Petition To Review

The Pennsylvania Workers’ Compensation Act outlines the Employee Petition to Review process. This legal process allows corrections of mistakes and modifications in the Notice of Compensation Payable (NCP) or compensation agreements.

Both employees and employers can use petitions for review to correct errors. They can expand the description of injury, or challenge issues related to medical treatment, billing, or compensation benefit offsets.

Lawyer writing an employee petition to review, focusing on correcting a workers' compensation claim. The image shows a lawyer at a desk, drafting legal documents related to workers' compensation cases, surrounded by papers, legal books, and a laptop in a professional office setting, illustrating the process of petitioning to amend an incorrect description of injury or benefit calculations.
A Petition to Review focuses on correcting a workers’ compensation claim.

Functions Of The Employee Petition To Review

The Employee Petition to Review helps injured workers correct any material errors in the original NCP. Such as, mistakes in the description of the injury, miscalculations of average weekly wage, or incorrect dates of injury. Filing the petition provides injured workers the chance to fix such errors. This helps to ensure that they receive the correct worker’s compensation benefits under PA workers’ comp laws.

Sometimes, an employer or their insurance carrier may also file a petition to correct a mistake in the NCP. For example, if the insurance company incorrectly calculated the offset amount for Social Security Disability Benefits. This might cause them to file a petition to review to make the adjustments. This helps to ensure that workers’ compensation insurance accurately pays on the claim.

Beyond correcting errors, the petition can also modify or expand the description of injury. Work-related injuries may evolve or worsen over time, and additional conditions can arise. A workers’ compensation judge (WCJ) may modify or expand the description of injury. This ensures the injured worker continues to receive adequate workers’ comp benefits for their medical needs.

Employers may use the petition to review medical treatment and billing. Or, to challenge compensation benefit offsets that reduce the amount of worker’s comp benefits for the employee. If a worker receives other income, Social Security Disability Benefits or pensions, a reduction of benefits may occur.

Filing a petition allows the injured worker to dispute this offset amount. This ensures that workers’ comp provides the correct benefits without needless reductions.

Correcting Mistakes In The Notice Of Compensation Payable (NCP)

When an error occurs in the NCP, the process for correction starts with the filing of a Petition to Review. An injured worker can file a petition if they believe a mistake occurred in the NCP issued by the employer. This often involves misclassification of their injury or an error in the calculation of their average weekly wage. The WCJ has the authority to review the case and make changes to the NCP if necessary.

However, injured workers do not always have to file a petition to correct mistakes. Cinram Mfg., Inc. v. WCAB (Hill) established that the WCJ can correct an NCP at any time. This may occur without a formal petition, if the employer has a fair opportunity to contest the correction.

The burden of proof falls on the party seeking the change. They must show a material mistake occurred at the time of issue of the NCP.

This could involve proving an incomplete description of injury. Or, a miscalculation of the average weekly wage, which can impact the employee’s partial disability payments. Without sufficient evidence, the WCJ may reject the request to amend.

Specific time limitations exist for filing a Petition to Review. Typically, one must file the petition within three years of the most recent payment of compensation.

Even if the mistake occurred at the issue of the NCP, the three-year statue still applies. The court clarified this in Fitzgibbons v. WCAB (City of Philadelphia). A petition filed after this period, will likely end up dismissed.

Expanding or Modifying the Description of Injury

Sometimes, a work-related injury worsens or other conditions develop, not part of the original NCP. In these situations, the Employee Petition to Review can expand or modify the description of injury. In such cases, the burden of proof lies with the injured worker. They must show that the new conditions directly relate to the original work injury.

Again, one must file the petition within three years of the last payment of compensation to remain valid.

Injured worker undergoing physical therapy as part of a workers' compensation recovery plan. The image shows a physical therapist assisting the worker with rehabilitation exercises in a clinic, highlighting the role of physical therapy in treating work-related injuries and helping employees return to work under workers' comp benefits
Injured worker undergoing physical therapy as part of a workers’ compensation recovery plan.

Reviewing Medical Treatment and Compensation Benefit Offsets

The Petition to Review also plays a key role in disputes regarding medical treatment, billing, or compensation benefit offsets.

Use of this petition settles disputes. Like, when a worker and their employer or insurance carriers disagree over the necessity or appropriateness of medical treatment. The petition enables them to have the issue reviewed by a WCJ. Under workers’ compensation laws, the WCJ has the power to determine the reasonableness and necessity of the medical treatment.

The petition also addresses compensation benefit offsets. This occurs when employers reduce the amount of benefits paid because the employee receives other forms of income. Injured workers can file a petition to review if they believe an incorrect or unfairly applied calculation exists .

Wrap Up

The Employee Petition to Review plays a key role for injured workers. It enables them to address errors, expand injury descriptions, and dispute issues with medical treatment or benefit offsets. It helps to ensure that workers receive accurate and fair compensation and medical treatment following a work-related injury. This not only enables injured workers to get the compensation they deserve, it helps to get them better so they can return to work.

For questions about your specific case, give us a call 24/7 at (215) 609-4183. Our workers’ comp lawyers can help get you the compensation you deserve.

Reinstatement Of Workers’ Compensation Benefits In PA

What Is Benefit Reinstatement?

Benefit reinstatement refers to an injured worker once again receiving workers’ comp benefits after a stop or reduction. This typically occurs when a worker, with terminated, modified, or suspended benefits, experiences a recurrence of their disability. This may also come up if a worker has a loss of earning power because of the original work injury.

Success with this process requires a strong understanding of Pennsylvania workers’ comp laws. Injured workers should know their rights. Always speak to a workers’ comp lawyer for help with your specific case.

Visual representation of workers' comp benefits stopping, featuring a stream of dollar bills abruptly halted by a large red stop sign, symbolizing the sudden cessation of financial support after a work injury.
Reinstatement of workers compensation benefits can happen after benefits have totally stopped.

Reinstatement After Termination

Workers’ comp benefits may terminate because of a full recovery determination. But, if the work injury symptoms return or worsen after the return to work, you may seek reinstatement. This often happens when a worker finds working a job has caused a recurrence of the original work injury.

To successfully petition for benefit reinstatement, you must establish two key points:

Recurrence Of Disability

The disability must relate to the original work injury. Prepare to show medical evidence proving the reoccurring symptoms or that new complications have developed from the original injury.

Causal Relationship

The current disability must directly connect to the original work injury. This typically involves medical testimony with a comparison of current condition and condition at the time of termination.

Reinstatement After Modification, Suspension, Or Commutation

When the disability decreases, a return to work modification or suspension of benefits may occur. This can include a return to work in a light duty or modified capacity. If the condition worsens, you can seek benefit reinstatement. Also, if a new loss of earning power related to the work injury occurs, you can seek reinstatement.

Return To Work Without Restrictions

Suffering a recurrence of a work injury after going back to the pre-injury job might lead to reinstatement. This happens frequently with lifting or overuse injuries.

Return To Work With Restrictions

Many workers return to work on light duty or with restrictions. If they suffer a lay off or loss of earning power, they can seek reinstatement. A worker laid off while on light duty gets a legal presumption that their lost earnings flow from the work injury.

Return To A Modified Job

Workers may return to a modified job and suffer a lay off or a worsening of condition. In this situation, workers may seek reinstatement of their workers’ comp benefits. They must demonstrate that the work injury caused the current disability.

Reinstatement After Voluntary Withdrawal From Employment

Willingly leaving a job may not disqualify you from the reinstatement of workers’ comp benefits. But, it depends on why you left.

Voluntary Withdrawal From Pre-Injury Job

You may qualify for partial disability benefits under certain circumstances. For example, if you left the pre-injury job because of ongoing work-related pain or medical issues.  But, you would need to show that your decision to leave directly relates to the pain or limitations caused by your work injury.

Voluntary Withdrawal From A Modified Job

If departure relates to the injury while on light duty or in a modified job, you may seek reinstatement. Again, you would need to show the decision to leave relates to the pain or limitations of the work injury.

Voluntary Withdrawal From The Labor Market

For eligibility to workers’ comp, you must show that the injury forced the withdrawal from work. Voluntarily leaving for a personal reason or retirement do not qualify.

Suspension For Non-Compliance

Failure To Attend An Independent Medical Examination (IME)

If you missed an IME and suffered benefits suspension, benefits should reinstate after attending the rescheduled exam.

Refusal Of Reasonable And Necessary Medical Treatment

If you refused necessary medical treatment, your benefits might suffer suspension. For reinstatement, you must demonstrate a willingness to undergo the required treatment. Keep in mind the care must have minimal risk and a high likelihood of benefit to justify a suspension.

Failure To Submit Required Documentation

Workers’ comp benefits can suspend for failure to submit required forms, like the LIBC-760. After compliance, the benefits may reinstate, though typically not retroactively.

Incarceration After Conviction

While locked up, workers’ comp benefits may suspend. However, Pennsylvania workers’ compensation laws allow for the immediate resumption of benefits upon release.

Reinstatement After A Compromise And Release Agreement

A Compromise and Release (C&R) agreement finalizes a workers’ compensation case. It may involve a lump-sum settlement in exchange for giving up future claims. Situations can arise where you may challenge the agreement, potentially allowing for reinstatement. This often requires the help of a skilled workers’ comp lawyer.

Image depicting the statute of limitations for workers' comp claims, featuring an hourglass with nearly empty sand and a ticking clock in the background, symbolizing the urgency and approaching deadline to file a claim.
The law has strict time requirements to reinstate workers comp benefits

Time Limits And Requirements For Reinstatement

PA workers’ comp laws impose strict time limits for benefit reinstatement.

Statute of Limitations

Generally, you have three years from the date of the last compensation payment to file a petition for reinstatement. This applies to terminated, modified, or suspended benefits.

Partial Disability

For partial disability benefits, you can file reinstatement within 500 weeks from when the benefits began, under certain circumstances.

Conclusion

Reinstating workers’ comp benefits often has many filing deadlines. Missing a filing can permanently bar you from getting your benefits.  If you believe you need reinstatement, consult a workers’ compensation lawyer.  Injured workers should know their rights and have a lawyer looking out for them.

For questions about your workers’ compensation claim, reach out to our offices 24/7 for a free consultation (215) 609-4183. Don’t go it alone. The insurance company has a lawyer helping them and so should you.

Employer Petition To Review In PA Workers’ Comp

What Is An Employer Petition To Review?

In Pennsylvania workers’ compensation, an employer petition to review refers to a formal request.  It corrects, amends, or modifies the Notice of Compensation Payable (NCP) or an agreement regarding workers’ comp. The employer submits the request to the Bureau of Workers’ Compensation and the Workers’ Compensation Office of Adjudication (WCOA).

This review petition can address mistakes made in the original agreement. It may also address changes in the nature of the work-related injury after the issued NCP.

A professional office setting where an employer is filing a petition to review in Pennsylvania workers' compensation. The individual, dressed in business attire, is seated at a desk holding a pen, with a blank document in front of them. The background includes typical office elements such as a computer, stacks of paperwork, and office supplies, indicating a formal and focused atmosphere.
Filing a Petition to Review Compensation Benefits

When Should An Employer File A Petition To Review?

An employer or the insurance company may file a petition to review to correct various types of mistakes. For example:

Description Of The Work-Related Injury

If the injury description appears inaccurate.

Average Weekly Wage Calculation

To correct errors in calculating the worker’s average weekly wage.

Medical Treatment Or Billing

To review the appropriateness of medical treatments or billing issues.

Date Of Injury

To correct the date of the injury.

How Does The Petition To Review Process Work?

Filing The Petition

The employer or the insurance company must file LIBC-378. Filed with the Bureau of Workers’ Compensation and the WCOA, this official form petitions to review. The form details the needed corrections or modifications.

Legal Proceedings

Once filed, a Workers’ Compensation Judge (WCJ) will review the case. The employer or the insurance company must prove a material mistake in the original NCP or agreement.

Burden Of Proof

The party seeking the modification, the employer or the insurance company, bears the burden of proof.  They must show that the material mistake of fact or law existed at the time of the issued NCP.

A judge in a courtroom setting, dressed in traditional judicial robes, bangs a gavel, symbolizing a ruling on an employer-filed petition to review in Pennsylvania workers' compensation. The background includes elements of a courtroom such as the judge's bench, an American flag, and legal books, highlighting the formal and serious atmosphere of the proceeding.
A WCJ decides a Petition to Review

Specific Scenarios And Case Law

With questionable work-relatedness of the injury, employers may show that the disability does not relate to work. For example, when the NCP makes false representations. A court may also set aside an NCP if the compensation appears grossly disproportionate to the injury’s impact.

Time Limitations And Jurisdiction

No Time Limit For Correction

The WCJ may modify an agreement at any time when shown to have material incorrect information.

Jurisdictional Limits

The WCJ can only review petitions where an NCP, agreement for compensation, or supplemental agreement exist. Without these documents, the WCJ lacks jurisdiction.

Independent Medical Examination And Termination Petition

Role Of Independent Medical Examination

An independent medical examination (IME) often provides evidence for a petition to review or a termination petition. An IME may show the extent of the injury or validate the need for continued treatment. But, it may also say the worker has fully recovered and can return to work.

Filing A Termination Petition

The employer or the insurance company can file a termination petition to stop workers’ comp benefits. This may occur if the worker’s disability no longer relates to work or the worker has recovered. The termination petition must provide supporting medical evidence, often gathered through an IME.

Wrap Up

Workers should know their rights. If your employer has filed a petition to review, you need to speak to a lawyer. An experienced workers’ compensation lawyer can protect your benefits, giving you peace of mind while you recover.

If you have questions about your case, give us a call. We can help get you the benefits you deserve. Reach out 24/7 for a free consultation (215) 609-4183.

Modification Of Workers’ Comp Benefits In PA

Injured employees and employers should understand the modification of workers’ compensation benefits in Pennsylvania. This post covers some instances that can lead to a modification of benefits. We also take a look into pre-litigation forms and notices, and the litigation process. 

Increase Or Decrease In Disability

Changes in disability status can directly affect workers’ comp benefits.

From Total To Partial Disability

If a worker’s health improves and they can do some work, their benefits may change from total to partial disability.

The employer must provide medical evidence that shows the worker’s improvement and ability to work in a partial capacity. This involves a medical evaluation and possibly vocational assessments.

From Partial To Total Disability

If a worker’s condition worsens and they cannot work, their benefits can change from partial to total disability.

The worker must provide updated medical documentation that shows the their condition worsened. This might involve more medical tests, evaluations, and possibly the input of a treating physician.

No Longer Disabled

If a worker fully recovers with no disability remaining, their workers’ comp benefits may terminate.

Terminating benefits involves a medical assessment that confirms the worker’s full recovery. The employer or insurer would then file the paperwork to adjust the worker’s status and end benefit payments.

An injured worker in work clothes with a bandaged arm sitting on an examination table while a doctor in a white coat examines the injury in a medical clinic, highlighting the importance of seeking medical attention for work injuries.
Doctor examining an injured worker

Risk Of Recurrence Of Disability

The risk of a disability recurring if the worker returns to work concerns both employers and the workers.

Proof Of Risk

The worker must show that returning to their previous job would likely cause a recurrence of their disability. This proof often involves medical evidence and expert testimony that indicates the risks of returning to work.

Employer’s Responsibility

The employer must prove that the job does not pose a risk to the work injury. They must conduct a thorough review of the job and the associated risks. This may involve altering the work environment, providing extra safety measures, or offering other positions with less risk.

Return To Work With Loss Of Earnings

Returning to work after an injury does not always mean a worker will earn the same wages as before. When an employee has a loss of earning capacity because of their injury, workers’ comp benefits may need adjustment.

Partial Disability Benefits

Benefits typically calculate at two-thirds of the difference between the worker’s pre-injury and post-injury wages. The partial disability benefit covers the gap in lost wages between the current earnings and previous average weekly wage. This calculation takes into account overtime or bonuses earned before the injury.

Limitations

Caps can limit benefits. Also, the number of days the worker works per week may affect them. Partial disability benefits cannot exceed the max compensation rate for the state.

The employer or insurer must ensure that the partial disability payments do not exceed this statutory limits. They must also monitor the earnings to adjust benefits as needed.

Earning Power Assessment

Earning power assessments determine a worker’s ability to work after the injury. They aim to evaluate the types of work a worker can perform and the wages they can earn.

Expert Opinions

The basis of earning power focuses on the work the worker can perform. It considers their remaining productive skills, education, age, and work experience. Vocational experts play a main role in this assessment.

A vocational expert conducts an evaluation of the worker’s capabilities and the labor market. They review medical records, conduct interviews, and analyze job listings.

Job Listings And Market Surveys

The assessment includes job listings from various agencies, private job placement services, and advertisements in the usual employment area. It aims to identify realistic job opportunities that match the worker’s capabilities.

The vocational expert compiles job listings to suit the worker. This takes into account the local job market and the worker’s qualifications. They may also reach out to employers to verify job availability and suitability.

Notice Of Ability To Return To Work

When an insurer receives medical evidence that says a worker may return to work, they must fulfill specific duties.

Written Notice

Insurers and employers must give timely notice to the worker about their ability to return to work. It must detail their physical condition or change of condition. It must also cover their obligation to seek employment and the potential impact on their benefits. The notice must inform the worker of their right to consult with a lawyer.

An injured worker returning during recovery, smiling and carrying a toolbox at a construction site with completed structures and co-workers in the background, symbolizing successful return to the workforce after a work injury.
Employee returning to work after a work injury

Pre-Litigation And Litigation In Modification Cases

Pre-Litigation Forms And Notices

Several forms prove critical in the pre-litigation phase for managing modifications to workers’ comp benefits.

LIBC-337 (Supplemental Agreement)

LIBC-751 (Notification of Suspension or Modification)

LIBC-757 (Notice of Ability to Return to Work)

Litigation Process In Modification Cases

When pre-litigation measures do not work out or disputes arise, the litigation process begins. This involves petitions and hearings to resolve modification issues.

Change Of Status Petition

This petition comes into play with a modification, reinstatement, suspension, or termination of benefits.

Either the employer or the worker can file a petition to modify the worker’s compensation status. Filed with the Bureau of Workers’ Compensation, the petition must include supporting documentation. Then, a hearing occurs before a Workers’ Compensation Judge (WCJ).

Unlike some legal actions, no time limit exists for filing a petition to modify benefits. This allows parties to address changes in the worker’s condition as they occur.

Wrap Up

Modifying workers’ comp benefits in PA involves a deep understanding of legal and procedural elements. If you have received a job offer, but still suffer from your work injury, you need a lawyer. Injured workers need to know their rights.

An experienced workers’ comp lawyer can help get the benefits and medical treatment you deserve. If you have questions about your workers’ comp benefits, we can help. Reach out to our offices 24/7 for a free consultation at (215) 609-4183.

Suspension Of Benefits In PA Workers’ Comp

Illustration showing a construction worker in a helmet standing in front of a large document marked "Suspended," with a gavel and courthouse in the background, symbolizing the suspension of workers' compensation benefits.
Suspension of workers comp benefits can happen a number of different ways

What Can Suspend My Benefits?

Return To Work With Residual Impairment

Benefits may stop if a worker returns to work with some impairment, but without the loss of earnings or earning power. The Pennsylvania Workers’ Compensation Act addresses this. It states if a worker can do their job without a significant loss of income, they may not qualify for more benefits. This applies even if the worker has not fully recovered from their work-related injury.

Refusing Reasonable Medical Treatment

Benefits can face suspension if a worker refuses reasonable medical treatment. The Act states employees must comply with the recommended medical services. This covers things like: surgical, medical, and hospital services, treatment, medicine, and supplies. Refusal to do so can result in forfeiture of compensation for any injury or increased incapacity.

Refusal To Comply With Exam Or Interview Order

If a worker refuses a medical exam or interview related to their claim, their benefits can face suspension.

Incarceration After Conviction

If incarcerated after the conviction of a crime, the worker’s benefits will face suspension. The incarceration has removed that individual from the workforce, making them ineligible for benefits.

Failure To Complete And Return Employee Verification Form

Workers must complete and return their verification forms to confirm ongoing eligibility for benefits. Failure to do so may cause the suspension of benefits until compliance.

Voluntary Withdrawal From The Labor Market

If a worker chooses to leave the workforce, benefits can face suspension. For example, retirement or choosing not to seek employment. 

Total And Permanent Disability From A Non-Work-Related Condition

When a worker becomes totally and permanently disabled from a condition unrelated to work, the employer can suspend benefits. This may occur because the non-work-related condition hinders any chance of the worker’s return to work. *This refers only to workers’ comp and not to total disability benefits.

Employer Job Offers And Earning Power Assessments

Employers can offer jobs that meet the worker’s capability post-injury. If a worker turns down such an offer without justifiable reason, their benefits may face suspension.

The Act requires employers to assess the earning power of the employee. This helps to ensure an appropriate and fair offered position.

Pre-Litigation Procedures For Suspension

Notification And Forms

Employers must follow specific procedures to suspend benefits. This includes notifying the employee in writing and using the designated forms. For instance, LIBC-751 (Notification of Suspension or Modification) and LIBC-762 (Notice of Suspension for Failure to Return LIBC-760).

Cessation Of Compensation

The cessation of benefits typically happens in one of the following ways. Compensation can stop through a final receipt, supplemental agreement signed by the employee, or notification of suspension or modification. If the worker disputes the suspension within 20 days, a supersedeas hearing will occur to address the matter.

What Happens During Litigation?

Burden Of Proof

The employer bears the burden of proof in litigation when it comes to the suspension of benefits. They must meet certain conditions. For example, proving the worker’s ability to return to work or the refusal to follow medical treatment.

Special Cases

Several notable cases that illustrate various aspects of the suspension of benefits:

  • Landmark Constructors, Inc. v. WCAB:

Employers must demonstrate job availability if the employee can return to work without restrictions.

  • Brandywine Mazda Suzuki v. WCAB:

Misconduct by an employee prior to the injury does not remove the employer’s obligation to prove job availability.

  • Crowell v. WCAB:

The employer cannot suspend benefits if the employee cannot perform the pre-injury job without significant pain.

How Does Refusal Of Medical Treatment Affect Benefits?

Forfeiture vs. Suspension

The refusal of medical treatment can lead to the forfeiture or the suspension of benefits. Forfeiture removes the worker’s right to benefits during the refusal period. Suspension pauses the benefits until the worker complies with the treatment.

This distinction matters. For instance, cases where the worker’s medical condition depends on doing the recommended medical procedures. Also, in situations where the worker’s ability to return to work depends on undergoing the medical treatment.

Employer’s Burden

The employer must prove the reasonableness of the medical treatment and that the worker unjustifiably refuses it. If treatment involves minimal risk and a high likelihood of success, refusal can lead to the suspension of benefits. The employer must show that the refusal directly impacts the worker’s recovery and ability to return to work.

Illustration of a person behind bars in a prison cell, looking dejected, with a guard standing outside the cell, symbolizing incarceration and its impact on the suspension of workers' compensation benefits.
Incarceration after conviction of a crime suspends workers compensation benefits

Impact Of Incarceration On Benefits

Automatic Suspension

Benefits automatically suspend upon an worker’s incarceration after a conviction. This self-executing suspension does not require a petition. The incarceration significantly changes the worker’s status and ability to work, justifying the suspension of wage loss benefits.

Scope Of Incarceration

Suspension applies to all forms of incarceration, including detention in alcohol recovery facilities and halfway houses. House arrest also qualifies as constructive custody, leading to suspension of benefits. The goal aims to ensure benefits only cover those working or recovering from a work injury.

Voluntary Withdrawal From The Labor Market

Retirement And Benefits

The suspension of benefits takes places when a worker voluntarily retires and has no intention of seeking further employment. But, if the retirement results from the work-related injury, the employee may still receive benefits.

Proving Retirement

The employer must prove the worker’s voluntary retirement through evidence. For example, the acceptance of a retirement pension and the refusal of suitable employment offers. The evidence must show that the worker has decided not to return to the workforce.

Other Reasons For Withdrawal

Workers who move out of the country or fail to seek employment in good faith may have their benefits suspended.

Decisions that lead to withdrawal from the workforce, unrelated to the work injury, can justify the suspension of benefits. This includes situations in which the worker’s substandard job performance occurred prior to the injury. This can impact their eligibility for benefits.

Conclusion

Suspension of benefits in Pennsylvania workers’ compensation involves various factors, including return to work, medical treatment compliance, and voluntary withdrawal from the workforce. Employers must follow specific procedures and prove the basis for suspension. Workers have ways to challenge suspensions through hearings and litigation.

All workers should know their rights to avoid problems down the road.  Knowing your rights helps ensure a fair process, supported by substantial evidence. Many situations arise where your benefits could face suspension. Knowing these situations and preparing for them, can help ensure you do not go without the compensation you deserve.

If you face suspension of your benefits, you need an experienced workers’ compensation lawyer to assist you. When a work injury has occurred, you need someone to protect your rights. The insurance company has a lawyer on their side and so should you.

We can help, don’t go it alone. Reach out to our offices 24/7 for a free consultation at (215) 609-4183.

 

Termination Or Cessation Of Workers’ Compensation Benefits

Termination Forms

Workers’ compensation insurance provides benefits crucial for injured workers. Circumstances can arise where these benefits may cease or terminate. Knowing the processes and reasons around the termination of benefits can help injured workers with their workers’ compensation case.

Pre-Litigation Forms

Agreement To Stop Weekly Workers’ Compensation Benefits (Final Receipt) – LIBC-340

Also called a “Final Receipt.” The worker signs this form in agreement to stop receiving workers’ comp benefits. By signing this form, the worker may terminate benefits. But, the insurance company may still cover medical expenses related to the work injury.

Supplemental Agreement For Compensation – LIBC-337

Known as the “Supplemental Agreement.” The worker and employer use this form to agree to adjust the benefits. If the worker’s disability has ceased, this form could terminate both indemnity and medical benefits.

Litigation Forms

Petition To Terminate Compensation Benefits – LIBC-378

Employers use this form to request the termination of benefits. A workers’ compensation judge decides this petition.

Physician’s Affidavit of Recovery – LIBC-497

A doctor completes this affidavit to declare an injured worker fully recovered and no longer in need of benefits. 

Injured worker celebrating full recovery, standing confidently with a cast and crutches in a workplace environment, with a sunny sky symbolizing a positive and bright future.
While employers try to stop benefits, injured workers have options.

What Causes Workers’ Comp Benefits To Terminate?

Full Recovery

Benefits terminate when an injured worker reaches full recovery. Substantial medical evidence must show the full recovery. An independent medical examination (IME) often provides support for this conclusion. This typically requires a physician’s affidavit or the worker’s signed final receipt.

Specific Scenarios For Fatal Claims

Meretricious Relationship or Prostitution:

Benefits can terminate if the dependent engages in a meretricious relationship or lives a life of prostitution.

Remarriage or Change in Dependency Status:

Death benefits for dependents may stop upon remarriage, death, or a change in the dependency status. For example, a widower who remarries can lose their benefits.

What Causes Workers’ Comp Benefits To Cease?

Death From Unrelated Causes

If an injured worker dies from causes unrelated to the workplace injury, the obligation to pay benefits typically ends. However, specific loss benefits may still apply.

Running Of The Statutory Period For Partial Disability

Workers’ compensation benefits for partial disability have a maximum statutory period of 500 weeks. Once this period ends, the benefits will cease by law.

Pre-Litigation Procedures

Final Receipt

A final receipt refers to a signed agreement in which the employee agrees to stop receiving benefits. Even after signing a final receipt, the insurance carrier may still pay reasonable and necessary medical expenses.

Supplemental Agreement

Both parties can agree to terminate benefits through a supplemental agreement. It must include a statement that the worker’s disability has ended.

Agreement For Compensation

Both the worker and employer sign this type of agreement. It can include terms that terminate benefits if it clearly states the end of disability.

Two people shaking hands over a table with documents and a pen, symbolizing a successful workers' comp agreement in a professional office setting.
Sometimes workers’ compensation claims resolve with an agreement

Litigation Process For Terminating Benefits

Burden Of Proof

In litigation, the insurance company bears the burden of proof to show that the worker’s disability has ended. This requires medical evidence. It must show a full recovery and the ability to return to work without restrictions.

Key Points In Proving Full Recovery

  • Medical Opinions: The insurance carrier must present medical opinions that unequivocally state the worker has fully recovered.
  • Employee’s Condition: The employer must prove that any current disability does not relate to the work injury.

Termination Of Lifetime Benefits

Full Recovery

An injured worker no longer has entitlement to benefits once fully recovered. Employers must obtain a final receipt or file a petition for termination to formalize this.

Partial Recovery

Even if an employee has partially recovered, benefits may still terminate. This may happen if proven that the employee’s current condition does not relate to the work injury.

Termination Not Proper

Benefits cannot terminate solely based on the worker’s ability to return to work. The evidence must show that all disability related to the work injury has ceased.

Workers’ Comp Lawyer

Injured workers should know their rights and the evidence needed to challenge or accept the termination of their benefits. If you receive a termination, you need to speak with a Pennsylvania workers’ compensation lawyer. They can help in dealing with the insurance company, filing forms, and representing you before a workers’ compensation judge.

A knowledgeable lawyer can help you handle your workers’ compensation claim, ensuring you receive the benefits you deserve. For personalized help, reach out to our offices 24/7 for a free consultation  (215) 609-4183.

Supersedeas And Fund Reimbursement In PA Workers’ Comp

Dealing with issues like supersedeas and supersedeas fund reimbursement can present challenges. This blog post aims to explain these concepts for injured workers.

Supersedeas In Pennsylvania Workers’ Compensation

Supersedeas in PA workers’ comp involves the suspension or reduction of benefits while resolving a dispute. This allows employers to file a petition to temporarily stop the payment of benefits. This may occur if they believe the injured worker has recovered or that the compensation requires adjustment.

Judge in a courtroom making a ruling in a workers' compensation case. The judge, wearing traditional judicial robes, is seated at the bench with a gavel in hand. The scene includes an injured worker and their attorney on one side, and an employer and their attorney on the other, set against a backdrop of wooden furniture, legal books, and an American flag.
Judge in a courtroom making a ruling on supersedeas

Changes to Supersedeas

In Baksalary v. Smith, a federal court ruled that the automatic supersedeas provision was unconstitutional. This decision lead to changes to the application of supersedeas, ensuring due process for injured workers.

How does Supersedeas Work Today?

Today, employers must file a petition. Next, a Workers’ Compensation Judge (WCJ) must review and decide on the request within 14 days. If granted, the benefits may face suspension or modification until a final decision on the case.

How The Process Works

Requesting Supersedeas

An employer must file a petition when they believe a worker has recovered or that benefits need adjustment. The petition needs a medical affidavit from a doctor who examined the worker within 21 days before filing.

The Hearing Process

The court schedules a hearing within 21 days of filing the petition. During this hearing, the WCJ will review evidence, which may include medical reports, witness testimonies, and other relevant documents. The WCJ must make a decision within 7 days if prima facie evidence exists that supports the employer’s claims.

What Happens After the Decision?

If granted, the supersedeas results in the suspension or reduction of the worker’s benefits. If denied, the employer must continue to pay the benefits until the final resolution of the case. One cannot appeal the decision on supersedeas.

Hands exchanging cash, symbolizing supersedeas fund reimbursement in a workers' compensation context. The professional transaction illustrates the reimbursement process after a denied supersedeas request, highlighting financial compensation for employers.
Reimbursement from the Supersedeas Fund.

Supersedeas Fund Reimbursement

Supersedeas fund reimbursement allows employers to recover compensation paid, if later determined the benefits were not actually payable. This reimbursement comes from a special fund maintained by assessments on all insurers and self-insurers in PA.

Criteria For Fund Reimbursement 

To qualify for supersedeas fund reimbursement, the employer must meet the following:

  • The employer made a request for supersedeas in a proceeding.
  • The court denied the request.
  • The employer continued to pay compensation because of the denial.
  • A final determination found that the compensation was not due.

Filing

Employers must file an Application for Supersedeas Fund Reimbursement (LIBC-662) with the Bureau of Workers’ Compensation.

Common Scenarios

Denied Supersedeas Requests

When the court denies an employer’s request, but the final decision concludes compensation was not actually payable.

Payments Made in Error

When the employer paid benefits based on incorrect information or determined the worker had fully recovered.

Legal Adjustments

If changes in legal interpretations or settlements occurred.

Tips for Injured Workers

Know Your Rights

As an injured worker facing a supersedeas petition, you need to know your rights. You have the right to present evidence and challenge the employer’s claims.

Talk to a workers’ compensation lawyer. An experienced lawyer will promptly respond to notices and petitions and gather medical records and documentation for your case. In addition, they will update you on any changes and court rulings that may affect your case.

Wrap Up

For wage loss due to a work injury, or the enforcement of a judgment related to your case, you need a lawyer. For questions or assistance with your workers’ compensation claim, reach out to our offices 24/7 at (215) 609-4183. The insurance company has a lawyer on their side and so should you. Let us help!

Independent Medical Examinations & Impairment Ratings

Injured workers in PA should know some of the procedures they may face during their claim. Certain procedures can determine the extent of the injury, the ability to work, and the compensation received. Here, we will cover Independent Medical Examinations (IMEs), expert interviews, and Impairment Rating Evaluations (IREs).

What Does Independent Medical Examination (IME) Mean?

An Independent Medical Examination (IME) refers to a medical evaluation performed by a doctor chosen by your employer or their insurance company. An IME aims to obtain an objective assessment of the medical condition following a work-related injury. Research shows these exams tend to favor the employer much more than a treating physician.

Many stakeholders report these examinations as barely an exam and not independent. But, employers have the right to request that injured workers undergo an IME at a reasonable time and place. This exam may allow the employer to dispute the extent of the injury and any ongoing medical treatment. It also allows them to challenge the worker’s medical restrictions.

@thwesq Replying to @laurencepatterso8 unfortunately, the financial incentive for these doctors seems too far out weigh any moral compass they may have had. Independent medical exams are not independent, and they are barely a medical exam. #workersrights #workerscomp #lawyer #workinjurylawyer #workinjury ♬ original sound – Tom Wing | Workers Comp Lawyer

Why Does An Employer Request An IME?

Employers often request an IME to gather a second opinion about the medical condition from a friendly party. An IME can provide evidence on the diagnosis, the current treatments, and the prognosis for returning to work. This can save the employer money on claims. IMEs help employers to challenge parts of an employee’s claim.

What If I Refuse To Attend An IME?

Refusing to comply with an order for an IME can lead to serious consequences. The Pennsylvania Workers’ Compensation Act addresses this. If you miss an IME without reasonable cause, you risk losing your benefits during this period. This means they could suspend wage loss and medical benefits.

How Often Can My Employer Request An IME?

The frequency of IMEs can vary. Typically, employers may request an IME every six months. This can depend on the circumstances of the case and the discretion of the Workers’ Compensation Judge (WCJ).

May I have My Own Doctor Present During An IME?

Yes, you have the right to have your own healthcare provider there during the IME. However, your doctor’s role remains limited to observing the exam. They cannot interfere, videotape or audiotape, question the examiner, or help you in responding to questions. Your lawyer may hire a nurse to attend the exam as well.

Independent Medical Examination (IME) scene showing a patient being examined by a doctor in a medical office, with medical instruments, records, and anatomical charts visible in the background, representing the detailed assessment process for workers' compensation claims.
A patient examined by a doctor for a workers’ compensation claim.

Understanding Expert Interviews

What Happens At A Vocational Expert Interview?

Vocational expert interviews assess the injured worker’s earning power when receiving workers’ comp. They look at their ability to return to work. They also determine the type of work they can perform, given the injury. The insurer can require the worker to submit to an interview with a vocational expert.

Why Conduct Vocational Expert Interviews?

The main purpose of a vocational expert interview involves assessing the worker’s earning capacity. They consider the worker’s education, work experience, skills, and current labor market conditions. Then, they will determine the types of jobs that might suit the injured worker.

The findings from the vocational interview can impact the continuation or modification of workers’ comp benefits.

What Qualifications Does A Vocational Expert Have?

Vocational experts must adhere to the criteria set forth by the Bureau of Workers’ Compensation. They must have a Commission on Rehabilitation Counselor Certification and one year of experience analyzing labor market conditions. Or, a bachelor’s degree and work under the direct supervision of someone with these qualifications.  

What If I Refuse To Attend A Vocational Expert Interview?

Refusing to attend a vocational expert interview can result in the suspension of benefits. The WCJ has the authority to enforce attendance at these interviews. They can also suspend benefits for failure to comply without reasonable cause.

Impairment Rating Evaluations (IREs)

What Does IRE Mean?

An IRE refers to a medical assessment used to determine the extent of permanent impairment from a work injury. An IRE aims to establish the degree of the body impairment and classify the disability status.

IREs must use the sixth edition of the American Medical Association Guides to the Evaluation of Permanent Impairment. The results of an IRE can impact the duration and amount of workers’ comp benefits.

How Does An IRE Affect Disability Status?

The IRE’s outcome determines whether the disability status remains classified as totally disabled or changes to partial disability. If the impairment rating hits 35% or higher, total disability benefits will continue.

If the impairment rating is less than 35%, the status will change to partial disability. This change means receiving partial disability benefits. While the name of the benefit changes, the amount of the benefit stays the same. However, an injured worker can only receive partial disability benefits for a maximum of 500 weeks.

What If I Disagree With The IRE Results?

If you disagree with the results of an IRE, you may be able to appeal the decision. This would involve filing a petition for review with the Bureau of Workers’ Compensation or hiring your own expert.

Patient reaching Maximum Medical Improvement (MMI) in a medical office, with a doctor explaining the stabilized condition using medical charts and x-rays. The patient looks relieved and hopeful, highlighting the recovery progress and thorough discussion about the condition.
Patient reaching Maximum Medical Improvement (MMI) in a medical office.

Reaching Maximum Medical Improvement (MMI)

What Does MMI Mean?

Maximum medical improvement (MMI) refers to a vital point in the recovery. It means the medical condition has stabilized and will likely not improve that much with further treatment.

An injured worker must reach MMI before an impairment evaluation. It can also impact decisions regarding your workers’ compensation claims.

Understanding the Editions of the Guides

The American Medical Association Guides to the Evaluation of Permanent Impairment, often referred to simply as the “Guides.” They serve to assess the extent of an injured worker’s permanent impairment.

Different editions of the Guides appear over time, each incorporating updated medical knowledge and assessment techniques. The sixth edition, currently used for IREs in PA, includes comprehensive criteria for evaluating various types of impairments and determining the overall impairment rating.

Wrap Up

Know your rights. For help with your workers’ comp case, consult with a workers’ compensation lawyer. An experienced lawyer can help secure the benefits you need to support your recovery and future well-being. For a free consultation, reach out to our offices 24/7 at (215) 609-4183.

The Heart and Lung Act And Comp Statutes In PA

This blog post hopes to simplify and explain the Heart and Lung Act and other related statutes. Here, we will only focus on injured workers in PA.

Illustration of a healthy heart and lungs, highlighting the Heart and Lung Act, which provides full salary and medical expense compensation to specific public safety employees who suffer temporary disabilities from job-related injuries.
Illustration of a healthy heart and lungs, highlighting the Heart and Lung Act, which provides full salary and medical expense compensation to specific public safety employees who suffer temporary disabilities from job-related injuries.

Heart And Lung Vs. Workers’ Comp

The Heart and Lung Act provides salary and medical expense compensation to certain public safety workers. This includes: police officers, firefighters, and some state employees. Heart and Lung offers more generous benefits than the Workers’ Compensation Act, but it has a more limited scope.

The main difference lies in the extent of coverage. The Workers’ Comp Act provides for partial compensation for both temporary and permanent disabilities. Heart and Lung offers full salary and benefits, but only for temporary disabilities that occur while performing job duties. Meaning, an injured employee under the Heart and Lung Act receives their full salary instead of a percentage.

Eligibility

To qualify for Heart and Lung, the injury must occur while performing official duties, not just during work hours. Heart and Lung compensation covers only incidents that arise from the hazardous nature of the specific job duty.

How It Works

The Heart and Lung Act mandates its provisions, making them non-elective. This means eligible employees must use this benefit, and not opt out.

When collective bargaining agreements stipulate such procedures, grievance arbitration often resolves disputes over eligibility or entitlements.

Heart and Lung covers injuries incurred in the performance of duties. This requires that injuries must directly relate to an employee’s work responsibilities to qualify for the benefits.

Full Salary

Full salary compensation refers to the gross salary before taxes and other deductions. This ensures that employees receive their complete earnings during their period of temporary disability. However, this does not include additional earnings such as overtime or holiday pay, which vary annually and between workers. The Act prevents financial harm for critical public safety workers while they recover from work-related personal injuries.

Due Process

Legal procedures under the Heart and Lung Act mandate a due process hearing before terminating benefits. The employer can terminate benefits if the worker’s disability becomes permanent. The employer can also terminate benefits if the worker can return to work.

This legal protection ensures that employees have an opportunity to contest any changes in their benefit status. 

Heart And Lung Vs. Act 534/632

Act 534/632 applies to employees of state penal and mental institutions. This Act guarantees full salary benefits if an inmate injures a worker. The Act also ensures full salary benefits if the worker suffers an injury while performing job duties.

How It Works

Unlike the Heart and Lung Act, Act 534/632 does not distinguish between temporary and permanent disabilities. The Act provides complete coverage for workers until they can return to work. This ensures long-term support for those working in high-risk environments within state institutions.

Heart And Lung Vs. Act 17

Act 17 of 2021 covers the unique challenges posed by the COVID-19 pandemic. It offers temporary compensation for public safety workers and National Guard members affected by COVID-19. This Act limits benefits to 60 days per incident.

County Jail Or Workhouse Employees

County jail or workhouse employees injured by inmate violence receive full salary benefits under the Heart and Lung Act.  However, these benefits last only for the period during which the worker qualifies for workers’ comp. 

Federal Laws

Federal laws also overrule the Pennsylvania Workers’ Compensation Act for specific groups of workers. The Federal Employers’ Liability Act (FELA) covers injured railroaders employed in interstate commerce, providing compensation for work-related injuries.

The Longshore and Harbor Workers’ Compensation Act protects maritime workers. This includes longshore and harbor workers. This Act covers those injured on or near navigable waters or in the shipbuilding industry.

The Jones Act offers compensation for seamen injured aboard flag ships and passenger vessels.

The Federal Employees’ Compensation Act (FECA) covers federal civilian employees.

The Defense Base Act (DBA) covers employees of contractors working on military bases outside the United States.

These statutes ensure that employees working in high-risk federal careers receive proper compensation for work-related injuries. They override state workers’ comp provisions where applicable.

Illustration depicting collective bargaining: A diverse group of employees, including men and women of different ages and ethnicities, sit around a large table in a meeting room. Some employees hold documents, while others engage in discussion. At the head of the table, a representative or union leader speaks, emphasizing negotiation and agreement. The atmosphere is collaborative and focused.
Illustration showing collective bargaining

Collective Bargaining

Collective bargaining plays a vital role in the specifics of workers’ compensation within the framework of these statutes. Agreements can establish supplemental benefits, alternative dispute resolution systems, and other specific procedures related to workers’ compensation.

Regulations allow for alternative dispute resolutions through negotiated agreements. This approach allows for tailored compensation arrangements that meet the unique needs of different worker classes of service.

State Employees’ Retirement System

The State Employees’ Retirement System can also influence workers’ compensation benefits. For example, workers with expired partial disability benefits can only receive additional service-connected disability supplements if they continue to receive partial disability benefits. This interaction ensures that workers’ comp benefits coordinate with retirement benefits.

The State Employees’ Retirement Board administers these retirement plans. They ensure that employees hired by the state receive the necessary support under the State Employees’ Retirement Code.

Wrap Up

Knowing these statutes can help injured workers navigate their rights and benefits more effectively. Talking with a workers’ compensation attorney can ensure that you receive the benefits you deserve. This includes benefits administered by the Department of Labor and the specifics of employer contributions towards retirement benefits.

Trying to navigate this alone can get confusing. Let one of our experienced lawyers help you. Reach out to our offices 24/7 for a free consultation (215) 609-4183.

Child Support, Uninsured Employers In Workers’ Comp & More

Child Support And Workers’ Compensation Benefits

How Can Workers’ Comp Benefits Affect Child Support Payments?

Workers’ compensation benefits in PA can largely impact child support payments. The state classifies workers’ comp benefits as income, allowing wage garnishment to satisfy a child support obligation. This ensures that noncustodial parents receiving workers’ compensation benefits remain on the hook for their child support payments.

A courtroom scene where a judge hands a document labeled 'Child Support Order' to a noncustodial parent who receives workers' compensation benefits, while a child stands beside the custodial parent. The background includes legal bookshelves, and a scale of justice is prominently displayed on the judge's bench, emphasizing the legal intersection of child support and workers' compensation.
Child Support can take workers’ compensation benefits in Pennsylvania

What Happens If Child Support Payments Fall Behind?

To cover unpaid child support, a lien attaches to the net proceeds of a settlement. This lien ensures the injured worker pays child support out of the compensation awarded.

What Defines A “Monetary Award” And “Net Proceeds?”

A “monetary award” includes any lump sum settlement paid under the Workers’ Compensation or Occupational Disease Acts, excluding structured settlement annuities. “Net proceeds” refer to the amount remaining after any deductions. For example: attorney fees, litigation expenses, unpaid medical expenses, and indemnity or medical payments. This would also include payments to the Medical Assistance program, provided this amount exceeds $5,000.

How Do Liens From The Department Of Human Services Affect Workers’ Comp?

The Department of Human Services (DHS) liens work differently. A DHS lien can enforce the lien on workers’ comp benefits even if the net proceeds fall below $5,000. A non-disbursement order can halt the release of the settlement funds until satisfaction of the DHS lien.

What Is The Required Documentation For Support Arrears?

Before the payout of any monetary workers’ comp award, the worker must submit their child support status statement.

Also required, documentation of any unpaid support from the Pennsylvania Child Support Program website. If arrears exist, the Workers’ Compensation Judge (WCJ) will order them paid directly to the state disbursement unit. This payment comes directly from the workers’ compensation settlement before any money goes to the injured worker.

Uninsured Employers In Workers’ Comp

What Is The Uninsured Employers Guaranty Fund (UEGF)?

The Uninsured Employers Guaranty Fund (UEGF) provides compensation to injured workers whose employers do not carry workers’ compensation insurance. It ensures injured workers receive the necessary benefits even if their employer fails to carry proper insurance.

What Notice Requirements Exist For Filing A Claim?

You must file notice of a claim against the uninsured employer before filing a petition for UEGF benefits. This notice must occur within 45 days of the worker learning that the employer does not have workers’ comp insurance. Failing to meet this deadline can prohibit the worker from claiming compensation from the uninsured employers fund.

Judgments And Liens In Workers’ Comp

How Can An Employee Obtain A Judgment Against An Uninsured Employer?

If an employer carries no insurance, an injured worker can file a claim petition and seek a protective judgment. The Bureau certifies this judgment, allowing recording with any common pleas court. However, execution of the judgement must wait until approval of the compensation agreement or award.

What Happens If An Employer Fails To Pay Benefits?

When an employer fails to pay benefits, the worker can file the approved agreement or award with the prothonotary. The prothonotary will then enter the unpaid balance as a judgment against the employer. This judgment becomes a workers’ compensation lien against the employer’s property, allowing for immediate execution to get benefits paid.

Can Creditors Take Workers’ Comp Benefits?

Creditors’ claims typically cannot touch workers’ compensation benefits, except for child support orders.

A distressed employer sits at a cluttered desk filled with financial documents and bills. The background shows a business setting with empty office spaces and equipment, reflecting a somber atmosphere of financial strain and uncertainty.
When an employer is Bankrupt, the Workers Compensation Security Fund steps in.

Bankruptcy And Insolvency In Workers’ Comp

What Happens If An Insurance Company Becomes Insolvent?

The Workers’ Compensation Security Fund ensures the payment of workers’ comp benefits when an insurance company files bankruptcy. This fund steps in to cover claims that the insolvent insurer can no longer pay.

What About Self-Insured Employers?

Self-insured employers must provide enough security to cover potential liabilities and financial difficulty. For example, bonds or letters of credit. The Self-Insurance Guaranty Fund steps in to pay benefits if a self-insured employer defaults.

What Implications Exist For Uninsured Employers?

For injuries occurring before January 8, 2007, no guaranty fund protects employees of uninsured employers. These injured workers must rely on claims against the bankrupt estate of the employer. In this instance, speak to a bankruptcy attorney and a workers’ comp attorney right away.

Wrap Up

Many issues can arise in workers’ compensation cases. From liens and judgements to child support obligations, lack of insurance, and even bankruptcy, many things can come up. Having a workers’ compensation attorney by your side will help you get through these issues without delays.

For help with your workers’ comp case, reach out to our offices 24/7 at (215) 609-4183 for a free consultation. Let us have your back.

Third-Party Subrogation in Pennsylvania Workers’ Comp

What happens when a third party’s actions contribute to a work injury? This post will look into third-party subrogation under the Pennsylvania Workers’ Compensation Act. It will address key forms, legal principles, and specific considerations to help injured workers understand their rights and obligations.

What Is Third-Party Subrogation?

Third-party subrogation occurs when a third party causes an injured employee’s compensable injury. This includes injuries caused, in whole or in part, by the act or omission of the third party. The PA Workers’ Compensation Act lays this out clearly.

The employer shall be subrogated to the rights of the injured worker, their personal representatives, estate, or dependents against such third party to the extent of the compensation payable under the law. 

Meaning, the employer or their insurance company can recover the amount paid in workers’ comp benefits from the third party responsible for the injury. The employer can also do this on behalf of the injured worker’s personal representatives, estate, or dependents.

Example

A malfunctioning piece of machinery injures a worker. The injured worker sues the manufacturer of the machinery and receives a settlement.

The employer or their workers’ compensation insurance provider can claim a portion of that settlement. This claim would equal the compensation benefits already paid to the injured worker.

Why Is Subrogation Important?

Subrogation serves three main purposes under the PA Workers’ Compensation Act:

Preventing Double Recovery

It ensures that the injured worker does not receive a double recovery. Meaning, receiving both full compensation from workers’ comp and a third-party settlement for the same injury.

Employer Protection

It ensures the employer does not unfairly pay compensation because of a third party’s wrongful act or omission.

Third-Party Accountability

It prevents a third party from escaping liability for their wrongful conduct.

Key Forms

Third Party Settlement Agreement (LIBC-380)

This form lays out the details of settlements from third-party recoveries and ensures all parties agree on the terms.

Compromise and Release Agreement by Stipulation (LIBC-755)

This form outlines the terms of the settlement and the release of claims. Commonly known as a C&R Agreement.

Supplemental Agreement for Compensation for Disability or Permanent Injury (LIBC-337)

This form adjusts the injured worker’s comp benefits when changes in their condition or circumstances arise.

Death Claim Supplement to Compromise and Release Agreement (LIBC-749)

Used specifically for settlements related to death claims. This ensures that dependents receive their due benefits.

A workers' comp judge in a courtroom, wearing judicial robes and seated behind a large wooden desk. The judge looks attentive and focused, with a gavel nearby. The courtroom includes flags, legal books, and an audience area, creating a formal and respectful atmosphere to address subrogation.
A workers’ compensation judge decides issues of subrogation

Legal Principles

PA Workers’ Comp Act, Section 319

Section 319 mainly governs workers’ compensation subrogation. This section clearly outlines the employer’s right to reimbursement from third-party recoveries.

Whitmoyer v. WCAB (2018)

This case made it clear that “future installments of compensation” only cover indemnity benefits like lost wages. They do not include future medical expenses.

Dale Mfg. Co. v. WCAB (1980)

The court identified three main purposes of subrogation: preventing double recovery, protecting employers from unfair financial burdens, and ensuring third-party accountability.

Kamp v. Green Acres Contracting Co. (2022)

The court affirmed the constitutionality of subrogation liens. Finding, it constitutional even if it equals or exceeds the employee’s third-party recovery.

Handling Recoveries and Liens

To calculate the employer’s subrogation interest accurately, consider reasonable attorney’s fees and other proper disbursements. This ensures a fair distribution of the recovery amount between the injured worker and the employer.

Example

An injured employee recovers $100,000 from a third-party settlement. The employer paid $50,000 in workers’ compensation benefits. The employer can reclaim that $50,000, adjusted for a share of the legal fees.

A person deep in thought, sitting at a desk with a notebook and pen, contemplating workers' compensation subrogation. The setting is a cozy home office with bookshelves and a window showing a serene outdoor scene, creating a warm and thoughtful atmosphere.
A person thinks about workers’ compensation subrogation

Things To Consider

Medical Expenses And Future Benefits

The law distinguishes between indemnity benefits and medical expenses. Employers can claim a lien on past medical expenses, but they cannot offset future medical costs through subrogation. This ensures that injured workers receive their necessary medical care without any interruption.

Disputes

Disputes over the amounts and validity of subrogation claims can come up. When they do, the Workers’ Compensation Judge (WCJ) hears these disputes to find a fair outcome. Injured employees and their attorneys may present evidence and arguments showing the the subrogation claim was appropriate.

Can Employers Waive Their Subrogation Rights?

Employers can waive their subrogation rights through explicit agreements. Such waivers must show clear documentation. This avoids confusion and ensures all parties agree to the terms. Without proper documentation, disputes may arise over the extent of the waiver and its impact on future claims.

Wrap Up

For injured workers looking to handle their recovery process in PA workers’ comp, they should understand third-party subrogation. By knowing your rights, you can ensure you receive the compensation you deserve.

Subrogation claims can get complicated. A workers’ comp lawyers can help to ensure that you do not end up with unfair financial burdens or without medical care. They can guide you through your workers’ compensation claim and protect your interests.

For advice on your case, let us help. Reach out to our offices 24/7 for a free case evaluation (215) 609-4183.

Breaking the Rules: Penalties In PA Workers’ Comp

After a work related injury, workers have many concerns. Will workers’ compensation insurance cover and help with my medical treatment and lost wages? What if the employer and the insurance carrier do not do the right thing? What about penalties for violations?

Here, we will cover the penalties imposed for various violations of the Workers’ Compensation Act. We will look at penalties and the procedures for enforcing them. Specific situations lead to these penalties and, though some entities receive exclusion. We hope to give injured workers the insight they need to manage their claims.

An illustration showing a workers' compensation penalty. The image features an official document labeled 'Penalty Notice' on a wooden desk, accompanied by a stack of dollar bills and coins, symbolizing financial repercussions. A gavel and a calculator are also present, highlighting legal and financial calculations. The background includes a watermark of the scales of justice, emphasizing the legal aspects of compliance and penalties in workers' compensation cases.
Penalties can cost the insurance company thousands of dollars

Monetary Penalties

Monetary penalties help to ensure adherence to the Pennsylvania workers’ compensation laws. These penalties serve both as a deterrent against non-compliance and as a remedy for the wronged party.

Penalty Limits

According to Section 435 of the Act, penalties cannot exceed 10% of the total compensation awarded. This includes interest. However, in cases of unreasonable delay, penalties may escalate up to 50%.

Applicable Amendments

Legislative amendments, as of August 23, 1996, have increased penalties for unreasonable or excessive delays from previously lower percentages. These amendments apply to acts committed post-amendment, regardless of the injury date.

Criteria For Imposing Penalties

To impose a penalty, a clear violation of the Act or the associated procedural rules must exist. This can include administrative oversights, failure to pay benefits timely, or inaccuracies in the benefits paid. Each violation may come under scrutiny.

Who Imposes Penalties?

When it comes to workers’ compensation, the enforcement of penalties involves several layers.

As the governing body, the Department of Labor and Industry has the power to impose penalties for violations. Additionally, the Workers’ Compensation Appeal Board and the courts also hold this authority. Most common, a judge will impose a penalty.

An illustration of a workers' compensation judge banging a gavel in a courtroom. The judge, dressed in a traditional black robe, is seated behind a wooden bench with an authoritative expression. The gavel is captured mid-swing, emphasizing the decisive nature of the ruling. The background includes elements like the American flag, law books, and the scales of justice symbol, highlighting the formal and serious environment of the judicial process in workers' compensation cases.
Workers’ Compensation Judges routinely assess penalties against employers.

Workers’ Compensation Judges (WCJs)

WCJs play a crucial role as the primary adjudicators. They assess the need for penalties in individual cases. In addition, they also determine the extent of the penalty for each violation.

Steps In The Penalty Process

The process of imposing penalties requires adherence to due process.

Violations

The first step involves proving a violation of the Act or procedural rules. This requires gathering and presenting the evidence of non-compliance.

Notice And Hearing

The law requires that all parties involved receive notice of the potential penalties and a chance to respond. This maintains the integrity of the legal process.

Discretion

WCJs have significant discretion in determining whether to apply penalties. The WCJ’s decisions consider a few main elements. For example, they will look at the nature of the violation and the impact of it on the injured worker. They will also take into account the past conduct of the violating party.

Common Examples

Delay Of Payment

Sometimes an employer or their insurer will not start payments within the stipulated 30 days after it becomes due. In this instance, a WCJ may impose penalties.

Failure to Comply

Non-compliance with a WCJ’s order, especially regarding compensation or medical expenses, frequently results in penalties.

Mishandling Payments

Issues such as sending checks to an outdated address can result in a penalty. Further, the incorrect calculation of interest due can also trigger a penalty.

Exclusions

Certain entities face exclusion from an imposed penalty under the Act.

Workers’ Compensation Security Fund

Not considered an “insurer” under the Act, this fund has exemption status from penalties. 

Uninsured Employers Guaranty Fund

This fund aims to provide relief in situations of uninsured employers. As it plays a protective role rather than punitive, this fund also possesses exemption from penalties.

The Wrap Up

After a workplace injury in PA, injured workers may struggle to make sense of the workers’ comp system. Workers should know what workers’ comp insurance entitles them to and how penalties work to make the most of their claim. Recognizing when penalties can come into play and knowing the exclusions can significantly impact the outcome of a claim.

Consult with a workers’ comp lawyer to ensure the protection of your rights and interests. If you have questions about your claim, let us help. Reach out to our offices 24/7 for a free case evaluation (215) 609-4183

Interest, Costs, and Counsel Fees: PA Workers’ Compensation

Knowing how interest, costs, and counsel fees function in PA workers’ compensation law can seem perplexing. Below, we look into this and break it down.

A conceptual illustration depicting accruing interest in workers' compensation. The image shows stacks of coins and paper money growing taller over time, symbolizing increasing financial accumulation. In the background, a graph displays an upward trend, indicating rising interest rates. Clocks and calendars represent the passage of time, while arrows pointing upwards emphasize the growth of interest. The illustration effectively conveys the concept of financial growth and accruing interest in workers' compensation claims.
Interest grows on past-due workers’ compensation benefits

Interest

First Installment

The employer must pay the first installment of compensation within 21 days of receiving notice of the employee’s disability. If the employer does not timely pay, 10% interest applies to all unpaid benefits from the due date.

Receiving Interest

The injured worker directly receives the interest payment. Statutory interest compensates the claimant for the delay in receiving benefits. Until paid in full, interest continues to accrue.

Voluntary Payments

Employers might pay interest on voluntary payments if not made timely.

Specific Loss Cases

In specific loss cases, interest starts accruing from the date that the employer receives notice of the specific loss.

Medical and Funeral Expenses

Medical expenses may accrue interest from the date the claimant presents the claim. Also, the employee may claim interest on funeral expenses they have paid.

Forfeiting or Waiving Interest

An employee can forfeit interest if they cause unreasonable delays in proceedings. But, waiving interest violates the law.

A conceptual illustration focusing on the costs associated with workers' compensation claims. The image features a desk cluttered with various medical bills and legal documents, a calculator, and a scale of justice. These elements symbolize the financial and legal burdens of these claims. A clock is also present, indicating the passage of time and emphasizing the accumulation of expenses. The image captures the theme of escalating costs in workers' comp claims, using purely visual elements without any textual information.
Costs add up in workers’ compensation claims

Costs

Litigation Costs

As the prevailing party in a litigated claim, the employee may receive reasonable costs. These costs may include witnesses, necessary medical examinations, and lost time. To receive these litigation costs, the employee must prevail on a disputed issue before the Workers’ Compensation Judge (WCJ).

Other Costs

The cost of obtaining medical records and stenographer’s costs for reproducing depositions and hearings, also qualify for recovery.

Estimating Costs

The WCJ can estimate and apportion costs at their discretion when separating costs proves challenging.

A conceptual illustration depicting attorney's fees in workers' compensation cases. The image features a desk equipped with a scale of justice, stacks of legal documents, and a briefcase, symbolizing the legal profession and associated costs. A calculator and a piggy bank are also present, representing the calculation of fees and the financial aspects of legal services. This visual setup effectively conveys the concept of accruing legal costs and the significance of attorney's fees in managing workers' comp claims.
An Employer may receive an order to pay an Injured Worker’s Attorney Fees

Counsel Fees

When a worker suffers a work related injury, they often have wage losses and need medical treatment. Paying fees and costs for a lawyer may seem impossible.

Workers’ comp lawyers operate on a contingent fee arrangement. Meaning, they receive payment when the injured worker receives payment.

Assessed Against the Employer

Mandatory Award

When an employee wins their case, the law presumes their entitlement to reasonable legal fees. An employer can dispute this if they can prove a reasonable basis for contesting.

Amount Of Fees

Fees depend on the skill, duration, time, and effort required. However, fees should only reflect the amount attributable to the litigated issue(s).

Reasonable Contest

Determining the reasonableness of a contest depends on if it genuinely resolves a disputed issue or harasses the employee.

Chargeable to Medical Providers

Neves v. WCAB (American Airlines) clarified a 20% fee agreement applies to both medical and disability benefits. In this case, the court stated that attorneys can deduct their fees directly from medical benefits.

The medical provider cannot charge any portion of its bill to the injured worker (balance billing).  Even if this bill incurred an attorney’s fee, according to Williams v. City of Philadelphia.

Chargeable to Employees

Approval and Fee Cap

All fees payable to an employee’s counsel must have WCJ approval, laid out in an order. The law limits attorney fees to 20% of the award unless cause exists to exceed this cap.

Chargeable to Third Parties

Non-Workers’ Compensation Benefit Reimbursement

Counsel fees can face deduction from non-workers’ comp reimbursements. This applies when the third party benefits financially from the successful litigation of the workers’ compensation claim.

Attorney Fee Dispute Between Counsel for Employee

Balancing Rights

If a lawyer files a fee agreement before discharge, the WCJ and WCAB can split up the fee between initial and current lawyers. This balances the employee’s duty to pay the legal fee with their right to choose their own legal representation.

Allocation of Fees

An employee has the right to change lawyers. However, that does not negate their liability to their prior lawyer. Gingerich v. WCAB (U.S. Filter).

Conclusion

Knowing the rules of interest, costs, and counsel fees in PA workers’ compensation insurance cases can help injured workers. The more injured workers know, the more likely they will receive the benefits they deserve. Don’t go it alone, talk to a workers’ comp lawyer today.

If you have questions about any of these subjects or your claim in general, let us answer them. Reach out to our offices 24/7 for a free consultation (215) 609-4183. The insurance carrier has a lawyer on their side and so should you. Let us help.

Reporting, Verifications, and Sanctions in PA Workers’ Comp

Workers’ compensation insurance, a form of disability benefits, provides injured workers with medical and wage loss benefits. Reporting obligations, employee verifications, and sanctions under PA workers’ comp may overwhelm both employees and employers. This guide aims to make it easier.

Workers’ Comp Reporting Requirements For PA Employees

What Must An Employee Report?

Employees must report any changes in employment status and the receipt of certain benefits. This includes: returning to work, incarceration, or receiving other state or federal benefits that could affect workers’ comp.

How to File the Required Forms

To file these forms, complete and promptly submit them to the designated office. Employees must ensure all information remains current and truthful to avoid fraud accusations or benefit disruptions.

Injured worker with arm cast completing workers' compensation paperwork at a table, with medical equipment in the background
Injured worker completing workers’ compensation paperwork

Do Employers Notify Employees of These Requirements?

The employer has the responsibility to inform the workers of their reporting obligations under the Workers’ Compensation Act. Employers must provide clear and understandable instructions to the workers.

What Happens If An Employee Fails To Report Correctly?

Employees must correctly report earnings and benefit information. They must also return the verification form within 30 days.

If an employee fails to do this, they may face suspension of workers’ compensation benefits. They can even face legal proceedings under the fraud provisions of the Act.

Can Employers Face Penalties?

Yes, employers also face repercussions if they fail to meet their notice obligations. These can include fines and legal challenges.

Employers must ensure that they fully comply with regulations to avoid penalties. This includes providing all required notices to employees in a timely and clear manner. Employers must also keep accurate records of all communications and notices issued as part of their efforts.

Employee Verifications In Workers’ Comp Work

What Must Employees Include In Their Verification Reports?

When completing verification forms, employees must report various types of income. This includes: unemployment compensation, wages from employment or self-employment, and social security, severance, and pension benefits.

What Forms Do Employers Use In The Employee Verification Process?

  • LIBC-756: Employee’s Report of Benefits for Offsets.
  • LIBC-760: Employee Verification of Employment, Self-Employment, or Change in Physical Condition.
  • LIBC-762: Notice of Suspension for Failure to Return Form LIBC-760.

These forms document and verify the employee’s current employment status, income levels, and any changes in their physical condition. To maintain eligibility for benefits, one must properly complete and timely submit these forms .

What Penalties Exist For Failing To Complete Verification Forms?

If employees fail to return the necessary verification forms within 30 days, their compensation risks suspension. If this happens, the suspension will remain in effect until the return of the completed forms.

How Can Employees Avoid Sanctions?

Employees receiving workers’ comp can avoid sanctions by following the reporting guidelines and deadlines.

For Employees

  1. Regular Updates: Keep your employer and insurer updated with your current employment status and any secondary income received. Let them know of changes in your health condition that might affect your workers’ compensation claim.
  2. Documentation: Keep copies of all forms submitted, along with notes on when and how you sent them to the insurer. If a dispute arises, these will come in handy.
  3. Promptness: Return all required forms and documents within the timeframes. Delays can lead to suspension of benefits or other penalties.
  4. Accuracy: Check the information you provide for accuracy. Errors can lead to accusations of fraud or overpayment, which might require you to repay benefits.

For Employers

  1. Clear Instructions: On their date of injury, provide employees with clear, written instructions of their reporting obligations.
  2. Timely Notices: Issue all notices regarding changes in employment status, ability to work, or benefits modifications promptly. Delays can lead to legal penalties.
  3. Training: Offer training sessions for HR on the latest regulations and reporting requirements.
  4. Record Keeping: Maintain accurate records of all notices sent to employees and any correspondence regarding workers’ comp claims.

Legal Implications of Non-Compliance

After a work related injury or illness, follow the rules. Failure to comply can lead to administrative hearings, penalties, and even criminal charges in cases of fraud.

HR employee receiving an email from an injured worker.
HR employee receiving an email from an injured worker.

Best Practices

Communication

Communication between employees, employers, and insurers can prevent misunderstandings and non-compliance.

Technology

Using online platforms for submitting and tracking the status of workers’ comp forms can reduce delays and improve accuracy.

Speak To A Lawyer

After a work injury, you need the right advice. Consult with a lawyer that specialize in workers’ comp to ensure compliance with state laws. This helps injured workers reduce risks, avoid penalties, and get the support they need.

If you have questions about your case, let us answer them. Reach out to our offices 24/7 for a free consultation (215) 609-4183.

Utilization Review Process In PA Workers’ Comp

The PA Workers’ Compensation Act provides for a review of medical treatment. This process goes by the name utilization review (UR). Workers who have suffered work injuries should know about the UR process. Injured workers can prepare themselves in case this comes up within their Pennsylvania workers’ compensation case.

Here, we provide a short overview of the UR process. We discuss the steps involved, the workers’ rights, and how to handle disputes.

Intro. To Utilization Review

The UR process serves as a critical part of the workers’ compensation system. This process evaluates the necessity and appropriateness of medical treatments given to injured workers. It determines whether or not workers’ comp will cover the medical treatments that an injured worker receives.

What Triggers A Utilization Review?

An employer or an insurance carrier trigger a utilization review by request. The UR occurs when doubt arises about the medical necessity of the treatment an injured worker receives. This may stem from concerns over the type, the duration, or the cost of the medical services.

Key Forms And Docs

Utilization Review Request (LIBC-601)

Employers or insurance companies use the Utilization Review Request. It requests a review of the medical treatment given to an injured worker. They have 30 days, after the receipt of the bill for the medical service, to timely file it.

Utilization Review Determination Face Sheet (LIBC-604)

The Utilization Review Determination Face Sheet summarizes the outcome of the UR. It indicates whether medical standards deem the treatment necessary according to medical standards.

Petition For Review Of Utilization Review Determination (LIBC-603)

To dispute the UR determination, one must file a Petition for Review of Utilization Review Determination within 30 days. This form seeks further review, decided by a Workers’ Compensation Judge (WCJ).

Close-up view of a wooden desk covered with a variety of papers, including utilization review forms.
Close-up view of a wooden desk covered with a variety of papers, including utilization review forms.

The UR Process Explained

The Review Procedure

After filing a UR request, an authorized Utilization Review Organization (URO) will conduct the review. The URO will use a medical provider licensed in the same specialty as the treating provider for the review. This helps to ensure a fair evaluation.

Timeline And Outcomes

The URO has 30 days from the receipt of the UR request to issue a report. The report will determine whether or not workers’ comp should continue to cover the medical treatments in question. An unfavorable report can hurt an injured worker’s ability to continue getting their treatment covered under the system.

How To Handle A Negative UR Decision

Challenging The UR Decision

When a UR finds the treatment unnecessary, one can challenge the decision. To do so, one must file a Petition for Review of Utilization Review Determination. This must occur within 30 days of receiving the UR decision.

Role Of The WCJ

The de novo review process allows the WCJ to consider all evidence anew. Meaning, regardless of the previous UR outcome, this judge will do a new review. This review involves a thorough examination of the medical records, expert testimony, and relevant evidence. The judge will consider all of this to reach a fair decision.

Workers' Compensation Judge in black robes seated at bench, issuing a negative utilization review decision with a stern expression, holding a gavel and document, in a courtroom with disappointed onlookers.
Workers’ Compensation Judge in black robes issuing utilization review decision

UR Process: Tips And Best Practices

Importance Of Docs

Complete and timely medical documentation proves crucial for a favorable UR outcome. Inaccurate or incomplete documentation can lead to the denial of treatment under workers’ comp.

Legal And Medical Consults

Having the knowhow of a workers’ compensation lawyer can help to guide you through the process. They know the process and can protect your interests.

Medical professionals who understand the UR process can also provide vital support. This support can help to protect your benefits.

Both lawyers and medical providers can offer strategic advice and help to prepare proper documentation. This ensures that the case presents effectively.

More To Think About

Medical Necessity

Injured workers should know what constitutes “medical necessity.” Necessary treatments must align with generally accepted standards of medical practice. Disputes most commonly occur over which treatments qualify as necessary and how long the treatments should last.

Long-term Treatments

For long-term or ongoing treatments, repeated URs may occur. Knowing how to handle these reviews each time they come up will help to keep the medical care coverage consistent.

Impact Of UR

The outcome of a UR can affect other aspects of the worker’s comp benefits. For example, disability payments and rehabilitation services. Injured workers should know how these elements can affect one another.

Wrap Up

The UR process plays a key role in the Pennsylvania workers’ compensation system. It verifies the necessity and reasonableness of the medical treatment that injured workers receive. Getting to know the UR process can help to ensure that you receive the right medical care and support throughout the recovery. Know your rights and do not delay in speaking with a workers’ comp lawyer.

A workers’ comp lawyer knows the system and can get you through it. From knowing the documents to handling challenges and appeals, a lawyer can fight for your rights. Do not miss out on the benefits that you deserve. Let us help you.

If you have questions about the UR process, let us answer them. Reach out to our offices 24/7 for a free consultation (215) 609-4183. 

Medical Benefits Under PA Workers’ Compensation

Workers’ compensation insurance covers wage loss benefits and medical benefits. In this post, we take a look into medical benefits under the Pennsylvania workers’ compensation system. Just as lost wages can affect injured workers, so can access to medical care. This guide aims to help workers understand the process, forms, and the right to medical benefits.

PA Workers’ Comp Medical Benefits

Workers’ compensation coverage helps injured workers recovering from work-related injuries or illnesses. Knowing the forms and process involved in claiming these benefits proves vital. It helps to ensure timely and proper medical care and compensation.

What Forms Do I Need To Manage My Medical Benefits?

Going through the many forms in the workers’ compensation system can present a hurdle for injured workers. Each form serves a specific function, from reporting injuries to disputing charges. Below, we provide an overview of the most common forms:

Medical Report Form (LIBC-009)

Medical providers use this form to report the details of an injury and the treatment given. It affects the processing and approval of medical claims.

Notice of Compensation Payable (LIBC-495)

An employer or their insurance carrier issues this form. It acknowledges that an injury or illness relates to work and that medical benefits are payable. Two types exist: one for cases with wage loss and one for ‘medical only’ where no wage loss exists.

Notice of Workers’ Compensation Denial (LIBC-496)

In a denied claim, an employer or their insurance company issues this form. It details the reasons for the denial of the workers’ compensation claim. This could include a dispute over the cause of the injury.

Notice of Temporary Compensation Payable (LIBC-501)

This form allows for the temporary payment of benefits while an employer investigates a claim. Before reaching a final decision, it provides financial relief for medical costs. This form can also provide wage loss benefits.

Application for Fee Review (LIBC-507)

This form addresses disputes over the fees charged by a healthcare provider. It entails a formal review process by the Bureau. This ensures consistency between the fees charged for the services provided and the rates set by the state.

Medical benefits form for Pennsylvania workers' compensation, highlighting required fields and checkboxes on a clear and organized document
Medical benefits form

How Are Medical Benefits Paid in PA Workers’ Compensation?

Medical benefits are usually paid directly to the provider. Governed by the Workers’ Compensation Act, the payment of medical benefits ensures that injured workers receive timely medical treatment. What to know about these payments:

Beginning Payments

Upon the claim’s acceptance, the medical benefits should start. Meaning, the coverage begins upon the acknowledgment of the injury as work-related.

Continuing Medical Benefits

Medical benefits should continue as long as necessary, independent of employment status or receipt of other benefits.

Payment Procedures

Employers or their insurers must pay medical expenses within 30 days of receiving the bills and relevant medical records. They can dispute the reasonableness or necessity of the treatment. This would entail filing a Utilization Review.

Disputes Over Medical Benefits

Disputes over medical benefits can arise for many reasons. For example, denials of coverage, the necessity of treatments, or the costs of the medical care.

Fee Review

This process reviews the fees charged to ensure they align with state guidelines and the services provided.

Utilization Review

Used to evaluate the reasonableness and necessity of the medical care received.

Legal Representation

When disputes come up, seeking legal help from a workers’ comp lawyer can seem invaluable.

Patient receiving IV treatment in a hospital bed with a nurse adjusting the equipment, depicting medical benefits under Pennsylvania workers' compensation.
Patient receiving IV treatment in a hospital bed with a nurse adjusting the equipment.

Tips for Managing Your Medical Benefits

Document Everything

Keep detailed records of all treatments, each communication, and any forms submitted or received.

Know Your Rights

Get familiar with the PA workers’ compensation laws that pertain to medical benefits.

Communicate

Keep open lines of communication with your employer and their insurance carrier. Let them know of any changes in your medical condition or treatment to avoid delays in benefit payments.

Seek Support

Do not hesitate to seek help from legal advisors, healthcare providers, or even support groups.

Wrap Up

Making sense of medical benefits can seem like a huge task. When it comes to workers’ compensation benefits, know your rights. Get familiar with the forms and the payment procedures. This helps to make sure you receive all the benefits that you deserve.

If you have questions about medical benefits, let us answer them. Reach out to our offices 24/7 for a free and confidential consultation (215) 609-4183. Let us help you through the process. The insurance company has a lawyer representing their interests and so should you.

Offsets, Credits, and Subrogation in PA Workers’ Comp

Offsets, Credits, and Subrogation in PA Workers’ Comp

Workers’ compensation provides financial and medical benefits to workers who suffer work-related injuries or illnesses. The Workers’ Compensation Act serves as the law behind this.

Here, we examine the interaction between workers’ compensation benefits and other forms of employee benefits. For instance, unemployment benefits, pension payments, and social security. The interaction often requires careful calculations and adjustments to avoid overpayment or under-payment.

Let’s look into offsets, credits, and subrogation to gain insight into their applications. We will look at how they affect both employers and employees. Lastly, we take a look into some challenges and solutions in managing claims. By knowing these things, workers can better address their own claims.

What Are Offsets In Workers’ Comp?

Offsets refer to specific reductions applied to the benefits that an injured worker receives. When a worker receives an additional form of income during their claim, these reductions may come into play. For example, unemployment benefits, severance packages, pension distributions, or social security retirement benefits. Any of these can trigger an offset.

Man and woman in business attire engaging in tug-of-war with a large hundred-dollar bill, symbolizing workers' comp offsets disputes in workers compensation claims.
Man and woman in business attire engaging in tug-of-war with a large hundred-dollar bill, symbolizing workers’ comp offsets disputes.

Benefits That Lead to Offsets

Unemployment Compensation

a worker unable to perform their job because of a workplace injury may receive unemployment compensation. In this instance, the employer will receive a credit for unemployment benefits received. Meaning, the unemployment amount paid deducts from the workers’ comp benefits for the same time period. This prevents the worker from receiving pay twice for the same time period.

Severance Benefits

Severance pay can also impact the amount of the workers’ comp benefits. If a worker receives severance pay after an injury, it may lead to a reduction in their comp benefits. The timing of this pay and the terms of the severance agreement will determine how it affects the workers’ comp benefits.

Pension Benefits

Pension benefits funded in whole or in part by the employer can also reduce the amount of workers’ comp. This occurs because pension benefits form part of the employee’s retirement plan. So, the pension benefits contribute to the overall income during the period of disability. This applies if the injured worker receives both the pension and workers’ comp at the same time.

Social Security Retirement Benefits

Social security retirement benefits cause an offset against workers’ comp payments. If an injured worker starts receiving social security retirement benefits after their injury, workers’ comp receives an offset. When social security has already approved the retirement prior to the injury, then the offset will not apply.

The Legislative Framework: Act 57

Act 57 represents a vital piece of legislation in the Pennsylvania workers’ compensation system. It provides a detailed framework for how to calculate and how to apply the offsets. The Act ensures that benefits remain fair and in line with the actual earnings prior to the injury.

Act 57 states that offsets require a dollar-for-dollar calculation. This means every dollar received from other benefits, reduces the workers’ comp benefits by that same amount. These calculations use the net amount of benefits received after any deductions, such as taxes.

Scales of justice on a dark background, symbolizing legal fairness and equality when balancing offsets, credits, and subrogation in workers compensation in pennsylvania
Scales of justice on a dark background, symbolizing the balancing of interests for offsets, credits, and subrogation in workers compensation in PA

Judicial Interpretations and Impact

Philadelphia Gas Works v. WCAB

This case has had a lasting impact on calculating offsets within the state of PA. The PA Commonwealth Court ruled that the calculation of offsets should use the net amount of benefits received instead of the gross. This helps to prevent too high of a reduction in the workers’ comp benefits. It ensures that the offset only accounts for the amount of money an employee takes home.

Harrison v. WCAB

In this case, the court addressed how to apply offsets, especially in situations that involve pension benefits. In certain instances, pension benefits might undergo a calculation based on the gross amounts to determine offsets. This occurs when multiple benefits overlap and the source funding the pension plays an important role in the calculation.

Implications of Act 57

The implications of Act 57 and its judicial application go beyond the calculations of offsets. These guidelines outline how to handle cases where multiple sources of income and benefits intersect with workers’ comp claims. By basing the calculations on the net amounts, Act 57 ensures a more accurate method of determining compensation levels.

Guidance for Offsets, Credits, and Subrogation

For Employees

Employees should know how extra income, such as unemployment, a pension, or social security, can affect their workers’ comp. This will help them with their overall financial planning during their recovery.

Employees should also keep detailed records. This includes all relevant documents, such as benefit statements, correspondence with employers, insurance adjusters, and any other related communications. This should include dates of receipt and amounts of any other benefits they received. This will guide the way for a smoother claims’ process and help if a dispute or audit should arise.

For Employers

For employers, compliance with both statutory requirements and judicial interpretations within workers’ comp remains non-negotiable. This involves knowing the law as it applies to offsets, credits, and subrogation. Employers should have clear methods for handling such things in the case of workers’ comp. These policies should appear accessible in an employee handbook.

For Both Parties

Effective communication between employees and employers proves vital in managing offsets, credits, and subrogation issues. Open lines of communication can lead to proactive solutions and mutual understanding. Regular updates can also help to keep everyone informed. 

Detailed Case Studies

Case Study on Offsets

John, a machine operator with over a decade of experience, suffered a work-related injury. The injury, that occurred during his regular shift, resulted in John’s inability to perform his duties. This led to a period of recovery away from work.

During his recovery, John applied for and received unemployment benefits to help manage his financial duties. Aware of possible issues with receiving both benefits, John’s employer took steps to comply with Pennsylvania’s Act 57.

Following the guidelines, the employer calculated the amount of unemployment compensation John received. Then, applied an offset to his workers’ comp benefits. The calculation relied on the net amount of the unemployment after all the deductions. For example, the taxes and other withholdings.

This careful approach helped to ensure that John did not end up with an overpayment. The employer also gave John a detailed explanation of how they calculated his benefits.

This case study makes it clear how employers should apply offsets in accordance with Act 57. It also highlights the importance of open communication and record-keeping in managing workers’ comp claims.

Case Study on Credits

Emily, an injured worker, worked for a large motor vehicle company. They provided her with severance pay. After clear communication and with the proper notifications, they applied a credit to her workers’ comp benefits . The reduction to Emily’s benefits equaled the amount of the severance pay, adjusted for any legal exclusions.

The employer consulted with Emily often. They explained the details of the credits applied to her workers’ comp benefits. During these talks, they outlined how they factored the severance pay into her total compensation package. This included a detailed breakdown of the legal exclusions and the exact calculation used to adjust her benefits.

This approach helped Emily to understand the adjustments and showed the company wanted fair dealings. These talks occurred via email which provided a clear record for both parties to refer back to.

Case Study on Subrogation

An insurance company covered the hospital expenses for Sam after a work-related injury. Once Sam received his workers’ comp benefits, the insurance company pursued subrogation to recover the costs it had paid. Following the successful subrogation claim, the insurance company kept all the parties informed about the proceedings and outcomes. This helped to maintain transparency throughout the process.

The Wrap Up

Handling offsets, credits, and subrogation within the PA workers’ comp system often proves complex. It requires a deep understanding of the legal landscape, effective communication, and proper administration. Always check with an experienced workers’ comp lawyer to ensure the protection of your rights.

If you have questions about credits, offsets, or subrogation, let us help. Reach out to our offices 24/7 for a free and confidential case evaluation (215) 609-4183.

Specific Loss Benefits in Pennsylvania Workers’ Compensation

Specific loss benefits help workers with serious injuries that cause loss of or permanent damage to a body part. In this post, we aim to make sense of those entitled to specific loss benefits and how the claims process works. We will also take a brief look into the workers’ compensation laws that govern specific loss. Let’s dive in.

Introduction to Specific Loss Benefits

Defining Specific Loss Benefits

Specific loss benefits provide compensation for the loss (amputation) or permanent loss of use of a body part. For example, significant hearing or vision loss, or permanent disfigurement from a work-related incident. Contrary to wage loss benefits, these benefits do not consider the number of missed days or returns to work.

Who Qualifies?

To qualify, the injury must result in one of the following:

  • amputation
  • permanent loss of use of a limb for all practical intents and purposes
  • binaural hearing loss of more than 10%
  • the loss of vision in one or both eyes
  • disfigurement.

Section 306(c) of the Pennsylvania Workers’ Compensation Act outlines eligibility. It provides a precise framework for what meets each of these conditions.

Abstract illustration of resilience and adaptation in the face of a specific loss injury, symbolized by a worker with a prosthetic leg at a construction site, embodying empowerment and the capability to thrive despite physical challenges.
An abstract illustration of a worker overcoming the challenges of a specific loss.

The Claims Process Explained

The claims process for specific loss benefits may seem confusing. Let’s look step-by-step to ensure that injured workers know what to expect and how to proceed. Workers should know the key forms and documents:

Notice of Compensation Payable (LIBC-495)

This form starts a claim. The carrier or self-insured must physically mail it to the employee.

Agreement for Compensation for Disability or Permanent Injury (LIBC-336)

This document outlines the agreed-upon compensation terms. Specifically, those between the injured worker and the employer or the insurance carrier for the specific loss.

Supplemental Agreement for Compensation (LIBC-337)

Used for amendments to the initial agreement, this form accommodates changes in compensation or the discovery of additional injuries.

Overwhelming pile of paperwork related to workers' compensation claims, depicting the complexity and bureaucratic challenges of managing specific loss cases in a cluttered office environment.
Paperwork for a Specific Loss Claim can overwhelm anyone

Determining Compensation Rates

The calculation for the amount of compensation for a specific loss bares similarity to that of total disability benefits. It takes into account the worker’s average weekly wage prior to the injury. It also looks at the nature and extent of the specific loss.

The law lays out a minimum and maximum compensation rate. This ensures that injured workers receive a fair portion of their lost wages.

Legal Framework and Rights

Legal Definitions and Criteria

The Workers’ Compensation Act provides detailed definitions of specific losses eligible for compensation. This means rendering the limb completely useless for any practical employment purposes. For example, the loss of use of a limb must have a total and permanent result.

Rights and Limitations of Claimants

Workers should be aware of their rights. This includes the right to compensation regardless of the number of weeks missed from work or lost earning capacity. The healing period holds no relevance in specific loss.

However, these rights do come with limitations. An employer’s acknowledgment of a work-related injury does not automatically imply acknowledgment of a specific loss claim.

Analyzing Key Case Law and Precedents

Court rulings have influenced the interpretation and application of specific loss benefits and the role workers’ compensation insurance plays. By looking at these decisions, injured workers can see how courts have ruled in similar cases.

Influential Court Rulings

  • Kemps v. WCAB (Steets): This case highlights that the loss of use must result in permanency and for all practical purposes. But, it does not require 100% uselessness. This case established the threshold for what constitutes a “loss of use.”
  • City of Butler v. WCAB (Botsis): This ruling clarifies an employer’s acceptance of a work injury. This acceptance does not stop them from contesting a specific loss claim for the same injury. This case drew distinction between accepting an injury and recognizing it as a specific loss.

The Role of Medical Evidence

Medical evidence plays a crucial role in specific loss claims. Medical testimony and documentation work together to establish the permanency and full extent of the injury. A doctor’s diagnosis must explain in detail how the injury leads to a permanent loss of use.

Maximizing Your Specific Loss Benefits

To ensure the best possible outcome from a specific loss claim, injured workers should consider the following:

Gather Medical Evidence

Collecting detailed medical records and securing expert medical testimony play a vital role in the process. Medical evidence needs to clearly show the permanency and total loss of use of the injured body part.

Understand the Claims Process

Review and get familiar with the required forms, documentation, and deadlines. This will help to prevent any needless delays or denials. The more you know, the better prepared you will find yourself to handle each challenge.

Seek Legal Help

Make sure that you speak to a lawyer that specializes in workers’ comp. They can provide valuable guidance through the claims process. A lawyer can help you with the legal complexities and get you through tough denials.

Wrap Up

When an injury results in a permanent loss, know your rights. For specific loss benefits, gaining a thorough understanding of the process becomes essential. By knowing their rights and seeking the legal support they need, injured workers can secure the compensation they deserve. 

If you have any questions about your claim or want to determine if specific loss applies to you, let us help. The insurance company has a lawyer representing their best interests and so should you. Reach out to our offices 24/7 for a free consultation (215) 609-4183.

PA Wage Loss Benefits And Overpayments in Workers’ Comp

Workers’ compensation benefits help workers who find themselves unable to work because of job-related injuries or illnesses. It offers compensation for lost wages and medical treatment. Managing this, especially if an overpayment occurs, may lead to confusion. This post hopes to help injured workers address these challenges.

A man with a cast on his left leg and his right arm in a sling sits in an office chair, looking down at his injured leg thinking about wage loss benefits and overpayments, with a "Get Well Soon" note in the foreground.
The Quiet Struggle: When Injury Leads to Wage Loss and Overpayment Dilemmas — A Worker’s Tough Recovery Journey.

Wage Loss Benefits

Wage loss benefits serve as a financial bridge for injured workers while they recover. The benefits aim to ease the impact of the lost earnings. They fall into two main categories:

Total Disability Benefits

Total disability caters to workers totally unable to return to any form of work because of their work injury. It accounts for the employee’s average weekly earnings prior to the work injury. Compensation amounts total about two-thirds of this figure. However, this falls within the bounds of the minimum and maximum thresholds.

Partial Disability Benefits

Partial disability benefits cater to those who can return to work after their injury, but at a lesser capacity. This can result in lower earnings than they made before their injury. This form of benefits that the insurance company pays out aims to fill in the wage gap.

The calculation accounts for the difference between the average weekly wage before the injury and the current earning capacity. Once again, adhering to the two-thirds rule, but capped at the maximum limit for total disability benefits.

Restrictions and Provisions

The entitlement to wage loss benefits has its conditions and limitations. For example, benefits end for employees that find work, earning equal to or greater than their pre-injury wage. The length of time to receive these benefits may also have a cap. Specific regulations determine the length of time an injured worker can receive workers’ compensation insurance benefits.

Benefits may adjust based on the worker’s ability to perform available work, which considers both physical capacity and vocational opportunities. Further, certain legal changes and updates to workers’ comp laws can alter who qualifies and the benefit levels.

Overpayments Within Workers’ Compensation

Overpayments happen when a worker gets more in benefits than they should. This can come from calculation errors, administrative oversights, or changes in the recipient’s employment status.

What Happens Next?

The process for fixing overpayments varies based on the cause and the circumstances of the excess payments. If the overpayment was not the fault of the employee, insurers might face some challenges in trying to reclaim it.

Adjustment Of Future Payments

In instances where overpayments occur, insurers can reduce future benefit payments. This happens to account for the overpaid amount. To do this, the insurer must show that keeping the overpaid amount would unjustly enrich the worker.

Mistakes By Employers Or Insurers

Situations involving overpayments because of errors by the employer or insurer receive delicate handling. If recouping the overpayment would put undue financial strain on the worker, limiting or foregoing those funds might occur. This can also happen with social security retirement offsets that the employer fails to claim.

Two determined men in a tug of war over an enormous bag of money, symbolizing the struggle with wage loss and overpayment recovery.
The Balancing Act Between Wage Loss Recovery and Overpayment Amidst Financial Hardship.

How To Prevent This

To avoid overpayments, take proactive measures. These may include:

  • Keeping the insurer and employer informed as to any changes in your employment status or your income.
  • Regularly reviewing the accuracy of the benefits received to make sure they align with your eligibility.
  • Communication with your employer and insurance carrier regarding your capacity to work and any earnings from employment activities.

Wrap Up

By understanding these pieces, workers can better navigate their claims. This helps to ensure they receive the support they need and avoid pitfalls. Staying informed, proactive, and on top of your claim can help to maximize your benefits.

You should have a workers’ comp lawyer on your side to ensure you get the benefits you deserve. If you have questions about your claim, let us help. Reach out to our offices 24/7 for a free consultation (215) 609-4183.

PA Workers’ Comp: The Average Weekly Wage

We will focus on Average Weekly Wage PA for this article. Other state rules may vary. In PA, the Department of Labor and Industry oversees the Bureau of Workers’ Compensation. The Department of Labor and Industry calculates the statewide average weekly wage rate for the calendar year.

What Is Average Weekly Wage (AWW)?

The average weekly wage is the calculation used to determine an injured workers average wages. Based on pre-injury earnings, it reflects the likely earnings if not for the injury. Workers compensation benefits use the AWW to determine compensation rate for lost wages.

@thwesq Replying to @bethnine your average weekly wage, which is the basis for your compensation rate, includes tips, overtime, and even wages from another jobs you had at the time of injury in PA. #workersrights #workerscomp #workinjury #workinjurylawyer #lawyer ♬ original sound – Tom Wing


Inclusions and exclusions can have an impact on the weekly compensation. The workers’ compensation rate schedule uses the AWW to determine the benefits due.

Included In AWW

Overtime Pay

The AWW includes overtime.

Bonuses and Incentive Pay

Annual bonuses and incentive pay undergo proration over the year and factor into the AWW.

Vacation Pay

Vacation pay also undergoes proration over the year. This ensures that time off does not negatively impact the worker’s AWW.

Prevailing Wage Rate Work

For those receiving a prevailing wage paid at times, the AWW can use these higher wages to more accurately reflect earnings.

Tips

Tips and gratuities reported on a federal income tax return can contribute to the AWW.

Board And Lodging

If an employer offers board and lodging as part of compensation, its value can factor into the AWW.

Supplemental Unemployment Benefits (SUB)

SUB pay, provided under a collective bargaining agreement, may qualify for inclusion.

Excluded From AWW

Fringe Benefits

This would exclude things like: contributions to retirement plans, health insurance, and life insurance.

Unemployment Benefits

Unemployment benefits received during a layoff do not count towards the AWW. They do not qualify as wages earned from employment.

Non-monetary Remuneration

Benefits received in forms other than money, excluding board and lodging, do not contribute to the AWW.

Earnings from Independent Contractor Work

Income from independent contractor work does not count toward AWW.

Vacation Pay Received After Injury

Vacation time paid out after the injury date does not increase the AWW, as it reflects earnings for work performed prior to the injury.

Mileage Reimbursements and Certain Allowances

Reimbursements for mileage and other business-related expenses do not count as wages for the AWW.

Veterans’ and Social Security Benefits

These benefits do not qualify for inclusion since they do not stem from job earnings.

A bronze balance scale with coins on one side and a clock on the other, on a desk with office supplies in the background, representing the concept of Average Weekly Wage.
Balancing all of the issues in the AWW can prove challenging.

How To Calculate Average Weekly Wage

Fixed Wages

For workers with fixed wages, the AWW calculation remains clear. If you receive a daily wage, weekly, monthly, or yearly, calculate what this amounts to for one week of work. You may base this on the number of days you work in a week.

Varied Wages

Workers with varied wages have a tougher calculation. First, you average the earnings over four 13-week periods right before the injury. Next, you drop the lowest of these four. Then, average the remaining three to find the AWW.

Special Cases

Seasonal Employment

With jobs performed only part of the year, special rules exist. The calculation of the AWW relies on earnings from all jobs in the past year.

Concurrent Employment

For workers holding multiple jobs at the time of injury, the AWW considers wages from all concurrent employments.

Wrap Up

Knowing how to calculate your AWW ensures you will receive the maximum compensation you deserve. Your AWW calculation should accurately reflect your earnings potential had the injury not occurred.

For injured workers with workers’ compensation claims, always speak with a workers’ compensation lawyer. Average weekly wage falls into one of those complex areas of the law. An experienced lawyer can help interpret these rules in the context of your specific situation.

Have questions on average weekly wage? Let us answer them. Reach out to our offices 24/7 for a free and confidential consultation (215) 609-4183.

How Do I Get Workers’ Comp Benefits? – Easy Guide

In PA, the workers’ compensation benefits system falls under the Department of Labor and Industry. The process can seem overwhelming for injured workers. It has many steps, forms, and legal proceedings. Here, we hope to simplify this process to help injured workers get the benefits they deserve.

Pre-Litigation: Initial Steps

After a work injury or illness, understanding and familiarizing yourself with the important steps and forms becomes essential. The employer has 21 days, after receiving notice of the work injury, to either accept or deny liability.

The Bureau of Workers’ Compensation and the Workers’ Compensation Office of Adjudication (WCOA) have developed specific forms. Each of these forms plays a role in the claim process.

Starting A Workers’ Comp Claim

Notice of Compensation Payable

Used by the employer or their insurance carrier, this form accepts a work-related injury and starts compensation. This acceptance is the first step toward securing your benefits. Also referred to as form LIBC-495.

Agreement for Compensation for Disability or Permanent Injury

This document represents a mutual agreement between you and your employer to start compensation payments. Basically, the employer acknowledges the disability or permanent injury, but without fully admitting liability. Also referred to as form LIBC-336.

Temporary Injuries

Notice of Temporary Compensation Payable

This form allows employers to begin medical payments for up to 90 days without formally acknowledging the injury’s compensability. This offers a temporary solution while conducting a further evaluation. Also referred to as form LIBC-501.

Notice Stopping Temporary Compensation

Employers use this form to stop temporary compensation. This step generally leads to a dispute regarding the eligibility of the injury for compensation. Also referred to as form LIBC-502.

Dealing With Claim Denials

Notice of Compensation Denial

If you have a denied claim, you will receive a Notice of Denial. This form outlines the reasons for the claim’s denial. If you choose to dispute the decision, this form sets the stage for the potential litigation. Also referred to as form LIBC-496.

Key Tips for Payments

Reporting and Record-Keeping

  • Report your injury promptly. Make sure to report your injury right away in writing.
  • Maintain you injury records. Keep everything that has to do with your work injury.
@thwesq Replying to @Shaun M you should always document and report an injury immediately. Insurance companies look for any reason to deny coverage. #workersrights #workerscomp #workinjury #workinjurylawyer #lawyer ♬ original sound – Tom Wing

Steps to Begin Payments

  • A Notice of Compensation Payable must formally begin the payment process. Any agreement made prematurely (within the first seven days of injury) does not count.
  • Employers may opt for Medical-Only Payments. In this situation, the employer initially chooses to cover medical expenses without paying wage loss. This decision could affect the employee’s ability to seek future wage loss benefits.
An injured worker with a cast on the arm sits with a professional, reviewing a Workers' Compensation document, symbolizing the steps for how to get Workers' Comp benefits.
An employer shows an injured worker the steps to obtain workers’ compensation benefits.

Litigation: Time For Court

Litigation becomes vital when a disagreement occurs between parties. Typically, this involves the compensability of the injury, the extent of the disability, or improperly denied or terminated benefits. If you have not done so yet, the time has come to hire a lawyer.

Filing a Claim Petition

Claim Petition

This form challenges the employer’s or their insurer’s decision. Essential for beginning compensation payments, following a denial or cessation of temporary benefits. Also referred to as claim form LIBC-362.

Fatal Claim Petition

Workers’ comp provides for a death benefit. In tragic circumstances that involve a work-related death, this petition seeks compensation on behalf of the deceased’s heirs. Also referred to as form LIBC-363.

Burden of Proof

Proving Your Case

As an injured worker, you must show the validity of your claim. This includes the work-related nature of your injury and the impact it has had on your ability to work.

Employer Counter-Arguments

Expect that your employer may try to show that you can return to work. They may also try to claim that the work-related injury did not directly cause your loss of earnings. These types of arguments occur often.

Conclusion

The workers’ compensation insurance process in PA has many tough steps and procedures. Staying up-to-date on the forms that you may come across will better prepare you and help you to avoid costly delays. Whether fully or partially disabled, workers compensation programs assist injured workers in need of medical care, facing lost wages.

Secure your rights and benefits under Pennsylvania’s workers’ compensation laws and speak to a lawyer today. We are here to help, don’t go it alone. Reach out to our offices 24/7 for a free and confidential case evaluation (215) 609-4183. 

Occupational Disease Claims in PA Workers’ Compensation

The Workers’ Compensation Act and the 1939 Occupational Disease Act

PA deals with occupational disease claims by looking at two main laws. The Pennsylvania Workers’ Compensation Act and the 1939 Occupational Disease Act govern occupational disease claims. These Acts prove central for workers suffering from work-related injuries regarding their working conditions. Particularly, injuries caused by physical hazards or chemical hazards.

Although important historically, the 1939 Act has less importance today because the Workers’ Compensation Act has expanded.

Expanding the Scope

Both the Workers’ Compensation Act and the 1939 Occupational Disease Act cover occupational diseases. The 1972 amendments to the Workers’ Compensation Act expanded its scope to include diseases.

These updates give coverage for workers exposed to hazardous conditions after June 30, 1973. This amendment includes coverage for any disabilities or deaths resulting from these conditions. Certain sections of the 1939 Act [301(a)2, 301(i), and 301(j)] can still play a vital role for specific diseases.

How Does It Work?

The Workers’ Compensation Act covers employment relationships, how claims work across different states, without restricting OSHA claims. As interpreted by PA Courts, it also limits legal principles like res judicata and collateral estoppel. For example, some employers have tried to limit recovery for lost wages on progressive diseases.

An image depicting miners hard at work in the confined space of an underground coal mine, illustrating a scenario where occupational diseases can occur due to prolonged exposure to coal dust. The miners are equipped with safety helmets, headlamps, and heavy-duty clothing, while manually extracting coal and transporting it in carts along tracks, a representation of the health risks associated with their profession.
Coal Miners at Risk for Occupational Diseases

Courts have also examined how often workers with permanent conditions, like pneumoconiosis, should undergo examination. For these kinds of illnesses, an insurance carrier cannot harass injured workers with multiple exams without a good reason.

What Is An Injury?

The Act defines “injury” to include work-related diseases and occupational hazards. This covers diseases caused by work in section 301(c)(1) or other listed diseases in section 301(c)(2). Including, a disease either worsened by work or directly caused by it.

To simplify the workers’ compensation claim process, the Act lists diseases, which it considers injuries. Recent updates added conditions like asbestos-related cancer. For example, Act 46 of 2011 recognized firefighter cancer as an eligible condition.

How Much Time Do I Have to File a Claim For Occupational Disease?

Disability or death from an occupational disease must occur within 300 weeks of the last toxic exposure. Usually, an injured worker can only receive workers comp. However, an injured worker may have a direct claim against an employer outside this time for an occupational disease.

The Act also details a three calendar year period for filing claims. This affirms the need for awareness of the employee who contracts the disability and its link to work. These rules help with timely and proper filing of occupational disease claims.

What Benefits Can I Get For an Occupational Disease Claim?

For workers’ compensation benefits, the Act covers lost wages and medical benefits. The compensation rate depends upon the worker’s wages and last exposure. The Act also outlines specific loss benefits, death benefits, medical costs, and more.

Several forms and rules address changes in claim status and show the need for adjustments based on the worker’s health or job status.

The 1939 Occupational Disease Act, though less used today, established the groundwork for the state’s workers’ comp system. It offers benefits for specific lung diseases and sets up a distinct legal process. This Act, alongside the Workers’ Compensation Act, creates a system for protecting worker health and safety.

The Wrap Up

Workers’ compensation programs provide more protections and more options for claims in labor and industry. PA’s approach to occupational disease claims shows a strong system aimed at worker protection. The Workers’ Compensation Act and the 1939 Occupational Disease Act provide a clear way to approach occupational diseases. They ensure workers have the protections and compensation they need.

Who Can Help?

Injured workers can find help in many places. The Bureau of Workers’ Compensation has many resources.

The centers for disease control oversee the protection of workers. For example, the National Institute for Safety and Health (NIOSH) is one organization focused on worker safety. Also, the National Institute for Occupational Safety and Health Administration (OSHA) lays out workers’ rights and protections. Many government agencies focus on occupational disease control and prevention.

When facing an occupational disease, always speak to a workers’ comp attorney. Learn your rights and make sure you get the treatment and compensation due. Reach out to our offices 24/7 for a free and confidential case evaluation (215) 609-4183.

Exclusions and Defenses to Workers’ Compensation Claims

Workers’ comp serves as a crucial safety net for injured workers, offering financial support for their recovery. However, not every injury or illness automatically receives coverage. Understanding the concept of affirmative defenses and exclusions can empower injured employees with the knowledge to navigate these situations.

Below, we will examine each category closely and use real-world examples. We hope to clarify some of the complex aspects of PA workers’ compensation laws.

An infographic titled 'Workers’ Comp Exclusions & Defenses' displaying a series of eight minimalistic black and white icons each representing different concepts. From left to right, top to bottom: 'Self-Inflicted Injury' shows a figure with an outstretched arm, 'Violation of the Law' with a police badge, 'Violation of Positive Work Order' with a crossed-out document, 'Personal Animosity' showing two figures turned away from each other, 'Intoxication' with a bottle and stars, 'Undocumented Workers' with a shadowed figure and ID card, 'Hostile or Military Actions' with a tank, and 'Statute of Limitations' with a calendar icon.
PA Workers’ Comp Exclusions and Defenses

Exploring Affirmative Defenses

In affirmative defenses, an employer can legally deny workers’ compensation benefits under specific conditions. These defenses play an important role in determining who is eligible for workers’ compensation benefits.

The Case of Self-Inflicted Injuries

What qualifies as a self-inflicted injury in the workplace?

Not all injuries at work constitute accidents. Sometimes, an employee might engage in actions that purposely cause harm to themselves. This includes clear and obvious cases of self-harm. It also covers situations where an employee’s negligence or willful disregard for safety results in injury.

For instance, ignoring prescribed medical dosages, leading to an overdose. This would not qualify as a work related injury, despite that the injuries occurred at work.

Case Study: The Overdose Incident

John, a warehouse employee, has prescription medication for a work-related back injury. Despite clear instructions on dosage, John deliberately took more than prescribed, hoping to speed up his recovery. This resulted in an overdose and led to hospitalization.

The employer discovered John misused the medicine on purpose. This enabled the employer to use the affirmative defense of self-inflicted injury. The employer denied further compensation for the overdose-related medical care.

Injuries from Violating the Law

How does breaking the law impact workers’ compensation?

Injuries sustained during the engagement of illegal activities often do not qualify for compensation. This applies to both minor and major violations. For example, driving under the influence at work or engaging in illegal drug use.

Case Study: The DUI Delivery

Samantha, a delivery driver, decided to drink over lunch before making her afternoon deliveries. She crashed the delivery truck and suffered serious injuries.

The investigation revealed her intoxication level was above the legal limit, leading to a DUI charge. Samantha broke the law at the time of the accident. This enabled the employer to successfully deny her workers’ compensation claim. The employer succeeded on the grounds of the affirmative defense, relating to breaking the law.

Violations of Positive Work Orders

What happens when employees ignore specific work orders?

Disobeying direct work orders can lead to denied compensation for employees injured on the job. Especially orders designed for safety.

The employer must prove three things to be successful in denying compensation. One, the employer must prove that the employee had awareness of the rule. Two, the rule must specifically relate to job safety. Lastly, the injury must result directly from the violation.

Case Study: The Forbidden Area

Alex sustained an injury after entering a restricted area of the construction site. The employer had the area clearly marked. The employer also told Alex the hazardous conditions of the area made it off-limits .

Despite previous warnings, Alex believed he could take a shortcut through the area. Alex did not receive compensation for the resulting injury because he violated a positive work order.

Exclusions: Common Workers’ Compensation Defenses

Exclusions represent times when workers’ compensation insurance does not apply. Often, exclusions occur either based on the nature of the incident or the status of the individual involved. Insurance companies use these exclusions when an injured worker files a claim. This may limit the ability of the employee to succeed in their workers’ compensation claim.

Personal Animosity: Workplace Disputes and External Conflicts

Conflicts that stem from personal issues, whether inside or outside the workplace, fall outside the scope of workers’ compensation. This means the workers’ comp system does not take on the burden for incidents unrelated to job duties.

Case Study: The Personal Feud

Emma and Sarah, coworkers at a retail store, had a longstanding personal feud. One day, it escalated into a physical fight at work, resulting in injuries. Workers’ comp did not cover the employees’ injuries. This depicts a matter of personal conflict, not related to their job duties .

The Role of Intoxication in Workplace Injuries

Injuries that result directly from an employee’s intoxication or drug use do not qualify for coverage. This exclusion highlights the importance of workplace safety and personal responsibility.

Case Study: The Intoxicated Fall

Mike, a factory worker, arrived at work under the influence of alcohol. While working, he fell from a platform and sustained multiple injuries. Tests confirmed his intoxication at the time of the accident. Mike did not receive benefits, given the clear evidence that his impaired state caused his fall.

@thwesq Intoxication is a complete defense to a Worker’s Compensation claim under section 301(a) of the Pennsylvania Workers’ Compensation act. Don’t drink and work. ##workerscomp##dontdrinkanddrive##besafe##lawyersoftiktok##lawyer ♬ original sound – Tom Wing

Undocumented Workers and Their Rights

The status of undocumented workers under workers’ comp laws often surprises both employees and employers. Undocumented status does not automatically exclude an individual from receiving benefits. However, it can affect the benefits from continuing.

Case Study: The Undocumented Worker’s Dilemma

Ed, an undocumented worker, suffered a hand injury while operating a machine. Initially, he received workers’ compensation benefits for his medical care and lost wages.

But, when Ed’s doctor medically cleared him for light duty, the fact that he could not legally work in the U.S. complicated his claim. The employer argued that Ed could not return to work because of his legal status and not because of his injury. This led to the suspension of Ed’s benefits.

Hostile Attacks and Military Actions

Workers’ comp does not cover injuries or deaths resulting from military actions or hostile attacks. This provision reflects the unique nature of these events, which fall outside the scope of typical workplace accidents.

Case Study: The Unforeseen Attack

A warehouse suffered damage because of military activity nearby. This caused injuries to several workers. The workers’ injuries did not qualify for workers’ comp because the incident, directly related to a military action. Thus, the injured workers could not seek compensation through the workers’ compensation system.

Final Thoughts

The statute of limitations creates another limit from filing a workers’ compensation claim. You typically only have three years from the date of your injury to file a claim petition. Success in a workers’ compensation case requires a broad understanding of the affirmative defenses and different exclusions.

Employees should always know the boundaries of their workers’ comp coverage and understand their rights. At the same time, employers should know how to properly manage their responsibilities.

For eligibility questions, contact us today: 215-609-4183. Use our settlement calculator for a lump sum value for your case. You can also find out your benefit rate.

PA Workers’ Comp: The Course and Scope of Employment

Course and Scope of Employment

One critical concept of many Pennsylvania Workers’ Comp claims: the “course and scope of employment.” This principle determines whether an injury is work-related and thus eligible for compensation benefits. Injured workers should understand this important legal term since it can have an impact on benefits.

Explaining the Course and Scope of Employment in Pennsylvania

Course and Scope of Employment Helps Decide if You Qualify for Workers' Comp.
Course and Scope of Employment Helps Decide if You Qualify for Workers’ Comp.

How Do Legal Definitions Affect Course and Scope?

The course of employment includes activities an employee does as part of their job duties. It includes tasks that further their employer’s business interests. An activity that relates to the business or affairs of your employer may qualify.

However, the boundaries of this definition are not always clear-cut. Many factors influence this determination.

These factors include the location, time, and specific activities performed at the time of injury. A finding on any of these issues can decide whether a particular injury qualifies for workers’ comp benefits.

What Makes Course and Scope of Employment so Important?

What activities might affect your Workers’ Compensation claim in Pennsylvania may not seem obvious. Activities that might appear unrelated to work may still qualify for benefits. Specifically, an injury that occurred in the course. Examples include traveling for business, participating in a company-sponsored event, or even injuries occurring in company parking lots.

Key Scenarios and Their Impact on Your Compensation Claim

Do Traveling Employees and Course and Scope

For employees whose work involves traveling, the boundaries of the “course and scope” extend beyond the physical workplace. Injuries sustained during travel for work-related purposes often qualify for compensation. Certain exceptions apply, highlighting the importance of understanding the specifics of your situation.

An employee who gets in a car accident commuting to their office would not likely qualify for benefits. Not generally considered an injury in the course. However, an employee who falls walking to their motor vehicle while running an errand for their boss may qualify. The difference: working at the time of injury.

What About Social and Athletic Events?

Company-sponsored social or athletic events present a unique challenge in determining if you qualify for Workers’ Compensation. While participation in these events can enhance company morale, an injury during these activities may not qualify for benefits. A major issue a judge may weigh include whether the employer required participation or you volunteered. Courts also look at the relationship of the event to your employer’s business.

Premises and Parking Lot Cases: In the Course and Scope?

Injuries occurring on company premises, including parking lots, generally fall within the “course and scope” of employment. What an employee is doing at the time of injury could affect if the injury qualifies. The timing of the injury can also impact whether an employer must pay workers’ compensation.

Practical Advice for Injured Workers

Grasping the basics of what counts as work-related activities marks the beginning for injured workers in Pennsylvania. Understanding how each fact of your situation impacts your benefits requires a lawyer. A consultation with an experienced workers’ compensation attorney costs nothing.

How Can A Lawyer Help You with Course and Scope Issues?

A Workers’ Compensation attorney can provide advice to help you navigate a complex area of the law. A lawyer also gathers the necessary documents to represent your interests in hearings. Claims denied for Course and Scope issues also require complicated legal arguments.

@thwesq Replying to @helencurtin575 the right time to talk to a lawyer after a work injury is as soon as possible. The insurance company has someone working hard for them. You should know the legal landscape you’re getting into before something goes wrong. Report the injury, see a doctor, call a lawyer. Not legal advice, informational only. #workersrights #workerscompensationattorney #lawyersoftiktok #lawyer #fyp ♬ original sound – Tom Wing

Preparing Your Claim: Steps to Take

If you’ve suffered a work-related injury, documenting the circumstances surrounding your injury is essential. This includes the time, location, and nature of the activity leading to the injury, as well as any witnesses. Promptly reporting the injury to your employer and seeking legal advice can help your claim’s chance of success.

Conclusion

The concept of “course and scope” in Pennsylvania Workers’ Compensation law may determine whether you qualify for benefits. Understanding how the law applies to various activities can mean the difference between a denied and accepted claim. With the right approach and legal support, you can increase your chance for a successful outcome. We have successfully litigated many cases with these issues and can speak with you for free about your case: 215-609-4183.

PA Workers’ Compensation Settlement Calculator

Workers' Comp Settlement Calculator





PA Workers’ Comp Settlement Value

Going through a work-related injury requires an understanding of your rights and potential benefits. After a work injury, so many unknowns exist, including when you can physically return to work. This leads to many financial worries. Getting an idea of the value of your case may help to relieve some of this stress.

@thwesq Replying to @Tik Tok settlement value for a workers comp claim involves balancing the different risks and potential benefits and injured worker is likely to receive #workerscomp #workerscompensation #settlement #lawyertok ♬ OK – Flight School & Zai1k

The PA Workers’ Comp Settlement Calculator helps injured workers estimate the value of their claims. Here, we will explain the calculator’s role in determining workers’ compensation benefits.

Disability Ratings

Total Disability

Total disability benefits offer help for employees completely unable to work because of their injuries. They provide a steady income during recovery by using the average weekly wage to calculate the benefits owed. 

Keep in mind, received compensation never exceeds the statewide average weekly wages for the year of injury. The maximum weekly compensation rate changes each year. The Pennsylvania Department of Labor calculates this number. For more information on that, you can read our guide on wage loss benefits.

Partial Disability

For a partially disabling injury, partial disability benefits provide income to make up the gap in lost wages. This helps workers that can work some, but not as much as they did pre-injury. The wage loss benefits correspond to their reduced earning capacity. Injured workers receive two-thirds of the wage loss in benefits for the partial disability.

Specific Loss

Injuries that result in permanent loss of use may qualify for specific loss benefits. These benefits compensate for an amputation or complete loss of use of a body part. Whether it is the loss of a limb or of a sensory function, the law determines the number of weeks of compensation owed.

The only exception to this rule is any disfigurement of the head, face, or neck. In this case, a workers’ comp judge awards the compensation.

Impairment Rating

After an injured worker has received 104 weeks of benefits, they may undergo an impairment rating evaluation. Done by a designated impairment rating evaluator selected by the Bureau, this evaluation provides an impairment rating score.

If your impairment rating comes in below 35%, your benefits will convert to partial disability. Partial disability benefits max out at 500 weeks. This caps the total risk to the insurance company, potentially limiting the value of your claim.

If the rating comes back at 35% or above, your benefits will not convert to partial disability. Total disability benefits have the potential to remain payable for a lifetime.     

Medical Expenses

Workers’ compensation provides for full coverage of the medical treatment costs incurred because of the work-related injuries. Workers’ comp insurance pays for medical costs, so injured employees can recover without financial worries. Always think about future medical costs when considering a settlement.

Workers Comp Settlement Calculator

Settlement Estimates

This work injury settlement calculator helps injured workers estimate the value of their claims. It considers general medical expenses, the average weekly wage, disability level, and historic settlement results. This estimate can give a basic starting point to chat with your lawyer about.

A calculator cannot replace a skilled workers’ comp lawyer. Only a lawyer can analyze all the unique details of your case.

Workers’ Comp Lawyers

Valuing a workers’ compensation claim requires legal knowledge. Workers’ comp lawyers are vital in giving guidance to make sure your settlement accurately reflects your claim’s value.

They have a deep understanding of the PA workers’ compensation rate schedule. As well as the labor and industry regulations. A skilled workers’ comp attorney will also know the system, including any risks you face as your claim moves through the process. This makes them key in getting the maximum compensation for injured workers. 

The More You Know

Knowing how to calculate workers’ comp benefits can help you to figure out wage loss and medical expenses. By having this knowledge, you can make more informed choices.

The workers’ comp rate schedule and Pennsylvania Department of Labor’s guidelines can provide important information. They help you to understand the settlement process, ensuring you receive fair compensation for your injuries.

How Do I Use The Workers’ Comp Settlement Calculator?

The calculator estimates your claim’s lump sum value based on the information you plug in. Based on your information, it gives a starting point for a conversation with a lawyer. It cannot replace legal advice from an experienced workers’ comp lawyer.

  1. Enter the year of your date of injury (2022-2024). Since rates change each year, this helps give a better estimate of the true value.
  2. Enter your average weekly wage. Use our guide and calculator to estimate if you need help. Give an accurate number to get a closer estimate.
  3. Select whether or not you are currently working. Benefits change when you work, so it needs to know.
  4. If you are working, enter your current weekly earnings. This helps calculate the benefit rate owed while working.
  5. Click “Calculate Settlement” to see your case value estimate. The crucial term in this context is “estimate.” Make sure you talk to a lawyer before making any decisions based on this number.

Example Settlement Estimate

Below you will find an example of a settlement value range based on the information entered. Our formula automatically calculates this range.

The image displays a user interface for a Settlement Value Calculator. It has fields where the user can input the year of injury, average weekly wage, and current weekly earnings if they are still working. The year selected is 2024, the average weekly wage entered is 927, and the current weekly earnings are 543, indicating the user is currently working. There is a button labeled "CALCULATE SETTLEMENT" and below it, the estimated settlement value is shown as a range between $13,312.00 and $86,125.00. There is a note on the right side that states "Future Medical Risk is Generally Estimated".
Example of Settlement Value of PA Workers’ Compensation Claim using the PA Workers’ Comp Settlement Value Calculator

Conclusion

This calculator serves as a useful tool to help you get an idea of the value of your case. It can only give you an estimate and does not replace the need for a lawyer. Many factors can affect the value of your case.

Call our office 24/7 for a free consultation and free case evaluation at (215) 609-4183. We look forward to getting you the money that you deserve.

Master PA Workers’ Comp Injury Relationship

Causal Relationship In PA Workers’ Comp Claims

PA Workers’ Compensation law requires an injury to have a causal relationship with the employment. Often referred to as “arising in the course of employment” and “related thereto.” This blog discusses the meaning of these terms, how courts interpret them, and what injured workers need to know.

To qualify for workers’ comp an injury must arise from and relate to employment.

To qualify for workers' compensation an injury must arise from and relate to employment.
To qualify for workers’ compensation an injury must arise from and relate to employment.

What Does “Arising In The Course Of Employment” Mean?

Arising in the course of employment means the injury must arise out of employment. The onset of the injury may occur during the employment, such as a forklift running over a worker’s foot. Or, the circumstances that cause the condition may occur in the scope of employment, such as an occupational disease.  

If an accident occurred outside work with no relation to the job, it would not fall under workers’ comp. In addition, workers’ compensation covers workplace injuries that occur while working for an employer. Workers’ compensation insurance does not generally cover injuries to an independent contractor.

How Have Courts Interpreted This Requirement?

Determining whether an injury meets the criteria can get complicated. Cases such as O’Rourke v. WCAB and Marazas v. WCAB discuss these principles.

O’Rourke v. WCAB

In this case, the PA Supreme Court dealt with a unique workers’ comp claim. Laura O’Rourke sought benefits after her son, Joshua Gartland, attacked her while she slept at home. Under a state-funded program, O’Rourke worked as an employee for her son, caring for him. He suffered from serious health problems from long-term drug use.

While in her home, O’Rourke suffered a brutal stabbing by her son. The court had to determine if her injuries qualified for compensation under the Workers’ Comp Act.

The Supreme Court concluded that the injuries did not arise in the course of employment nor were they related thereto. They determined that the nature of her employment did not require overnight care during the attack.

Marazas v. WCAB

This case went up to the Commonwealth Court of PA. Marazas, employed as a driver technician, reported to work tired after an on-call weekend. Because of this, he requested a reduction in his workload for the day.

His manager refused and Marazas resigned. While removing his personal belongings from the company truck as instructed, Marazas tripped over a pallet jack. This occurred on the employer’s premises and resulted in Marazas sustaining injuries.

The Commonwealth Court of PA awarded Marazas workers’ compensation benefits. Marazas occupied the employer’s premises and carried out a task under the employer’s direction at the time of injury.

What Does “Related Thereto” Mean?

Related thereto examines whether the injury has a direct connection to the employment, medical or otherwise. The Workers’ Compensation Act 61 of 1972 introduced the “related thereto” requirement. It added another layer in determining what qualifies as a work injury.

What Have The Courts Said?

Krawchuk v. Philadelphia Electric Co.

Krawchuk v. Philadelphia Electric Co. significantly expanded this interpretation of work relatedness. The Pennsylvania Supreme Court ruled that the actual onset of an injury does not need to occur at work. However, the circumstances causing the condition must occur in the scope of employment and relate thereto.

In this case, the PA Supreme Court addressed the claim of Rosemarie Krawchuk, the widow of John Krawchuk, who worked as an electrical engineer. He died from a heart attack after working under great stress because of his employment. The heart attack occurred at his home, following a period of intense work related to a special project known as “PMS4.” He also had to prepare for a treatise he had to deliver in California.

The PA Supreme Court reversed lower courts’ decisions and awarded death benefits. They interpreted the Act to include job-related heart attacks, occurring off the employer’s premises. Providing, the injury arises in the course of employment and relates thereto.

Medical Connection

In situations with a medical connection, one must establish a clear and certain link. This must show a connection between the injury and the job duties or conditions. Courts look to clear medical testimony to establish this causal relationship between the injury and employment.

Non-Medical Connection

Sometimes, the situation lacks a medical basis. In these situations, the courts look for evidence that the injury would not have occurred “but for” the employment. When the job puts the worker in the situation that leads to the injury, the courts may consider it work-related.

The “but for” test applies for incidents that occur outside traditional work environments. For example, injuries sustained while traveling for work or activities indirectly related to the worker’s job.

Weaver v. WCAB and Morgan v. Giant Markets, Inc. expanded the “related thereto” requirement. When the causal connection appears obvious, unequivocal medical testimony becomes unnecessary.

Worker engaged in construction task arising from and directly related to employment, surrounded by essential tools and materials on a busy construction site.
Worker engaged in construction task arising from and directly related to employment, surrounded by essential tools and materials on a busy construction site.

What Does This Mean For Workers?

This broadens the definition of “work-related injury.” Workers must establish a clear link to their work conditions or activities, showing the injury arose out of employment. Conditions covered by workers’ comp include when an accident arises because of work-related stress or activities. Even if the physical onset does not occur in the course of employment and happens elsewhere.

This helped with issues including occupational diseases, aggravation of pre-existing conditions, and repetitive conditions, like carpal tunnel syndrome.

Final Thoughts

For injured workers, understanding the terms “arising in the course of employment” and “related thereto” proves critical. They cover a wide range of injuries. Some injuries arise directly at work to those with a more indirect connection to employment. These legal standards determine the eligibility for compensation in PA.

Workers suffering wage losses for their work injuries need a lawyer. If you have questions about your injury or what qualifies as a work injury, speak with a lawyer. Reach out to our offices 24/7 for a free and confidential consultation (215) 609-4183.

Definition Of An Injury In PA Workers’ Comp

Defining a Work Injury In Pennsylvania

The definition of the word “injury” holds crucial weight in PA workers’ comp. It shapes the journey of recovery and compensation for injuries each year. Here, we will define the term “injury” under the PA Workers’ Compensation Act. This definition helps to provide clarity for workers injured on the job.

Act 61

In 1972, PA took a significant step with Act 61. This Act changed workers’ comp law. It replaced the requirement of an “accident” with the broader concept of an “injury.” This key change enabled more people to get help for job-related injuries.

What Is A Work Injury?

A work injury includes any harm or disease that arises in the course and scope of employment. This applies even if the worker has a pre-existing health condition. If a worker’s preexisting condition gets worse because of their job, they can still qualify for workers’ comp.

Injury And Occupational Disease

Occupational diseases also fall within the definition of “injury.” Covered under workers’ compensation, a disease or illness directly related to work conditions or to work hazards. However, any exposure that occurred prior to June 30, 1973 does not qualify.

Courts have held the COVID-19 illness, contracted at work, qualifies for workers’ comp under this section. This provision has given many long term COVID-19 survivors peace-of-mind.

How Do Courts Define A Work Injury?

PA courts historically steered clear of pinning down an all-encompassing definition of “injury.” Instead, focusing on whether the harm arises out of employment and the relation to employment. This provides flexibility, allowing for a case-by-case assessment.

Aggravation of Preexisting Condition

Workers’ comp law can involve determining if a preexisting condition worsened or if a previous work injury recurred. The distinction is critical in a workers’ comp claim. It can affect the eligibility for compensation and the share of liability among employers and insurers.

Under PA law, if your work aggravated a pre-existing condition, the aggravation qualifies as a new injury. A pre-existing condition can make an insurance company more likely to deny the claim initially. However, many injured workers receive benefits even though they have pre-existing health conditions.

Cumulative Trauma and Repetitive Stress

Repetitive stress injuries (RSIs) occur when you perform repetitive movements or overuse something. These actions can lead to various conditions, including: carpal tunnel syndrome, tendonitis, median nerve injuries, and bursitis. These conditions may develop over time because of continuous work-related activities.

The law acknowledges that injuries can result from repetitive trauma or continuous exposure to harmful conditions.

Risk factors include:

  • The type of work, such as assembly lines or other high risk repetitive work.
  • Use of vibrating hand tools
  • Exposure to chemicals or vapors
Diagram of Repetitive Stress and Occupational Disease Injuries Caused by Work Hazards covered by Workers' Compensation
Diagram of Repetitive Stress and Occupational Disease Injuries Caused by Work Hazards covered by Workers’ Comp

Tips For Injured Workers

Injured workers should report their work injuries right away. They should seek a medical evaluation. Lastly, they should talk to a PA workers’ comp lawyer.

Employers must maintain a safe work space and aid in the claims process for the work related injury or illness. Employers should cover the medical expenses and the lost wages. A workers’ comp lawyer can advise you and guide you through the process. They can also make sure your employer does the right thing, so you get the benefits you deserve.

Final Thoughts

When an injury happens on an employer’s premises, it is important to know your rights and what counts as an injury. The definition of “injury” in Pennsylvania Workers’ Compensation Law is broad. It covers a wide range of injuries occurring in the course of employment.

This legal concept can cause challenges. Having an experienced lawyer on your side will ensure you get the help you need and the benefits you deserve. If you have questions about your work injury, let us answer them. Reach out to our offices 24/7 at (215) 609-4183.

PA Workers’ Comp Employment Relationships

Pennsylvania Employment Relationships and Workers' Comp

In PA, the Workers’ Compensation Act covers employees for work related injuries and illnesses. It mandates that employers must provide workers’ compensation insurance for their employees. If you have suffered a work injury, your employer may be liable for workers’ compensation. Keep in mind, employers often misclassify workers.

We hope to make things clear for injured workers and employers in PA. We will cover who qualifies for benefits and how the law views different job roles.

Employee or Independent Contractor?

Hiring Power

Employers typically have a greater control over selecting employees than independent contractors.

Ability to Fire

Employers may have more discretion in the removal of an employee than an independent contractor.

Control Over Work

Employees can have more oversight and direction as to how to complete job tasks and perform their jobs. An employer also more likely supplies the tools needed for the job for an employee. An independent contractor may purchase their own supplies.

Overall Control

Employers usually manage an employee’s hours worked and methods of production. Independent contractors typically decide when and how they will do the job.

Employees and independent contractors may also differ in wages and benefits. Employees may get a steady wage, while contractors do not. Employee may also have benefits, not typically provided for independent contractors.

This case gives more information: Universal Am-Can, Ltd. v. WCAB

Special Rules for Construction Workers

Construction workers and general contractors have specific rules. The Construction Workplace Misclassification Act (Act 72), protects workers in specific industries after a work injury.

@thwesq Worker misclassification is a nationwide problem, but I see it all the time in Workers’ Compensation cases here in Pennsylvania. #greenscreen #lawyer #employees #workersrights #constructionworker #construction ♬ original sound – Tom Wing

What Makes You an Independent Contractor in Construction?

A Written Contract

You have a written agreement for the work you perform.

Freedom in Your Work

You have the ability to do your job without your employer telling you how you do it.

Running Your Own Business

You operate a business separate from the person who hired you.

If you answer “yes” to all questions below:

Requirements for Independent Contractors in Construction in PA
Requirements for Independent Contractors in Construction in PA

The Statutory Employer

Someone other than the original employer might be held liable for workers’ comp benefits. Common in construction, when working through subcontractors. This can make you the statutory employee for workers’ comp, even if that employer did not withhold income taxes.

The following case introduced the McDonald Test, which helps identify a statutory employer: McDonald v. Levinson Steel Co.

Am I a Borrowed Employee?

Sometimes, your job might send you to work for another company. This can make things confusing after an on-the-job injury. Let’s break down what happens with workers’ compensation when you’re a “borrowed employee” in Pennsylvania.

Imagine you usually work for ABC Staffing. ABC Staffing sends you to work for XYZ Logistics Company as a packer. ABC Staffing pays your wages, but you work under XYZ Logistic Company’s control as a loaned employee.

This situation makes you a borrowed employee, also called a borrowed servant. If you suffer an injury while working for XYZ Logistics Company, who covers the lost wages and medical bills? The law looks at the amount of control each employer had over you at the time of your injury.

Employer control

XYZ controlled the work you performed and how it happened. Generally, the company that controlled your work at the time of injury must pay workers’ compensation benefits. Many times, the staffing company will pay for the medical care and lost wages owed and not the borrowing employer. This setup helps ensure coverage for work injuries, no matter where you work.

The following case gives an overview of this kind of employment with a staffing company: JFC Temps, Inc. v. WCAB.

Who Does Not Qualify for Workers’ Comp?

Casual Workers

Sporadic work, not central to the business, may not have coverage.

Domestic Workers

Usually covered only if the employer opts in for coverage.

Agricultural Workers

Certain conditions, like earnings or days worked, determine their coverage.

Final Thoughts

Workers’ compensation is a unique area of the law. Not a common law area, instead centered around the Workers’ Comp Act.

Complex employment relationships can make workers’ comp confusing. Knowing the rules for different employee relationships and construction workers, can help make sense of it. This knowledge can protect your right to receive benefits for injuries and illnesses at work.

Seeking advice from a lawyer can ensure you protect your rights. If you have questions about qualifying for workers’ comp, let us know. Reach out to our offices 24/7 for a free consult (215) 609-4183.

Pennsylvania Workers’ Compensation Rate Calculator

Workers’ Compensation Rate Calculator

Instructions: Select your year of injury, enter your Average Weekly Wage, and click calculate

2024 Workers' Compensation Rates & Average Weekly Wage

The Bureau of Labor & Industry has given an update on the average weekly wage for 2024. Section 105.1 of the Workers’ Compensation Act requires this update every year. You can use our free calculator to get your compensation rate based on your wages.

The 2024 Statewide Average Weekly Wage

Starting January 1, 2024, the statewide average weekly wage (AWW) for work injuries occurring in 2024 stands at $1,325.00, marking a 4% increase from 2023.

Injured workers can receive workers’ comp for lost wages and medical expenses. Typically, wage loss benefits total 2/3 of the regular pay (Average Weekly Wage), but not always.

To calculate your AWW, fill out the Statement of Wages form LIBC-494C provided by the Bureau. To estimate your AWW, use the average amount of your weekly pay (before taxes and deductions).

How To Calculate The Average Weekly Wage

The Average Weekly Wage (AWW) includes all wages, from all jobs, where the employee worked at the time of injury.

Combining all wages to determine the AWW ensures the compensation reflects the total earning potential lost. This makes the workers’ compensation calculation much more accurate.

Several things play a role in what counts towards the AWW. This includes wage rates, overtime pay, bonuses, vacation pay, and board and lodging if provided by the employer. Tips also count, as long as they appear on federal income tax returns. Additionally, certain types of supplemental unemployment benefits, typically coming from services performed, can factor into the AWW.

For seasonal employees, the calculation takes a unique form. The AWW typically accounts for 2% of total earnings from all jobs in the previous year (seasonally adjusted). This takes into account the fluctuating nature of seasonal work.

For salaried employees, divide the annual salary by 52 weeks to find your average weekly wage.

Exclusions From The AWW

Specific exclusions apply to the AWW calculation. Some fringe benefits, like employer contributions to health insurance or retirement plans, do not count toward the AWW. The same applies to unemployment benefits and non-monetary compensation, except for board and lodging. Earnings from independent contractor work generally do not count either.

Special rules apply to certain groups of workers. Volunteer emergency workers, for example, have an additional presumption regarding their earnings, even if unemployed. Teachers under annual contracts and workers with specific loss injuries also face unique guidelines that affect their AWW calculations. For more information on these different class codes and their risk, reach out to a workers’ comp lawyer.

Workers’ Comp Benefit Amounts Explained

The Workers’ Compensation Act provides the compensation formula for wage replacement based on weekly rates. We calculate your benefit rate based on the guidelines in the Act using a percentage of the AWW. However, compensation, by law, cannot exceed the statewide average weekly wage in the year of the injury. While you may find that your comp rate seems low, note that workers’ comp benefits are not taxable.

@thwesq Replying to @angieGelos123 wage loss benefits in workers’ comp aren’t always that simple, but it’s a percentage of the average weekly wage to account for taxes and other deductions from pay that dont come out of workers compensation. It isnt perfect (take home money here in PA hovers between 70-80% for most people) #workersrights #workerscomp #lawyer #lawyersontiktok ♬ original sound – Tom Wing

Disability Benefits

If a worker suffers total disability, meaning they are out of work completely, they will receive their full comp rate. When a worker cannot work full time, but has some income, the disability qualifies as partial. In this instance, they would receive 2/3 of the difference between the average weekly wage and their current earnings.

Also remember, the number of days that you miss work matter. No disability compensation becomes due if wage loss lasts for less than 7 days. Disability payments would start on day 8 if wage loss exceeds 7 days. Once wage loss hits 14 days or more, all the disability is payable, including the first 7 days.

How To Calculate Workers’ Compensation Benefit

This graphic shows how to calculate your PA workers’ comp benefit rate based on your AWW for injuries that occurred from 2022 through 2024. Remember, the maximum weekly compensation rate equals the statewide AWW for your year of injury.

Pennsylvania Workers' Compensation Rates for years 2022-2024
Pennsylvania Workers’ Compensation Rates for years 2022-2024. Source: PA Bureau of Labor and Industry.

This graphic outlines the compensation rates based on the worker’s average weekly wage. To use this graphic properly, you must use the year of your date of injury or illness for the calculation.

For example, a worker injured in 2024 with an average weekly wage of $900.00 would have a comp rate of $662.50 per week. Or, if a worker had an average weekly wage of $1,200.00 per week, they would receive 66 2/3 percent ($800.00) in compensation.

You receive either a flat rate in workers comp’ or a percentage of your AWW. You can also use the calculator above to calculate your benefit rate for a work related injury from 2022-2024.

Image of the Workers' Compensation Rate Calculator web tool, displaying an input for the year "2024", a field to enter the average weekly wage, and a 'CALCULATE' button, with the calculated compensation rate for 2024 showing as $662.50
Simplifying the calculation of workers’ compensation rates with a user-friendly digital tool – just enter your details and get an instant comp rate.

Conclusion

Whether you have worked for a small business or a large corporation, work injuries can change your world. When facing a number of weeks out of work, injured workers often find themselves in stressful situations. Workers’ compensation insurance benefits cover medical treatment and wage loss for injured workers, helping to ease this stress.

The AWW and compensation rate calculations can present some challenges. By familiarizing yourself with the basics, you better prepare yourself for what to expect with a work injury.

If you have questions about your compensation rate or need any help with your claim, let us know. Reach out to our offices 24/7 for a free and confidential consultation (215) 609-4183. We have experienced workers’ compensation lawyers ready to assist you today.

Who Qualifies for Workers’ Comp Benefits in Pennsylvania?

In PA, the Department of Labor and Industry oversees workers’ compensation. Workers’ comp is a form of disability benefits established to help injured workers. The law requires employers to carry workers’ compensation insurance for all employees.

Workers who have suffered an injury, illness, or occupational disease as a result of their job may qualify. Covered by workers’ comp, full time, part time, and seasonal employees may meet the criteria. Workers’ compensation coverage includes lost wages and medical expenses. Also, if an employee dies as a result of their job, workers’ comp may provide a death benefit for the family. 

This guide hope to explain PA workers’ comp laws, including rights, jurisdiction, notice rules, and time limits for filing claims. Employees need to know the rules if they suffer an injury to protect their rights and get the benefits they deserve. 

Who Is Eligible For Workers’ Compensation?

To qualify for workers’ compensation benefits, the injury must relate to and arise from the employment. This includes both physical injuries sustained at the workplace and illnesses directly resulting from job-related activities.

More specifically, a clear connection between the job and the employee has to exist. The injury must take place while doing work-related tasks or relate to the job in some way.

Employment Relationship

The claim hinges on a valid employment relationship. The law requires that the injured party must have an employer-employee relationship.  An Independent contractor does not typically qualify for workers comp benefits.

Nature of Injury and Work Relation

For an injury to qualify for workers’ comp, it must occur within the scope of the employment. This means that the injury should relate to the tasks or duties assigned as part of the job or occur on-site. For example, if a worker suffers an injury from a slip and fall while walking to their desk at work, they may receive benefits.

If I Get Hurt at Work In PA, Do I Get Workers’ Comp?

As long as you qualify as an employee and the injury falls within the course and scope of your employment, likely, yes. Workers’ comp covers most workplace injuries that occur within Pennsylvania. Always talk to a lawyer regarding the particulars of your case.

General Rule in Pennsylvania

The Act applies to all work injuries within Pennsylvania. The act also covers injuries outside Pennsylvania under specific conditions. For more information, see the McIlvaine Trucking Inc. v. WCAB (States) case.

A safety-conscious worker in a PA factory, highlighting the significance of safety in workers' comp discussions. He sports a white hard hat, safety goggles, and gloves, with a long-sleeved shirt and utility vest. The factory behind him bustles with machinery and workers.
A safety-conscious worker in a PA factory, highlighting the significance of safety in workers’ comp discussions.

Jurisdiction Outside Pennsylvania

Under certain conditions, the law covers injuries that happen outside PA. These conditions apply when a job mainly happens in PA or when signing the hiring contract occurs in PA. This provision ensures that employees who travel out of state for work-related purposes remain covered under the Act.

Disputes in Multi-State Employment

For employees working across state lines, disputes often arise over which state’s law applies. The law deals with this by looking at where the employee works and where they signed the employment contract. This approach provides clarity and fairness in determining jurisdiction, especially in cases of mobile or multi-state workers. A lawyer can help you to determine the best place to file a claim.

What Time Limits Apply to Workers’ Compensation Claims?

You must give notice of your injury within 120 days of the injury. The law requires employer notification of an injury within 120 days from the injury date. This rule mandates prompt reporting of injuries to ensure timely processing of the claims. It can also help with early injury treatment, which could result in faster recovery and return to work.

To receive retroactive benefits back to the date of injury, employees must report their injury within 21 days. After those 21 days, the benefits will begin from the date of notice. If the employee fails to report their injury after 120 days, the employee may lose all rights to their benefits. 

@thwesq The three most common mistakes made by injured workers in #pennsylvania when reporting a work injury #CapCut #workers #workerscomp #lawyer ♬ 5 seconds short jingle bass house techno(1385287) – Gloveity

The Discovery Rule

The discovery rule extends the time for notifying the employer about an injury and its connection to work. This extension lasts until the employee becomes aware or should reasonably become aware of it. This rule applies when injuries or illnesses that develop slowly. For example, repetitive stress injuries or occupational diseases/illnesses that arise from the employment.

Legal Notice Depends on the Totality of Circumstances

You need to provide a clear description of the injury and follow the rules for notification. See Sections 312 and 313 of the Act (77 P.S. §§ 632 and 633) for the complete requirements. Keep in mind, late notice can affect an employee’s eligibility to receive workers’ comp benefits.

The injured worker must tell their employer or representative about their injury. The employee should tell their employer how the injury happened and how it relates to the job. The worker should always put this in writing, when possible, to have a record of this notice. This will help if and when a dispute arises.

Is There a Time Limit to File A Workers’ Comp Claim?

Yes. A 3 year time limit applies for filing a claim petition, counting from the date of injury.

General Time Limits

Section 315 of the Act requires an injured worker to file a claim petition within 3 years of the date of injury. This limitation underscores the importance of timely action in pursuing a workers’ comp claim.

Statute of Limitations-Exceptions

Scenarios such as commutation of partial disability, or the payment of specific loss benefits, can influence the time limit. These situations reflect the Act’s flexibility in handling different types of injuries and the issues surrounding them.

Other situations may extend the timeline as well. For instance: employers lying, withholding medical records, or paying for injuries in other states.

This rule prevents workers from unfair punishment for issues beyond their control. These situations might include employer fault or not receiving important information in a timely fashion. Always talk to a lawyer to see how this would apply in your particular case.

Impact of Late Discovery

If injuries appear later, like from long-term exposure, the time limit to report them may extend. This extension helps employees file claims for work-related injuries by addressing the challenges in identifying their cause. Always talk to a lawyer to see how this would apply in your particular case.

Conclusion

The workers’ comp system in PA can seem overwhelming, especially while going through a work injury. It has so many rules, so many deadlines, and a bunch of exceptions. Getting through the process requires a deep understanding of each of these rules, deadlines, and exceptions.

For injured workers, navigating this process can add stress to their already stressful situations. Don’t go through this alone, let us handle it. The insurance company has a lawyer on their side, so why don’t you?

If you need help with your claim or have any questions, give us a call. Reach out to our offices 24/7 for a free and confidential case evaluation (215) 609-4183.

Pennsylvania Workers’ Compensation: The Exclusive Remedy

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PA workers’ comp relies on two main principles: employer immunity and the exclusive remedy provision. These principles form the legal framework for the workers’ compensation system and have notable impact on workplace injury lawsuits.

Employer Immunity and Exclusive Remedy

What Is The Exclusive Remedy?

PA workers’ compensation laws center around the exclusive remedy rule. Basically, it establishes employer immunity from tort liability.

This means that employees cannot typically sue their employers for work related injuries. This makes workers’ comp the exclusive remedy for injured employees who have been injured on the job. It ensures employer protections from lawsuits and provides benefits to injured workers for medical care and lost wages.

A grand courthouse facade with towering columns, illustrating the authoritative structure of Workers' Compensation law and the exclusive remedy principle, standing as the cornerstone of employee protection and legal resolution.
Engraved with the weight of law, this courthouse symbolizes the exclusive remedy rule—where Workers’ Comp serves as the sole legal recourse for workplace injuries, underpinning the intricate relationship between worker safety and employer liability.

What Does The Judge Do?

Workers’ compensation judges (WCJs) play a vital role in this process. For example, a WCJ may find that an injury falls under workers’ comp. This type of finding may lead to the dismissal of a tort suit against the employer. This stresses workers’ compensation as the exclusive remedy for workplace injuries.

The principle of exclusivity also holds constitutional support. It not only applies to the employer. It also applies to co-workers, shielding them from common-law liability for workers’ comp-covered injuries. This does not apply to cases of intentional harm.

Any Exceptions to the Exclusive Remedy?

Immunity is not absolute. The Act does not completely bar employees from using other legal avenues. In cases involving personal animus or intentional acts, other legal options might exist. If an employer intentionally harms an employee, that employee may have legal recourse outside the workers’ comp system. 

In addition, the Uninsured Employers Guaranty Fund acts as a safety net for workers injured by uninsured employers. This fund ensures that employees have a recourse in cases where their employers fail to have insurance.

In this context, injured workers have the option to file claims against the fund. They may also have the option to file a civil suit against their employer.

@thwesq The exclusivity provision of the #pennsylvania workers compensation act generally prevents a #lawsuit in tort against the #employer after a #workinjury , but not always #CapCut ♬ original sound – Tom Wing

What About Third-Party Actions?

The system also covers the handling of cases where a third party causes an injury or death. The Act notes the importance of a prior written contract. Employers and their insurers cannot assume responsibility for damages, payments, or compensation in the absence of this contract. This ensures clarity and fairness in the allocation of liability and the protection of the employers’ interests.

What About Workers’ Comp Insurance Carriers?

Another aspect of the workers’ comp system gives immunity to workers’ compensation insurance carriers. The Act limits tort actions against the carrier for damages resulting from alleged intentional mishandling of workers’ compensation claims. This immunity ensures that carriers can operate without the fear of constant litigation.

This immunity is not without exceptions. Cases of vocational malpractice and intentional infliction of emotional distress may fall outside the scope of this immunity.

Wrap Up

PA workers’ comp laws present a complex system for addressing job injuries. We hope to have clarified the principles of employer immunity and the exclusive remedy.

When in this situation, do not hesitate to talk to a lawyer. An experienced workers’ comp lawyer can protect your rights.

If you have questions about workers’ compensation benefits, let us answer them. Get all the benefits you are entitled to. Call our offices 24/7 for a free and confidential consultation (215) 609-4183.

Applying for Social Security Disability While on PA Workers Comp

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Collecting Social Security Benefits While Out of Work Due to a PA Work Injury

Can I Apply for Disability While on Workers’ Comp?

Work injuries can lead to long time periods out of work. This raises the question of getting Social Security benefits during this time.

Social Security benefits provide financial support to people. This includes disabled workers. They should understand how workplace injuries, disabilities, and the eligibility for Social Security benefits relate to each other.

This blog explores the eligibility criteria. It considers the implications for individuals seeking Social Security benefits while out of work from a work injury.

We will look into the requirements and the application process. Then, see how work related injuries can impact SSDI benefits. We hope to offer insight for those looking for help during their recovery.

Collecting SSDI and Workers’ Comp

Social Security Disability Insurance (SSDI) provides financial assistance to individuals with disabilities. This includes those unable to work because of a qualifying disability. A work-related injury that results in a disability may make an individual eligible to receive such benefits. However, they have to meet a strict criteria.

Criteria for Social Security Disability Insurance

To qualify for severe and long-term disability, the disability must prevent substantial gainful activity. Also, it must last for an expected timeframe of at least 12 months or result in death.

Further, applicants need to collected enough work credits through their employment history to qualify for SSDI benefits. The number of work credits needed for this depend on the age at which the worker becomes disabled. Often, younger workers will require fewer credits.

This system ensures that SSDI support extends fairly to those who have contributed to the Social Security system. But, it also accounts for the difference in work history among the age groups. Understanding the specifics of work credit requirements is important for people to accurately assess their eligibility. This also helps them to prepare for their SSDI application.

SSDI Benefits and Work Injuries or Illnesses

The connection between a work injury and qualifying for SSDI benefits might seem complicated. Not all work injuries or illnesses qualify as disabilities under the SSDI guidelines. Several key factors make this determination:

  • The degree of the injury affects the injured worker’s eligibility. How severe of an injury and the nature of that injury will determine if it qualifies as a disability. A temporary injury might not meet the criteria to receive SSDI benefits.
  • The duration and prognosis play a crucial role. SSDI benefits require a long-term disability to last for at least 12 months or expect death as the result. A work related injury that causes a temporary disability may not meet this requirement.
  • Also considered, the impact on the ability to work. The injury must impair the ability to perform substantial gainful activity. The injury must prevent participation in the previous work or any other substantial work.
@thwesq Workers’ Compensation and Social Security disability have different requirements, but if you meet those requirements, an injured worker can receive both benefits at the same time. #ssdi #workerscomp #workersrights #lawyer #workinjury ♬ original sound – Tom Wing

 

Workers’ Compensation and Social Security

People seeking SSDI benefits, because of their work injury, must go through the application process. Before starting this process, get all documentation. This means, collecting medical records and work history information. Also, gather any other documents that show the work injury and the resulting disability.

Infographic of the SSDI claim process outlining the steps for application and appeal. Icons represent the submission to the Social Security Administration, claim evaluation, decision outcome of approval or denial, and the final appeal judged by an Administrative Law Judge. The image is designed to be informative for users looking to understand the SSDI application procedure.
Application Process for SSDI

To file a claim, submit an application for SSDI benefits through the Social Security Administration (SSA). To submit an application, go online, call by phone, or visit a local SSA office.

For the disability determination, the SSA will review the application. Next, they will consider medical evidence and other related factors. Then, they will make a determination on the eligibility for SSDI benefits.

If the SSA decides you do not qualify, you can appeal the decision to a judge within 60 days. A lawyer can argue your case to make sure the judge gets the most convincing version of your case. The lawyer can also cross examine the expert SSA will hire to suggest jobs you could perform.

Benefits at the Same Time: Consider the Options

Seeking SSDI benefits because of a work injury should involve careful thought. This could have legal implications.

When collecting both workers’ compensation benefits and social security disability benefits, you may come across a workers’ comp offset. In other words, the SSDI benefits may take a credit for workers’ compensation benefits received for the same disability. Receiving workers’ compensation can affect the total amount of SSDI benefits received.

Legal help can prove beneficial when trying to manage SSDI and workers’ comp. Seeking legal advice from a professional, experienced in SSDI claims and work-related injuries, can provide invaluable guidance.

Conclusion

When out of work due to a work injury, individuals may consider applying for Social Security benefits. As we can see, the eligibility for SSDI benefits depend on many factors. Among them, the severity and duration of the disability.

Understanding this criteria and getting through the SSDI application process can seem tough. Especially, during a period of disability, resulting from a work injury. You can file for Social Security Disability while on Workers’ Compensation. However, you should speak with a lawyer before applying to learn about how they interact.

Let us help you handle the complexity of workers’ compensation laws. Reach out for a free and confidential case evaluation today.

PA Workers’ Comp Rights and Responsibilities

Workplace injuries and illnesses can have a huge impact. Rights and responsibilities in PA workers’ comp state law not only affect employees, but also employers. They try to ensure fair treatment, proper care for injured workers, and a safe workplace.

Here, we will look into the rights and responsibilities of employees and their employers. We hope to shed light on the legal framework, obligations, and key considerations for both sides. After a workplace injury, illness, or occupational disease has occurred, injured workers deserve to know what to expect.

Employee Rights and Responsibilities

Right to Workers’ Compensation Benefits

Employees in PA have the right to seek workers’ compensation coverage if they have been injured on the job. This state’s workers’ compensation covers medical expenses, wage replacement, total disability benefits, partial disability benefits, and benefits for specific losses or disfigurement. In PA, the Department of Labor and Industry oversees the workers’ compensation system.

Reporting the Injury

Employees have a duty to promptly report a work-related injury to their employer. Reporting should occur right away, but in no event should it exceed 120 days after the injury. 

@thwesq Replying to @Shaun M you should always document and report an injury immediately. Insurance companies look for any reason to deny coverage. #workersrights #workerscomp #workinjury #workinjurylawyer #lawyer ♬ original sound – Tom Wing

Medical Treatment

Injured workers have the right to seek medical care. Employees are covered when treating with an approved healthcare provider under their employer’s workers’ compensation insurance company. For more on this, see “The Pennsylvania Workers’ Compensation Claims Process” under Step 2.

Always adhere to the treatment plan set by the healthcare provider. Follow all restrictions the provider sets, like light duty. Speak to a workers’ comp lawyer if you have questions about where you can treat or if you think your employer violated your restrictions.

Non-Retaliation Rights

Employees have the right to file for workers’ comp benefits without fear of retaliation or firing. Retaliating against an employee for filing a workers’ compensation claim falls under illegal acts in PA.

The Claims Process

Employees should cooperate in the claims process by giving accurate and truthful information. This includes going to medical appointments and in a workplace investigation. Seek help from a lawyer to protect your rights.

Employer Rights and Responsibilities

Safe Workplace

Employers in PA have a legal duty to provide a safe workplace for their employees. This includes complying with safety regulations, having the necessary safety equipment, and offering training to prevent injuries.

Workers’ Comp Insurance

Employers must carry workers’ comp insurance in PA. This helps injured workers by providing things like wage loss benefits and medical care.

Reporting and Investigating

Employers should have procedures in place for workers to report their work injuries. Employers have a duty to investigate all reported incidents and keep accurate documentation.

Non-Retaliation Policy

Employers cannot retaliate against a worker that files for workers’ comp. Retaliation, such as firing or discrimination because of a comp claim falls under an illegal act. Speak to a workers’ comp lawyer right away if you have faced retaliation because of a work injury.

Return-to-Work Process

Employers should ease the return-to-work process for injured workers by offering suitable accommodations or modified duties. They must also follow the medical professional’s restrictions.

An illustrative scale balancing icons of clocks, hearts, money, and documents, epitomizes the equal importance of health, time, finance, and legal knowledge in Workers' Compensation rights and responsibilities
Decoding the Scales of Workers’ Comp – Each icon in this balanced scale represents key pieces of Workers’ Compensation, highlighting the balance between an employee’s benefits and the employer’s duties.

Legal Rights and Duties

Both employees and employers should familiarize themselves with the legal guidelines that  govern workplace injuries in PA. Knowing these can help with compliance and to protect the rights of both parties.

Workers’ Compensation Act

The Act outlines the rights and responsibilities of employers and employees, regarding workplace injuries and the claim process. Both you and your employer should know these rights and responsibilities.

Statute of Limitations

Most work injuries require the filing of a workers’ comp claim within 3 years of the date of the injury. For uninsured claims, expect a much shorter timeframe. Injuries such as repetitive trauma may have a modified date, such as the last day of work.

If you believe you have a claim, speak to a lawyer as soon as possible. After the end of the statute of limitations date, you have lost all rights to file the claim. 

Disputes

Often, workers’ comp claims result in disagreements or disputes. This may lead to hearings and legal proceedings through a workers’ comp judge. In some instances, this could even end up at the Workers’ Comp Appeal Board or in front of the Commonwealth Court.

Final Thoughts

Knowing your rights and responsibilities if a work injury occurs, helps to ensure a fair and safe workplace. With awareness of your duties, both parties can go through the process more smoothly.

This knowledge ensures that injured workers get proper care and support. It also helps to uphold legal requirements and to maintain a productive workplace.

Know your rights. If you have questions about rights and responsibilities, let us answer them. Don’t go it alone. Reach out to our offices 24/7 for a free case evaluation (215) 609-4183.



Independent Contractors Eligible For Workers’ Compensation

When a workplace accident leaves an employee injured or ill, workers’ comp steps in to help. But, what about independent contractors that suffer workplace injuries or illnesses? Let’s look into classification, eligibility, exceptions, and scenarios in which independent contractors might qualify for workers’ comp benefits in PA.

Are Independent Contractors Eligible For Workers’ Compensation?

Generally, no. Pennsylvania workers’ compensation laws only apply to employees, providing benefits for work-related injuries or illnesses. Viewed as sole proprietors and not employees, independent contractors usually do not receive workers’ compensation insurance coverage.

Should the negligence of a place of business cause a personal injury, the independent contractor could seek damages. However, this would fall under the business’ general liability insurance, outside the scope and limitations of workers’ compensation coverage. For this post, we will only focus on workers’ compensation benefits and who qualifies.

Who Counts as an Independent Contractor?

Independent contractor refers to people or entities hired by an employer to perform specific tasks or services. Unlike employees, contractors have more control over how they do their work. The employer exercises less control over the worker, with less direct supervision, and less employer-provided benefits.

Regarding earnings, they receive payment differently from employees. They often bill for their services either through a flat fee per project or at an hourly rate. Whereas employees, may receive a regular salary or wage.

Set and outlined upfront in a contract, payment terms might include things like rates, schedules, and methods. This setup provides flexibility, but also means contractors must manage their own taxes, insurance, and retirement planning. Employees typically benefit from deductions and employer contributions.

What Factors Determine Status?

Understanding this distinction not only affects taxes, but also dictates eligibility for benefits and protections under various labor laws. This distinction between an independent contractor and an employee becomes especially important when a work injury occurs.

The classification depends on a few factors. For example, the degree of control the hiring party has over the worker’s tasks. Another involves the independence of the worker in how they complete these tasks. Lastly, we look at the nature of the work relationship.

@thwesq Replying to @Linzy Binzy in PA the independent contractor question isn’t always simple. #workerscomp #workinjury #misclassifiedemployees #pennsylvania ♬ original sound – Tom Wing

How Much Control?

The degree of control by the hiring party over the contractor’s work may help to determine the status. Hiring party control has an impact on the classification of workers. Employees usually have more oversight and direction as to how they complete their tasks and do their jobs.

How Much Independence?

For independent contractors, the hiring party exercises minimal control. The contractor decides the specifics of how they do their tasks. For instance, they decide on things like work methods, hours, and project management. This freedom in how they complete tasks or set their work hours sets them apart from employees.

What Does The Work Relationship Say?

The nature of the work relationship can also affect the classification. For example, written contracts and the provision of tools and equipment more often than not apply to employees. Also, expecting ongoing employment compared to a project-specific commitment often serves as a telling factor.

The provision of employee benefits such as health insurance, retirement plans, and paid leave further implies an employee status. Independent contractors typically do not receive these types of benefits. This helps to set up the boundaries of independence and dependency in work relationships.

This image is a side-by-side comparison of two men, each representing different work models. On the left is an independent contractor: a man dressed in casual work attire with a cap, a tool belt filled with various tools, and carrying a briefcase, suggesting a skilled tradesperson prepared to tackle a job. The background includes a rural setting with an open road and a plane overhead, implying travel or flexibility in job location. On the right is an employee: a man in a formal work uniform with a nametag and a clipboard, standing in an urban setting next to a desk with papers, symbolizing a structured work environment with established routines. The contrast between the two illustrates the different nature of being an independent contractor versus an employee.
Meet the Contractor with a tool belt and the Employee with a clipboard: Two Work Worlds in One Image.

When Might Independent Contractors Get Workers’ Comp? 

While independent contractors generally do not qualify for workers’ comp benefits in PA, some exceptions do exist:

Misclassification Disputes

Sometimes, the hiring party will misclassify a worker as an independent contractors. They may try this to save money on their business insurance or they may just honestly not know the rules. In either case, this happens fairly often.

Filing a 1099 tax form alone does not define you as an independent contractor. In reality, many contractors suffer from this type of misclassification when they should fall under the classification of employees. In such cases, these workers can challenge their status and seek workers’ comp benefits.

Elective Coverage

Some independent contractors can choose to buy their own workers’ compensation insurance coverage. We see this most often when the contractor works with many clients. Or, when they wish to protect themselves from a work-related injury, when in a high-risk type of job. This responsible business practice gives them peace of mind.

Dual Role Scenarios

Sometimes, workers perform tasks both as an employee and as an independent contractor for the same employer. In this case, they could be eligible for workers’ comp for the work they did as an employee.

This dual status can complicate their ability to qualify for benefits. Eligibility requires a thorough examination of the nature and context of the work performed. As well as, a look into what tasks fall under which classification.

Voluntary Coverage by Employers

Employers in PA can choose to cover workers’ comp insurance for certain independent contractors under their insurance company’s policy. However, this is not a common practice and varies based on the employer.

Legal Considerations and Challenges

The eligibility of independent contractors for workers’ comp benefits involves many legal issues. Filing a workers’ compensation claim under these circumstances requires a skilled workers’ compensation lawyer. Disputes over worker classification, misclassification lawsuits, and individual cases often lead to complicated legal issues and court battles. This requires a lawyer experienced with the Workers’ Compensation Act who can get you the benefits you deserve.

Conclusion

The eligibility of independent contractors for workers’ comp benefits in PA mostly depends on their classification, work relationship, and their specific situation. While traditional coverage does not typically apply to independent contractors, as we have seen, some exceptions do exist.

Both independent contractors and employers should familiarize themselves with these distinctions. This ensures compliance with state laws and protects individuals in the case of work-related injuries or illnesses.

If you believe that you have been misclassified, get a free case evaluation today. Reach out to our offices 24/7 for a confidential and free consultation (215) 609-4183.

Unemployment Benefits And Workers’ Comp Benefits In PA

Work-related injuries can leave people unable to do their jobs. Workplace injuries can also lead to time away from work and financial worry. While out of work because of a work injury, questions tend to come up about applying for unemployment benefits.

For those seeking unemployment benefits, while recovering from a work-related injury in PA, this blog speaks to you. Let’s take a look into the interplay with workers’ compensation and unemployment benefits.

Can I Collect Unemployment Benefits After A Work Injury? 

In PA, people collecting workers’ comp generally should not receive unemployment benefits at the same time. The reason stems from the contrasting nature of these benefits and the credit against workers’ comp. Workers’ comp serves those unable to work because of a work injury, causing either a full or partial disability. Unemployment serves those able and available to work, but unemployed for reasons outside the worker’s control.

@thwesq Can I get #unemployment #benefits after a #workinjury #workinjurylawyer #workerscomp #workmanscomp #workerscompensation #pennsylvania #pa #law #lawyer #legal #legaltiktok ♬ Nights In Bloom – Cubicolor

Factors For Eligibility

Ability To Work

To qualify for unemployment, people must have the ability to do and the availability for suitable employment. This often goes against the restrictions of their work-related injury.

Guidelines For Reporting

When applying for unemployment you must report an ability to work. A workplace injury might limit this capacity, which could cause you not to qualify.

Does Workers’ Comp Get A Credit For Unemployment?

Yes, your employer will receive a dollar for dollar credit for any unemployment benefits for the same time period. Keep in mind, you pay taxes on unemployment, but not on the workers’ comp. Because of the possible credit and tax issues, always talk to a lawyer to maximize your take home pay.

What About Exceptions?

In a workers’ compensation claim with denied wage loss, the injured worker may wish to apply for unemployment. A lawyer will often advise they apply in this instance. Other situations include a job separation, a full recovery, or a lack of work.

Recovered And Able To Work

If someone has made a full recovery from their work related injury, they might qualify for unemployment. This may apply even if the worker received workers’ compensation. But, they must have the ability and availability for suitable employment.

Job Separation

A person may qualify for unemployment benefits after they leave a job. For example, a layoff or a termination could entitle a person to unemployment. However, a resignation could prevent a success in a claim for benefits.

Can I Get Unemployment After Workers’ Comp?

In some cases, an injured worker will fully recover from their job injuries. At this point, the workers’ comp benefits may have stopped and the person now has the ability to return to work. However, this person has not found a new job yet. In this instance, they may qualify for unemployment benefits.

Workers’ Comp Dispute

Another scenario may occur when a dispute comes up. Many times, a dispute regarding the injured worker’s eligibility for workers’ compensation insurance arises. An injured worker might qualify for unemployment compensation benefits during this time. 

Workers' compensation and unemployment benefits comparison illustration: on the left, a worker discussing injury with a healthcare professional in an office, surrounded by recovery symbols; on the right, an individual applying for unemployment benefits online at home, with a calendar and to-do list.
Applying for Unemployment and Workers Compensation Benefits

Key Differences In The Two Programs

Qualifying Rules

Workers’ comp requires an injury from a work-related event to qualify for benefits. Unemployment requires an ability and availability to work to qualify.

Nature Of The Benefits

Workers’ comp provides financial and medical help to people injured on the job. It covers lost wages and medical care. Unemployment benefits provide temporary financial support to out-of-work people, actively seeking a job. 

Taxes

A worker will pay taxes on unemployment benefits. Workers’ comp gets an exemption from taxation.

Things To Think About

Applying for unemployment after a work injury requires careful thought. Think about the criteria to qualify and any conflicts. If you apply, follow the requirements and honestly report the status of the work injury.

Seeking Advice

Talking with a workers’ comp lawyer can give you a clear picture of your individual needs and eligibility. Always make sure to check with your lawyer before filing for unemployment.

Wrap Up

Applying for unemployment benefits, while out of work due to a work injury, can cause issues. Workers’ compensation and unemployment benefits have differing criteria.

While people typically should not receive both benefits at the same time, some exceptions do exist. Factors such as recovery from the injury, job separation, and comp benefits ending can affect this decision. Understanding these rules can help people get the support they need and maximize take home pay.

Injured at work? Call our offices 24/7 at (215) 609-4183 for a free consultation.

Reporting A PA Work Injury: Steps & Best Practices

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Steps & Best Practices for Reporting a PA Work Injury

Work injuries can impact an employee’s well-being and livelihood. Injured Pennsylvania workers should know how to report a workplace injury promptly and effectively to protect their rights. Proper reporting starts the workers’ comp process and protects your legal rights. To receive the workers’ compensation benefits you deserve, proper reporting is critical.

Use our guide of the steps and best practices for reporting work related injuries and occupational diseases in PA.

The Importance of Reporting Workplace Accidents and Injuries

When injured at work, prompt reporting helps both injured workers and employers. For employees, timely reporting ensures quick access to medical care and eligibility for workers’ compensation benefits. For employers, it allows for timely investigations, implementation of preventive measures, and compliance with Pennsylvania law.

Step-by-Step Guide to Reporting a Work Injury

Notify the Employer

Report the injury to your employer right away. Make sure to report your work accident within 21 days. If you do not report the injury within 120 days of injury you may lose all rights to benefits.

You should always notify the employer in writing. Make sure to include details about the work accident. The details should include: the time, the location, how the injury happened, and the nature of the injury. Filing a claim requires notice to your employer, and you may need to prove you gave it later.

Seek Immediate Medical Attention

If injured, prioritize your health and seek medical attention right away. This ensures proper care for the injury and creates a record of the incident. Make sure to tell the doctor everywhere you have experienced pain since the work injury.

Complete Incident Report Forms

Employers typically have an incident report form for injured employees to fill out. Complete this thoroughly and accurately. Make sure to provide all the details about the work injury.

An injured worker with an arm in a cast is seated at a desk, reporting a work injury to their employer. The employer, dressed in a suit, stands close, pointing at a document on the desk, possibly an incident report form, indicating where to fill in details. The office backdrop includes a calculator, some papers, and a background of filing shelves, suggesting a professional setting.
Injured worker filling out an incident report for a work injury.

Keep Records

Keep a copy of all the documents related to the work injury. This includes incident reports, medical records, emails, and any communication with your employer or the insurance company. This may serve as evidence to prove the claim later.

Best Practices for Effective Reporting

@thwesq The three most common mistakes made by injured workers in #pennsylvania when reporting a work injury #CapCut #workers #workerscomp #lawyer ♬ 5 seconds short jingle bass house techno(1385287) – Gloveity

Report Injuries Promptly

Time is crucial when reporting a work injury. Delays might result in problems or disputes over the validity of your claim and your ability to collect compensation.

Be Honest and Accurate

Give truthful and detailed information about the work injury. Include information about how it happened and the impact it has had on your health and your work.

Keep Communication Open

Maintain communication with your employer, the human resource department, and the healthcare providers throughout the process.

Seek Legal Advice

Think about talking to a workers’ compensation lawyer. Issues may come about at any time once you report a work injury. An experienced attorney can protect your rights.

Employer’s Role and Responsibilities

Employers have a legal obligation to provide a safe working environment and to handle reported work injuries properly. They should:

Document reported injuries accurately

This should include a fair and honest description of the work injury.

Investigate the work incident promptly

They should investigate to see what went wrong. They should also fix anything unsafe to prevent future work injuries.

Provide necessary forms and guidance to the injured employee

They should give the injured worker the forms to complete. They should also help the employee going through the process.

Facilitate access to medical care and workers’ compensation benefits

They should help to get the employee into see a doctor right away. Further, they should do the right thing and pay the injured worker the workers’ comp benefits they deserve. They should also file the workers’ compensation claim with the insurance company.

Conclusion

Following this guide can help get a claim accepted quickly. Unfortunately, in practice, many employers do not do what they should do. At the time of an injury, always have a lawyer look into your case. Make sure your employer treats you right from the beginning.

For questions on reporting or help with your claim, schedule a free and confidential case evaluation today. Call our office 24/7 at (215) 609-4183.

 

How To Calculate Workers’ Compensation Benefit Amounts in Pennsylvania

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Table of Contents

Understanding PA Workers' Comp Total and Partial Disability Rates

Introduction

Workers’ Compensation serves as a crucial safety net for employees injured or ill due to work-related incidents in Pennsylvania. Determining the compensation amount for an eligible claim involves various factors, including medical expenses, wage replacement, and disability benefits. This comprehensive guide aims to shed light on the key elements that influence the amount of workers’ compensation coverage available for a claim in Pennsylvania, offering insights into the calculations, benefit structures, and related considerations.

Workers’ Compensation Benefits in Pennsylvania

Pennsylvania’s Workers’ Compensation Act provides various benefits to eligible employees, including coverage for medical expenses, wage loss benefits, and disability compensation. The amount of compensation available is contingent on specific factors and calculations governed by the state laws and regulations.

Calculating Wage Loss Benefits

Wage loss benefits in Pennsylvania are typically calculated based on a percentage of the employee’s average weekly wage (AWW) at the time of the injury. The compensation amount is approximately two-thirds (66.67%) of the AWW, subject to a maximum limit set by the state. The AWW is determined based on the earnings of the employee in the period leading up to the injury, which includes wages from concurrent employment.

@thwesq Will #workerscomp pay for my lost #overtime after a #workinjury ♬ original sound – Tom Wing


 

For 2023, for earners with an AWW between $1,909.50 and $954.76, the compensation rate is 66 ⅔ percent of the AWW. However, the statutory maximum for weekly compensation for 2023 is $1,273.00 per week, so higher wage earners are limited in their recovery. if the average weekly wage is between $954.75 and $707.22 the compensation rate is $636.50. For those with an AWW below $707.22, the weekly total disability rate is 90 percent of the AWW. 

Temporary Total Disability vs. Partial Disability

Workers’ Compensation benefits in Pennsylvania can be categorized as temporary total disability (TTD) or partial disability. TTD benefits are payable to employees unable to work due to their injuries or illnesses for a specific period, while partial disability benefits apply to those who can work but have limitations or reduced earning capacity due to their condition. Partial disability is calculated as two-thirds of the difference between the average weekly wage and the actual earnings post injury. Keep in mind, an injured worker can only receive 500 weeks of partial disability. 

Permanent Partial Disability and Impairment Rating Evaluations

For cases involving permanent impairment or disability, Pennsylvania uses the Impairment Rating Evaluation (IRE) process to determine the extent of impairment. This evaluation helps assign a percentage rating, which affects the compensation amount for partial disability benefits. If the injured worker’s impairment rating is less than 35 percent, benefits are converted to partial disability benefits, which triggers the 500 week maximum. There is no cap on total disability benefits.

Medical Expenses and Coverage

Workers’ Compensation in Pennsylvania covers reasonable and necessary medical expenses related to the work injury or illness. This includes doctor visits, surgeries, hospital stays, prescription medications, physical therapy, and other relevant treatments. There’s no specific monetary limit on medical benefits as long as the treatment is deemed reasonable and directly related to the work-related injury or illness. Though, if a provider believes the amount paid for a service is incorrect they can file a Fee Review with the Bureau.

Additional Considerations and Limits

Pennsylvania Workers’ Compensation laws impose certain limits on the duration and total amount of benefits an injured employee can receive. Understanding these limits and any additional considerations, such as coordination with other benefits like Social Security Disability Insurance (SSDI), is crucial for an accurate estimation of available compensation, Social Security Retirement, and pensions. The most significant cap is the 500 week limit of partial disability benefits. 

Conclusion

Determining the amount of workers’ compensation coverage available for a claim in Pennsylvania involves a multifaceted assessment of various factors, including wages, disability ratings, medical expenses, and specific regulations. By understanding the intricacies of compensation calculations and benefit structures, both employers and employees can navigate the process more effectively, ensuring fair and appropriate compensation for work-related injuries and illnesses. If you have questions about calculating your compensation, reach out for a free consultation. 

The Pennsylvania Workers’ Compensation Claims Process

Workers’ Comp benefits in PA help employees who suffer from workplace injuries or occupational diseases. Injured workers often miss days away from work because of these injuries resulting from work. Workers’ comp pays medical expenses and compensation during this time. Workers’ compensation benefits enable employees to focus on their recovery and plan for their eventual return to work.

Understanding the workers’ comp claim process is crucial for both employees and employers. The workers’ compensation claims process may vary by state. However, this blog will delve into the workers’ comp claims process in Pennsylvania.

We will shed some light on the steps involved in the claims process and how to file a workers’ compensation claim. We will also go over the rights of employees and the obligations of employers.

Filing A Workers’ Comp Claim

The Pennsylvania Workers’ Compensation Act mandates that most employers provide workers’ compensation coverage to their employees. This coverage includes medical care and disability benefits for employees who suffer work-related injuries or illnesses. The process to obtain these benefits involves several important steps.

The image depicts a person in a workplace environment, sitting at a desk and diligently filling out paperwork to report and document a work-related injury. The scene highlights the concern and careful attention to detail as the individual records the circumstances and severity of the injury, surrounded by a setting that underscores the importance of workplace safety and the procedural steps for injury documentation.
Reporting a work injury

Step 1: Reporting the Work-Related Injury

After an employee sustains a work injury or illness, they need to report it right away. To receive retroactive benefits back to the date of injury, employees must report their injury within 21 days. After those 21 days, the benefits will begin from the date of notice. If the employee fails to report their injury after 120 days, the employee may lose all rights to their benefits. 

When providing notice of a work injury, this should be in writing. It should include details about the incident. For example, list information such as the date, time, nature of the injury, and all the affected body parts.

After receiving notice, the employer must report the claim to their workers’ compensation insurance carrier and the state. The employer has 21 days to either accept or deny liability for the claim. The injured worker should receive a claim form from the Department of Labor, notifying them of their employer’s decision. Expect to receive one of these three notices with this decision:

  1. Notice of Compensation Payable: The employer has accepted liability for the claim. This may include wage loss or only medical benefits.
  2. Notice of Temporary Compensation Payable: The employer will pay benefits for up to 90 days without admitting liability. This may include wage loss or only medical benefits. However, the employer can still deny liability within the 90 day period.
  3. Notice of Workers’ Compensation Denial: The employer has denied liability and has not agreed to pay any benefits.

Step 2: Seeking Medical Attention

After reporting the injury, the employee should seek medical treatment. The employer may have a list of their panel doctors for employees to choose from. The employee may have to treat with these providers for the first 90 days of their claim in order for their employer to pay.

However, for this to be the case, strict requirements exist. For example, the employer must provide the employee with proper notice of their rights and duties. In addition, the panel of doctors must meet the required criteria. Without meeting these requirements, the employee can seek treatment from any provider they choose.

Step 3: Filing the Claim Petition

Certain situations may prompt the filing of claim petitions. If the employer or its insurance company fails to provide benefits, this would prompt the need to file a claim petition. Just as a denied claim or a dispute over the extent of the injury would provoke the filing of a petition.

The employee can file a claim petition with the Pennsylvania Workers’ Compensation Office of Adjudication. This legal document starts the formal process to resolve the dispute and seek benefits.

Step 4: Evaluation and Decision

Once you file the claim petition, the court schedules a hearing to consider the evidence of both parties. A workers’ comp judge will review the case, consider medical evidence, witness testimony, and other relevant evidence. The judge will then make a decision. This stage usually requires the use of expert medical testimony to prove an ongoing disability.

Step 5: Appeals Process

Both parties have the right to appeal within 20 days of the judge’s decision. The appeal process involves escalating levels of review, including the Workers’ Compensation Appeal Board. If necessary, the Commonwealth Court may hear the appeal.

Conclusion

@thwesq Replying to @helencurtin575 the right time to talk to a lawyer after a work injury is as soon as possible. The insurance company has someone working hard for them. You should know the legal landscape you’re getting into before something goes wrong. Report the injury, see a doctor, call a lawyer. Not legal advice, informational only. #workersrights #workerscompensationattorney #lawyersoftiktok #lawyer #fyp ♬ original sound – Tom Wing

The Workers’ Comp claims process in PA demands knowledge of procedures and specific rules. Both employers and employees need awareness of their rights and responsibilities. By following these steps, people involved in workers’ comp claims can secure the benefits they deserve.

For questions on the claims process, you can call our office 24/7 at (215) 609-4183.

Understanding PA Workers’ Compensation Coverage

Workers’ comp provides wage loss and medical benefits to injured workers while they recover. This can give injured workers some peace of mind while they focus on their health. The Bureau of Workers’ Compensation oversees this employee assistance program.

Employees should know the key role that timely reporting and documentation play in the workers’ compensation claim process. The law has strict deadlines for notifying employers of work-related injuries or illnesses. If missed, this can hurt an employee’s ability to get benefits. Do not miss out on benefits over a failure to report your injury on time.

Learning the rights and obligations under the Act can help workers manage their claims. This includes how to calculate wage loss benefits and pick a doctor. Knowing these rules helps injured workers act quickly after a workplace injury. This will help avoid delays with both medical care and benefits.

PA Workers’ Comp Insurance Coverage

Workers’ compensation insurance operates as a state-mandated insurance program. It provides benefits to employees who suffer injuries or illnesses in the workplace or while performing job-related duties.

One of the main questions in workers’ comp involves coverage. In other words, people want to know what types of injuries and illnesses qualify for coverage. We will now take a look into coverage. 

What Comp Covers

The workers’ comp system provides for several types of benefits. It covers medical care and expenses as well as disability benefits for those unable to work. It can cover specific loss benefits for the permanent loss of use of a body part. Workers’ comp also pays death benefits to a spouse and qualifying dependents of workers who have died as a result of their job.

Each of these categories of benefits have their own unique sets of limits and criteria.  Injured workers and their families should speak with a lawyer to discuss the benefits they may qualify for.

Some of the most common qualifying injuries we see:

Workplace Accidents and Traumatic Injuries

This area covers injuries that result from accidents at the workplace. Slips, falls, burns, fractures, cuts, and machinery-related accidents would all fall into this category.

Repetitive Stress Injuries (RSIs)

An industrial worker engaged in repetitive labor on an assembly line, with visible signs of stress and fatigue. The worker's posture is slightly hunched, focusing intently on the monotonous task of handling or assembling identical parts. The background is a blur of machinery and conveyor belts, symbolizing the never-ending cycle of the task. The worker's expression, barely visible under safety gear, conveys a sense of enduring monotony, highlighting the physical and mental strain of repetitive stress in the workplace
Repetitive Stress in the Workplace

RSIs arise from repetitive motions or overuse. This can lead to conditions like carpal tunnel syndrome, tendonitis, and bursitis. These conditions may develop over time because of continuous work-related activities.

Occupational Diseases

Workers’ comp often covers diseases or illnesses directly caused by workplace exposures. For instance, respiratory issues connected to the exposure of hazardous chemicals, including asbestosis. Also, certain types of cancers linked to occupational exposures would meet this criteria for occupational injuries.

Work-Related Mental Health Conditions

Recently, we have seen an increased awareness of mental health issues resulting from work-related stress, trauma, or harassment. Qualifying for mental illness coverage has more challenges. However, workers’ comp might include conditions like anxiety, depression, and PTSD if they directly relate to the job. 

Criteria and Exclusions

Workers’ comp eligibility hinges on a few factors. Typically, for an injury or illness to qualify, it must arise from and relate to work.

Some exclusions to this do exist. For example, injuries sustained while violating company policies may not qualify. Just as any injuries that occurred during intoxication may not qualify. Further, injuries sustained while engaging in personal activities unrelated to work may not qualify.

Claims Process

Submitting a workers’ compensation claim involves specific steps that vary by state. In PA, employees must report the injury or illness to their employer.

To receive benefits back to the date of injury, employees must report the injury within 21 days. If reported after 21 days, benefits will start as of the date of notice. But, after 120 days, employees may lose all rights to benefits. After the report of an injury, employers must send the claim to their insurance company and the state.

Once the employee has reported their injury, they should see a doctor right away. Medical care helps to jump start the recovery and to protect the claim.

An injured worker should speak with a lawyer as soon as possible. The insurance company should cover lost wages and medical expenses. A workers’ compensation lawyer can protect these benefits.

@thwesq Replying to @helencurtin575 the right time to talk to a lawyer after a work injury is as soon as possible. The insurance company has someone working hard for them. You should know the legal landscape you’re getting into before something goes wrong. Report the injury, see a doctor, call a lawyer. Not legal advice, informational only. #workersrights #workerscompensationattorney #lawyersoftiktok #lawyer #fyp ♬ original sound – Tom Wing

Conclusion

Proper guidance can help when going through the workers’ comp claim process. The journey has many steps to handle to avoid delays or denial of compensation.

A workers’ comp lawyer can offer advice and help get your claim through the system. With their in-depth knowledge of PA workers’ compensation laws, they can ensure that employees fully exercise their rights. For example, securing the appropriate medical evaluations or negotiating settlements that reflect the true extent of their injuries or illnesses. Do not leave money on the table, get all you deserve.

Informed decisions, supported by legal advice, are the key to securing the financial and medical support needed for recovery. If you have any questions, you can call our office 24/7 at (215) 609-4183.



Workers’ Compensation in the Era of Remote Work Injuries

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Remote Work and Workers’ Comp

The landscape of work has been undergoing a significant transformation. Things have changed in the wake of Great Resignation and the rising trend of remote work. This shift has brought about new challenges and different considerations for PA workers’ compensation laws.

In this blog post, we delve into how these workforce trends are reshaping workers’ compensation claims and workplace injuries. We will also look at how employers and employees can make changes to adapt to this ever-changing world. With modern trends, comes new challenges and concerns. Both employers and employees find themselves in unknown territory, trying to keep up.

Insurance companies and injured workers also find themselves in uncharted waters. Both have struggled to keep up with these rapidly changing trends. We will take a closer look at how this may affect the injured worker.

An ergonomically designed home office setup featuring a woman sitting at a desk with her elbows at a 90-degree angle, using an ergonomic chair with lumbar support. The computer monitor is at eye level to prevent neck strain, and the keyboard and mouse are positioned to keep her wrists neutral. The room is well-lit with task lighting to minimize eye strain, and there's a plant on the desk, adding a touch of nature to the workspace.
Ergonomic Home Office

Workforce Trends Reshaping Workers’ Comp

As remote work continues to become more popular, we can see a change in the nature of work-related injuries. Many remote workers have non-traditional office space setups at home. This may account for some of the increase we see in ergonomic injuries, such as back pain or wrist strains.

These issues raise important questions about workers’ compensation benefits and risk management. We know that the employer has a responsibility to ensure a safe work environment on site. However, how does that work when that environment exists within the employee’s home?

Ergonomic Injuries: A Growing Concern

Many worker’s work environments do not properly align with their physical needs. This may lead to ergonomic injuries. Without this proper alignment, strain and discomfort can cause injuries to occur.

In a traditional office, employers often provide ergonomic chairs, desks, and computer setups to reduce these risk factors. However, one might overlook these considerations in a home office. Employees that work from their dining room tables or couch may not have the support and comfort that an office environment provides. This can lead to the risk of ergonomic injuries.

In a home setting, many workers do not have the space to have a proper setup. Another obstacle for at home workers could stem from the cost of ergonomic equipment. Ergonomic designs generally cost more.

Mental Health in Workers’ Compensation

Another thing to consider, mental health issues. The mental health implications of remote work hold significant importance, and we cannot ignore them. The World Health Organization has reported a 25% increase in depression and anxiety globally. We can partially attribute this spike to the shift from office environments to work-from-home environments .

This shift in work dynamics means that employers and workers’ compensation insurance systems need to pay attention. More attention should focus on mental health and mental illnesses as part of workplace well-being. In the long-term, this would benefit everyone.

Prevention Strategies for Remote Work Injuries

Tips For Employers:

Offer ergonomic assessments to employees. Remote ergonomic assessments can help employees set up their home office spaces. They can focus on minimizing the risk of injury for workers.

Provide mental health support. Have access to mental health resources. This can include such things as counseling services or online wellness programs to support employees’ mental well-being.

Engage in regular check-ins. Maintain regular communication with remote employees. This can help identify any challenges they may be facing, including potential work-related injuries or mental health issues.

Tips For Employees:

A proactive workspace setup goes a long way. Invest time in setting up a home office that supports your physical health. Using an ergonomic chair and placing your computer screen at eye level will help prevent injury. Make sure you feel comfortable well working in your home workspace.

Take regular breaks. Incorporate regular breaks into your work hours to reduce the risk of strain and mental fatigue. If you feel pain, adjust your workspace and stand or stretch as needed.

When you need support, do not hesitate to seek that support. If you find yourself struggling with mental health issues or ergonomic injuries, ask for the help you need. Reach out to your employer or a healthcare professional for help and support.

Remember, you should always report any injuries to your employer right away.

Conclusion

The shift to remote work presents new challenges all around and especially in the realm of workers’ compensation. Both employers and employees need to be proactive in addressing these challenges. Ensuring a safe and healthy work environment, at home or in a traditional work setting, will help prevent injury.

By understanding the risks associated with remote work, we can all take the necessary steps to mitigate them. Together, both employers and employees can navigate these changes effectively and work to maintain a productive and healthy workforce.

In addition, insurance companies’ concerns with medical costs need to focus more on prevention and proactive steps. In this era of working from home, things will continue to change and evolve. Workers’ compensation and insurance coverage should keep evolving as well.

We must continue to adapt to these changing workforce trends. However, both employers and employees must stay informed about their rights and responsibilities under Pennsylvania workers’ compensation laws. By doing so, we can ensure a smoother transition into this new era of work.

If you suffered an injury at work, either in a traditional work setting or as a work-from-home employee, we can help. Reach out to us today for a free and confidential case evaluation.

How Does Workers’ Comp Work in PA?

Workers’ compensation ensures employees receive financial support and medical care in cases of work-related injuries or illnesses. This blog post aims to explain how workers’ comp works under the Pennsylvania Workers’ Compensation Act. We will only focus on PA workers’ compensation laws here.

Understanding Workers’ Compensation in Pennsylvania

What is Workers’ Compensation?

Workers’ comp is a state-mandated insurance program, designed to protect employees. These protections cover employees with injuries and illness caused by their work.

In PA, the Pennsylvania Bureau of Labor and Industry administers workers’ comp. This program helps employees get compensation for their medical expenses and lost wages. It also protects employers from lawsuits related to workplace injuries.

Am I Covered?

PA requires nearly all employers to provide workers’ comp coverage to their employees. This includes both private and public sector employers. However, some exceptions exist, such as sole proprietors and certain agricultural workers.

Types of Injuries Covered

PA workers’ compensation covers a broad range of work-related injuries and illnesses. This includes accidents like slips and falls. It also covers conditions that develop over time, such as repetitive stress injuries or occupational diseases.

The Workers’ Compensation Claim Process

Reporting an Injury

When an employee suffers an injury or work-related illness, they should promptly report the injury to their employer.

Reporting must occur within 21 days of the injury or diagnosis to qualify for retroactive back pay. If the employee fails to report the injury within 120 days, they lose all entitlement.

This means the end of the workers’ comp claim and the employee will not qualify for any workers’ comp benefits. Reporting ensures that the claims process can begin in a timely manner.

Seeking Medical Treatment

Workers’ comp covers all reasonable and necessary medical expenses related to the work-related injury or illness. Employees have the right to choose their own healthcare provider.

But, there can be limitations within the first 90 days of a claim. Often, that would necessitate an employee to receive medical treatment through an employer’s approved panel of doctors. The panel may allow the injured worker to seek medical treatment without delay.

Filing a Claim

When loss of work from an injury exceeds/expects to exceed more than 7 days, the employer must file a formal workers’ compensation claim. The Pennsylvania Bureau of Workers’ Compensation receives this notification. The employee receives notification and the claims process begins.

Investigation

Once filed, the employer or its insurance company will investigate the claim and the circumstances surrounding the injury. Interviews of both the employer and the injured employee may happen during this process.

With an accepted claim, the injured employee will receive compensation and notice in the mail. With a denied claim, the injured worker would need to file the appropriate petition.

Benefits

Workers’ comp benefits include medical benefits, wage loss benefits, and specific loss benefits.

Medical benefits cover all reasonable and necessary medical expenses related to the injury or illness. Wage loss benefits provide compensation for lost wages during the recovery period. Temporary Total Disability (TTD) benefits also refer to wage loss benefits.

When an injured worker has wage loss, while continuing to work, Temporary Partial Disability (PTD) benefits would apply. Specific loss benefits provide for permanent disfigurement or loss of use or loss of a body part.

Legal Aspects of Workers’ Comp in PA

Employer Responsibilities

Employers have several responsibilities in workers’ compensation.

They must carry proper insurance coverage. They must post notices about workers’ comp in an obvious location.

They must accept or deny liability within 21 days of the injury. They must send written notice of the claim’s acceptance or denial to the injured worker.

Injured employees should not fear reporting their injuries. Employers also cannot retaliate against employees for filing a workers’ compensation claim.

Employee Rights

Employees have certain rights in workers’ compensation in PA.

They have the right to receive medical treatment for their work-related injuries. They have the right to receive wage loss benefits if they are unable to work or are working at a wage loss. They have the right to appeal decisions on denied claims.

Employees should understand their rights and exercise these rights to protect their interests.

Dispute Resolution

Disagreements can arise during the workers’ comp process. With a denied claim, an employee can request a hearing before a workers’ compensation judge. This allows both parties to present evidence and arguments, and the judge will make a decision.

The Workers’ Compensation Appeal Board and the Commonwealth Court, if necessary, hear appeals.

Denied Workers' Compensation Claim Process Diagram - Detailed visual guide illustrating the step-by-step appeal process for denied workers' comp claims in Pennsylvania, featuring the initial denial notice, Workers' Compensation Judge review, Workers' Compensation Appeal Board examination, Commonwealth Court appeal, and potential PA Supreme Court review. Ideal for individuals navigating the complexities of workers' compensation denials.
How the court process works for Workers’ Comp

Attorney Involvement

An attorney, though not required, can add serious benefit. When complex cases and claim disputes arise, a workers’ comp attorney knows what to do.

Lawyers can provide legal guidance and protect the rights of the injured worker. They can calculate the average weekly wage, making sure injured workers receive the compensation they deserve.

Attorneys can protect the injured workers, making sure they do not return to work until medically able. They can make sure the notice of compensation payable lists all injuries include.  Lawyers can also make sure your medical bills do not end up on your credit report.

Questions and Concerns

Will My Employer Fire Me for Filing a Workers’ Comp Claim?

PA law prohibits employers from firing or retaliating against employees for filing workers’ compensation claims. If an employee faces such retaliation, they have the right to take legal action.

How Long Can Workers’ Comp Benefits Last?

The duration of workers’ compensation benefits in PA varies depending on the circumstances of the injury or illness. Temporary Total Disability (TTD) benefits may be available as long as the employee remains unable to work. Other benefits may have different durations.

Can I Choose My Doctor?

Employees have the right to choose their own healthcare provider, from the list of approved providers, within the first 90 days of a claim. However, the employer must follow all its obligations for this to apply. After the initial 90 days an employee can treat with any medical provider. This allows injured workers to receive treatment from a trusted medical professional.

Will Workers’ Comp Offer a Settlement?

Many workers’ comp cases settle for a lump sum. A lawyer can often help to negotiate a higher settlement. Use our free settlement calculator to estimate the value of your case online.

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Conclusion

Workers’ comp helps employees receive financial support and medical care after an injury or illness caused by their work.

Understanding how workers’ comp works in PA is essential for both employers and employees. This upholds everyone’s rights and responsibilities under the program.

Talk to a workers’ comp lawyer today for a free case evaluation. Let us answer your questions about your rights in your workers’ compensation claim.