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Navigating through workers’ compensation issues can be difficult and that is why we are here to help! Check out our facts below to find out more about workers’ compensation benefits or check out Workers’ compensation blog for answers to your workers’ compensation questions.

What is Workers’ Compensation?

Workers’ compensation is an insurance policy that all Pennsylvania employers are required to have for their employees to pay benefits for workers who are injured on the job, or whose work causes a disease or worsening of a pre-existing condition.

In Pennsylvania, workers’ compensation has been protecting workers from workplace illness and injury since 1915, when the Pennsylvania Workers’ Compensation Act was signed into law. This act requires virtually all employers — including employers operating very small or non-profit organizations — to pay for workers’ compensation benefits for their employees. In the event of a work-related injury or illness, these benefits pay for wage loss, medical costs, and other losses.

There are thousands of rules in a Pennsylvania workers’ comp case, and you should have an experienced attorney available to advise you of your rights and obligations. There is no need to trust the insurance company or your boss to tell you the truth.  There is no need to lay awake at night worried that you are not being treated fairly or that you are making mistakes because you do not know the law. We are here for our clients. We will review medical records, injury reports, injury descriptions, wage calculations, alternative benefits, and health insurance. We will review your FMLA options and collective bargaining agreement. We will prepare you for both IME’s and IRE’s. And yes, at no charge. A successful end to a work injury claim requires workers to know the rules, avoid mistakes and plan ahead.

Am I covered by workers’ compensation?

 The good news is that if you are a worker, you are (or should be) covered by workers’ compensation. Unlike other forms of insurance, this is not an insurance program you need to apply to or pay premiums for. Your employer is required to get this coverage for you and pay for the coverage. You’re covered even if you are a part-time worker. However, the law carves out exceptions for certain occupations.

If you do not fall into these categories, and your employer has not paid for workers’ compensation coverage, he or she may be in violation of the Pennsylvania Workers’ Compensation Act. If you are injured and you are not covered as required by law, you may be able to receive some benefits through the Uninsured Employer Guaranty Fund.

How important is workers’ compensation?

 Every worker may be at risk of work-related injuries or illness and, as such, every qualified worker will want to ensure they have proper coverage. The trade, transportation and utility sectors in Pennsylvania saw the most injuries in 2015, with 41,855 reported injuries. Manufacturing saw 22,291 injuries, but workers in the educational and health services fields reported 45,221 injuries — more than many people would have predicted. Even office workers are at risk. In 2015, 3,628 injuries were reported in the financial sector, and professional and business services saw 12,115 reports of injuries.

Even if you think you are in a “low risk” career, keep in mind the most common cause of injuries in all sectors in 2015 were a sprain and strain injuries — and these can happen in offices as well as on construction sites and other traditionally “more dangerous” fields. Check with your employer and your employment agreement to ensure you are covered.

What are compensation benefits paid for work injuries?

 All medical bills that are related to your work injury are paid by the workers’ compensation insurance company, so long as the medical treatment is reasonable and necessary for the injury. If you are losing wages because you can’t work, or are working modified duty with lower weekly wages, the insurance company must pay “wage loss benefits.” These benefits are typically two-thirds of a number of wages that you are losing. There are some exceptions to the two-thirds rule. There are minimum and maximum amounts under some limited circumstances. A more detailed answer is provided below regarding a number of your benefits. Also, if you lose a body part or functional use of a body part, you are entitled to wage loss benefits. Finally, if you have a permanent scar or disfigurement above your neckline, you are entitled to wage loss benefits IN ADDITION to any other wage loss benefits (a more detailed answer appears below regarding scar claims).

What if I had a pre-existing medical condition that got worse because of my job?

 You are entitled to workers’ compensation benefits if your job aggravated or caused a significant worsening of a pre-existing medical condition.

Are injured workers required to give a recorded statement to an insurance company after being injured?

No. A request to give a recorded statement is a red flag that your claim is under investigation and the insurance company is looking for reasons to deny your claim. You should consult one of our attorneys to discuss whether you should agree to a recorded statement and discuss the common pitfalls and traps.

Can my employer fire me, or lay me off, after a work injury?

Your employer cannot fire you for reporting a work injury or filing a workers’ compensation claim. If you are fired or laid off after a work injury, you are still entitled to FULL workers‘ compensation benefits. A firing or layoff may result in the loss of your rights to workers’ compensation checks ONLY IF you willfully disobeyed your employer’s rules. If you were fired following a work injury, you should consult one of our attorneys immediately to discuss your rights.

TIP – If you know that your injury may keep you out of work for some time, you can ask for FMLA leave (Family Medical Leave Act).

Can I have a lawyer without telling my employer?

Yes. We have many clients who simply need guidance and answers. There is no rule that requires you to tell your employer that you have a lawyer. Of course, that does not apply if your case is in Court. Even better, we do NOT charge any fee to simply monitor your case. Yes, you read that correctly. If you want an attorney in your corner to answer questions in confidence, there is no fee at our firm for that service. We are happy to share that we have helped hundreds of folks by answering questions and giving advice for free. We only get paid if we win your case in Court, or settle your case. Otherwise, there is no fee at all if you want to hire one of our attorneys for advice and answers.

Does my scar have any value?

The only scars that have value in a workers’ compensation case are permanent scars or disfigurements that appear above your neckline. If you have a scar that is visible while wearing even a low cut t-shirt, you may have a claim for additional benefits. Scars resulting from neck surgery are commonly compensated IN ADDITION to your regular weekly checks. The value of a scar is typically determined by a judge. There is no set value of a scar. The value varies depending upon each Judge’s personal opinion of how unsightly the scar appears (how deep it is, how long it is, how noticeable it is, and how discolored it appears). There are time limits on pursuing a claim for a scar. You should consult one of our attorneys to preserve your claim, pursue the claim, and get you the best results.

How much should I receive on workers' compensation?

Generally, you should receive two-thirds of your prior average weekly wage. There are certain minimums and maximums, depending on your pay. Your employer is supposed to look at your wages over the past year and use a standard calculation to determine your workers’ compensation payment. Your compensation should account for any overtime that you worked and possibly other factors as well. If you think that you are being underpaid, we would look at your wage information, or obtain that information for you if necessary, and determine how much you should be getting in each check. If you are being underpaid, we will ask the insurance company to correct the payment, pay you any back benefits, and sue them if necessary to correct the problem. If we win you more money, our fee would be 10% of the increase only. That is, we would NOT take 10% of your whole check in these circumstances. Our fee would only come from the increased amount.

Can the Insurance company send my checks late, or whenever they feel like it?

No. Your checks should come in the same installments as when you were working. If you were paid weekly before you were injured, your workers’ compensation checks should also arrive weekly. Late checks are common. If your check is late, the insurance companies will commonly tell you that your claim “came from the system.” Don’t believe it. In this case, you should keep copies of each check and each envelope. On each envelope, write down the date that you received it. Once we establish a pattern of late or sporadic checks, we can notify the carrier and file for penalties if necessary to correct the problem.

How do my medical bills and scripts get paid?

Medical providers who treat you for a work injury should send the bills directly to the workers’ compensation carrier. You should not be required to pay any deductibles or co-pays. You should not allow your employer to pressure you to bill your regular health insurance carrier.

What do I do if workers' comp won’t pay my medical bills?

This typically means that your employer is trying to avoid admitting that you suffered a work injury. If the workers’ compensation carrier denies payment for a medical bill, you may ask your provider to bill your health insurance. Nevertheless, you should call an attorney immediately to take action to avoid collections by the medical provider and determine your rights to correct the problem.

Am I stuck with the company doctor?

 Your employer may direct you to treat with a company physician for the first 90 days after your treatment begins. You must do so only if your employer provided you with a list of “panel” physicians when you were hired and after you report a work injury. If no such list exists, you may treat with a physician of your choice. If surgery is recommended, you may seek a second opinion with a physician of your choice. If you have any questions about your rights in this regard, you should call us BEFORE you seek medical treatment in a non-emergency situation.

Why is a rehab nurse calling me or coming to my doctor’s visits?

Many workers’ compensation carriers hire a nurse who may contact you to offer to help manage your medical care. The nurse works for the insurance company and is typically paid to minimize your medical treatment and try to convince your physician to release you back to work. You are not required to speak to the insurance company’s nurse. You are not required to allow him or her into your office visits with your doctor. You are not required, and you should NEVER permit your doctor to speak the insurance company’s nurse without you being present. These nurses often will tell you that your doctor is required to speak to them and that you have no rights to stop it. This is a misrepresentation of the law. Nothing in the PA Workers’ Compensation Act permits your doctor to discuss your confidential medical information with anyone other than you. The doctor is required to send his bills and notes to the carrier for payment, but this does NOT mean that the doctor is permitted to talk about your medical condition on the phone or in person with your employer or insurance company. You should tell your doctor that any discussions about your medical condition should not occur without your permission or without you being present.

Do I have to go to an independent medical examination (IME)?

 The insurance company may request that you attend an examination with a physician that they have hired. Typically, the insurance company can send you to an IME up to twice per year. However, if there are a series of repeated IME’s, you may have a basis to object. If there is a dispute in this regard, the insurance company cannot stop your benefits without asking a Judge first. The IME appointment must be at a reasonable place and time. The insurance company generally may not be permitted to send you over an hour away from your home. There is no specific rule as to how far you may be required to travel. But, if an IME is scheduled, your alarms should be ringing. IME doctors make the most money by disagreeing with your doctor and testifying in court against you. The IME doctor does not have any interest in your case other than making money. If you are scheduled for an IME, we strongly suggest that you speak with us before you attend so that you are fully prepared.

How do I pay for an attorney?

A common hesitation from hiring a workers compensation attorney is because you are wondering how much does the worker’s compensation get. If you are on workers’ compensation, you can hire us at no charge to monitor your case. Yes, we do not charge any fee to give you advice, guide you, deal with the insurance company for you, or simply monitor your case with you. If your claim has been denied, our fee is 20% only if we obtain benefits for you. If the insurance company has sued you to stop or lower your benefits, our fee is 20% only if we are successful in maintaining your benefits. There is no risk to you. No recovery, no fee. If we successfully settle your case, our fee is only 20%.

How do I settle my workers' compensation claim?

You have the right to settle your workers’ compensation case for a lump sum. However, there must be an agreement between you and the insurance company. Neither party can force the other to settle. A settlement is typically the result of knowing the value of your case and convincing the insurance company that your case is worth a certain amount. For our clients, we prepare a detailed written settlement demand backed with facts that justify the amount that is fair to you. We successfully negotiate millions of dollars in settlements every year for our clients.

How do I know the value of my workers' compensation claim?

There are many factors in any settlement. One significant factor is your average weekly wage (AWW). The amount of your pre-injury wages directly impacts a number of benefits to which you are entitled. Typically, this is a significant factor in negotiations, but not always. The second factor that we find significant is what, if any, residual earning capacity that you have. That is a fancy way of asking what other work you might be able to do if you are no longer able to return to your pre-injury job. Insurance companies like to assume that, even after a work injury, you could return to other jobs with equal or higher earnings than before you were injured. We will review your medical condition, work with your doctor if necessary, and even hire our own experts to determine how the injury has impacted your future earning capacity. These and other factors go into our settlement demands. Needless to say, it is a complex process and we pride ourselves on strong settlement demands that are supported by the facts and law in your favor.

When is the best time to settle?

There is no set time when settlements are discussed. Typically, settlement discussions are raised anytime there is contested litigation where your employer is either denying your benefits or trying to stop your benefits. Another time to consider settlement is when it becomes apparent that your injury is permanent and may prevent you from returning to your regular job. Many of our clients use their settlement money to start over, pay down debt, or obtain training/education for a career that is less physically demanding.

How long does a case take in court?

 If your benefits have been denied, or if you have been sued to stop or lower your benefits, typically it takes 9-12 months from the time when a petition is filed to the time that a Judge issues a decision. Cases could take more or less time depending on whether there are multiple petitions filed and the number of witnesses who testify.

For settlements, which do require an approval from Judge, it only takes about 2 months.

Where can I turn if i have an issue with my claim or if my question isn't answered here?

 If you have been injured or have developed an illness due to work and need help with the workers’ compensation benefits process, contact My Comp Lawyers for a free consultation. Whether your employer has failed to secure coverage for you or whether your claim was rejected, our legal team can offer advice and support.

CONTACT US for FREE workers compensation case management. Our expert team cares about your needs, let us help you get the compensation you deserve.

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