Philadelphia Workers’ Compensation Law Firm
The Pennsylvania Department of Labor and Industry has stated that 85,000 people are injured each year in work related accidents in Pennsylvania alone. Fortunately those people have the Pennsylvania Emergency Workers’ Compensation Act to protect them while they are injured on the job.
Everyone who is injured at work needs to know how the workers’ compensation laws protect them. Handling a workers’ compensation claim is neither an easy or straightforward matter for the uninitiated. In fact a great deal of our workers’ compensation clients are referred to us from other attorneys who do not handle workers’ compensation cases because of the complexity of the legal technicalities and the practical considerations involved. The following is some basic information on Pennsylvania workers’ compensation Claims.
The Pennsylvania Workers’ Compensation Act has broad application to almost all injuries that occur in Pennsylvania and to injuries that occur out of state to Pennsylvania Employees.
In the Commonwealth of Pennsylvania, Workers’ Compensation is available when you:
- sustain an injury,
- in the course and scope of your employment.
The presence of these two factors will entitle you to payment of reasonable, necessary and causally related medical expenses. This is the Medical Benefit of our workers’ compensation system.
In addition, if you are unable to make your pre-injury average weekly paycheck because of the work injury, you are entitled to a workers’ compensation wage loss payment. This is called the Indemnity Benefit in our workers’ compensation system.
Under the Pennsylvania Workers’ Compensation Act there many additional benefits including, but not limited to, payment for the amputation of, or loss of use of, certain body parts and for scarring of the face and neck. These benefits are called Specific Loss Benefits. There are benefits for occupational diseases such as asbestosis and coal miners disease; fatal claim benefits; Heart & Lung benefits; benefits for widows and children. There are other benefits available as well.
You are not permitted to recover for pain and suffering under the workers’ compensation law. workers’ compensation is the exclusive remedy of an employee against his or her employer in most, but not all, situations. The Pennsylvania Workers’ Compensation Act is complex. If you have been injured in a work related accident or event, you need to speak with a lawyer. You will be required to deal with people who are much more familiar with the process, and whose interests will not likely be consistent with yours. Do not go it alone.
Total Disability and Partial Disability
In Pennsylvania, the term “total disability” in workers’ compensation language means that you are unable to earn any money. This is often called “TTD” on your workers’ compensation check. Technically speaking there is no specific time limitation on your receipt of total disability. However, your workers’ compensation insurance carrier has many ways of fighting your total disability status, and they are likely to use them.
“Partial disability” means that you are able to earn some money, but not as much money as you made at the time of the injury. Partial disability is limited to 500 weeks of payments; or about 9 and 1/2 years of total time.
How Long Will My Workers’ Compensation Last?
There is no specific time limitation to your eligibility for collecting “total disability.” However, from a practical perspective, your employer, its workers’ compensation carrier or its third party administrator will not likely allow you to collect compensation without end; at least not without a fight. They will try to find a method to challenge your entitlement.
When you receive “partial disability” payments there is a 500 week period at the end of which your eligibility for wage loss payments can expire.
As a general rule in Pennsylvania, once your claim has been accepted by your employer or awarded by a workers’ compensation judge, your benefits will continue until you agree to change them, or until a workers’ compensation judge enters an award permitting the employer to terminate, modify, or suspend your benefits.
The employer’s workers’ compensation insurance carrier has a variety of methods for challenging your entitlement to compensation. The three most common methods are by filing Petitions to Terminate, Modify, and/or Suspend your compensation.
A Termination Petition requests that a workers’ compensation judge determine that your workers’ compensation case is over because you are “fully recovered” from your work injuries. An Order of Termination would completely stop your wage loss and medical benefits. We often see opinions from defense doctors that state that a Claimant is “fully recovered” from whatever happened on the date of injury, and that whatever medical problems continue are attributable to another cause.
Modification and Suspension Petitions will only change your entitlement to continuing wage loss payments and do not change entitlement to medical benefits. A Suspension is appropriate where you have no loss of earning capacity. For example, if you return to a job that pays you as much as you made at the time that you got hurt, a Suspension is appropriate.
A Modification is appropriate where you have some earning capacity, but not as much as you had at the time of your work injury. For example, if you returned to a job but your earnings were $100.00 short per week, you would be entitled to collect $66.67 per week in the form of “partial disability.” Remember that there is a 500 week time limitation on “partial disability.”
Utilization Review is one of the tools used by the workers’ compensation insurance industry to limit the amount of your Medical Benefits. Remember, the standard for the payment of medical benefits in Pennsylvania workers’ compensation is that the treatment must be:
- Necessary; and
- Causally Related to the work injury.
This is a rather liberal standard in favor of the employee. If a medical provider sends a bill to the workers’ compensation carrier in the proper form, the burden is on the insurance carrier to pay the bill within thirty (30) days or to submit the bill to a Utilization Review Organization, also called a “URO”. A URO can only address the reasonableness and necessity of the treatment. A URO can not address the causal relation to the work injury. If a URO has been performed and results in an unfavorable decision, in whole or in part, it must promptly be appealed to a workers’ compensation Judge. Time is of the essence in all of these matters.
Ultimately, if the case is properly handled in a timely fashion, once the employer or its carrier accepts your claim, the workers’ compensation insurance carrier has to convince a workers’ compensation judge that facts exist that entitle them to stop or change your benefits. Just because the carrier says it is entitled to change your benefits does not mean that it will automatically be successful in so doing. There is ample opportunity for us to litigate the matter and present your side of the facts. This is what we do on a regular basis and we do it well.