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.
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.
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.
