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.
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.
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.
