We’re thoroughly prepared to assist you in all areas of Pennsylvania Workers Compensation claims, that’s why we have compiled a list of common questions in regards to Pennsylvania Workers Compensation and Work Injuries that may be able to answer any questions you may have fairly quickly.
If you can’t find the answers to the questions you’re looking for, do not hesitate to reach out for a free consultation. You owe it to yourself, and we’re here to help.
You must report your work related injury immediately to a person in supervisory authority at your place of employment. You have 120 days to properly report your work injury. But, telling a coworker is not good enough to meet the reporting requirements. Also, the sooner you report your injury to your employer, the more likely your claim will be accepted. Any delay in reporting a Pa. Workers’ Compensation injury will be considered as suspect and could likely prompt a denial of the claim.
If an injured worker pursues a PA Workers’ Compensation claim and is subsequently fired for reasons that occurred before the work injury, the law presumes that the firing was in “retaliation” for having filed the Pa Workers’ Compensation claim. This means that the employer may not avail themselves of any defenses as to job availability when defending the Workers’ Compensation action by arguing that the firing prevented any future job offers by the employer.
The Pennsylvania Workers’ Compensation Act allows an injured worker to file a claim within three years of the date of injury. This is known in legal terms as a statute of limitations. However, if the injury is not clear to the injured worker as being work-related, then the statute of limitations may be extended and the clock will not start ticking until the injured worker is informed by their doctor that their injury or condition is related to their work activity.
If a panel physician recommends surgery within the first ninety days after your work injury, the injured worker is entitled to get a second opinion from their own choice of physicians. The employer must pay for this second opinion. If the procedure is recommended by the second opinion then the injured worker must have the surgical procedure performed by one of the panel physicians if the second opinion and the surgical procedure are to take place within the first ninety days after the work injury. If the ninety days have expired, then the injured worker is free to select a non-panel physician to perform the recommended surgical procedure if the injured worker chooses to proceed with the surgery after a second opinion. Choosing a doctor for a second surgical opinion and the decision selecting the physician to perform a work-related surgical procedure are often difficult issues.
Yes, your employer must provide you with a copy of the panel list of physicians along with a notice and acknowledgment of your rights at both the time of hire and, most importantly, soon after your injury is reported to your employer. If your employer fails in either circumstance, you may treat with any healthcare provider of your choosing and you will not be limited in the first ninety days after the work injury to treat with a company doctor on the panel list of physicians.
Under the PA Workers’ Compensation Act, an individual that experiences a work injury and needs medical attention must treat with one of the six posted panel healthcare providers designated by the employer for the first ninety days after the work injury. If the employee does not treat with one of the panel physicians, then the employer is not obligated by law to pay for such treatment outside the panel list during the first ninety days. After the ninety days, the injured worker is free to treat with whomever they choose. There are exceptions to the ninety-day rule. For example, if the employer does not provide a written acknowledgment form containing a list of the panel physicians to the employee soon enough after the work injury, then the employee may treat with doctors outside the otherwise posted list of healthcare providers. Another common occurrence is the employer’s failure to include a particular specialist or practice of healthcare, such as chiropractor, on the panel of six posted providers. In this circumstance, if the panel does not contain the name of a chiropractor, then the injured worker is free to treat with any chiropractor of their choosing.
If you return to work after a work injury and are working with restrictions as a result of your work injury, then you are entitled to an automatic reinstatement of your temporary total disability (TTD) benefits in the event of a layoff. If, however, you have returned to work after a work injury without work restrictions but still have lingering effects from your work injury, a petition may be filed to reinstate your TTD benefits. In this situation, as well as the previously mentioned scenario, it is the employee’s burden to prove that the earnings loss is once again due to the work injury and that the job loss is through no fault of the employee.
If you are injured on the job, your employer may offer you a light duty job that fits within your restrictions at or below your pre-injury average weekly wage. The employer is not obligated by any rule or law to make such modified work available for any specific period. However, if the employer discontinues the light duty work and your earnings loss is, therefore, once again, caused by no fault of your own (i.e. layoff or discontinued employment) then you are arguably entitled to an automatic reinstatement of your temporary total disability benefits. There are certain legal thresholds that must be met to obtain a reinstatement of temporary total disability benefits.
If you are injured on the job in Pennsylvania and can no longer do your time of injury job, the employer may offer alternative work for the injured worker, which fits within the injured workers’ physical restrictions put in place by the work injury. You should always make certain that any job offer for light duty or modified work is presented by the employer in writing with at least a job description, along with the hours of employment and the rate of pay. Additionally, the employer is required to issue the injured worker a formal “Notice of Ability to Return to Work” with attached reports from a doctor clearly outlining the injured worker’s restrictions as they relate to the work injury.
Pennsylvania is an “at will” employment state. This means that absent a contract for employment, an employer may fire an employee for any reason as long the reason is not based on a violation of federal and state laws that provide protection for certain classes of individuals such as the disabled, a person’s race, or religion. Being fired for the express reason of having filed a Workers’ Comp claim against your employer is simply wrong and a violation of state and federal law. An action for retaliation may be brought against the employer. Also, the retaliatory firing will provide no defense for the employer attempting to argue that your Workers’ Compensation benefits should be denied because of any fault of the employee.
If an injured worker receiving PA Workers’ Compensation benefits returns to work at a different job with a different employer and earns less money at this new job, the injured worker may be entitled to a payment of partial disability benefits at the rate of 2/3 of the difference between the injured worker’s pre-injury average weekly wage (AWW) and the amount of the new earnings. For example, if your time of injury job had an AWW of $400.00 per week and you return to work at a lighter duty job (or any job that fits within your restrictions) that pays $200.00 per week, then you may be entitled to a partial disability payment of $133.20 per week. ($400-$200= $200 x 2/3= $133.20). As long as your earnings loss is because of your work injury preventing you from earning your pre-injury AWW, you are entitled to partial disability benefits under the PA Workers’ Compensation Act.
Yes. Any medical treatment that is reasonable, necessary, and related to your work injury—including prescription medications—are paid for by PA Workers Compensation benefits. If the PA Workers’ Compensation insurance carrier believes or has reason to believe that a certain drug, medical treatment, or medical procedure is not reasonable or necessary, they may hold payment on the bill and submit the bill for Utilization Review. This would include the prescribing doctor’s treatment and the writing for prescription medications by this doctor.
If your employer and their PA Workers’ Compensation insurance carrier have denied your work injury, your health insurance is obligated to pay for your medical bills related to your work-related injury while your claim for PA Workers’ Compensation benefits remains denied. However, in the real world, it doesn’t always work as smoothly as we wish. Often, health insurance companies will deny payment for medical treatment that is considered to be work-related. The health insurance company reviews your medical treatment notes. There is a history of the injury occurring at work in the history portion of your medical providers’ records. Therefore, the health insurance company sends you a denial of payment letter. Of course, your PA Workers’ Compensation claim has been denied and while you are appealing your denial, it appears that no one will pay your medical bills, neither Workers’ Compensation nor your health insurance. Do not worry though, there are simple tasks that an experienced attorney can perform that will instruct your health insurance company to pay your medical bills while your PA Workers’ Compensation claim is being appealed to a PA Workers’ Compensation Judge.
If your employer forced you to take your earned vacation time and/or sick leave while your PA Workers’ Compensation benefits were denied, upon receiving PA Workers’ Compensation benefits after an award of benefits, you may be able to buy back your sick time and/or vacation time. While the employer and PA Workers’ Compensation insurance carrier cannot take credit for your used sick and vacation time against your award for PA Workers’ Compensation, they may allow you to buy back your time with the money you subsequently receive from an award of PA Workers’ Compensation benefits. Credit for other benefit payments either earned or unearned and the subject of buying back vacation time and/or sick time is a complicated area of the PA Workers’ Compensation Law.
If the injured worker has earned or accumulated vacation or sick time, then the injured worker can take his or her vacation or sick time without the employer taking any credit from the worker’s PA Workers’ Compensation weekly benefits. Such vacation and sick time is considered an earned benefit and is owned by the employee. Therefore, unless the employer makes the decision to pay the injured worker wages as a substitute for PA Workers’ Compensation Benefits, the employer may not take any credit for vacation or sick pay. If your claim is denied and your employer forces you to take your vacation and/or sick pay while you are off work due to your work injury and, thereafter, your claim is accepted or granted by a PA Workers’ Compensation Judge, you will be entitled to receive PA Workers’ Compensation benefits for the same time period that you received your vacation or sick pay.
If you are receiving PA Workers’ Compensation benefits and must retire due to your work-related injury from your time of injury employer, your receipt of pension benefits may be offset against your PA Workers’ Compensation benefits. The employer has the legal ability to reduce your Pennsylvania Workers’ compensation benefits by the proportional amount the time of injury employer funded your pension. In other words, if your time of injury employer funded 20% of your pension, then upon proof of such payment, the employer from which you retired may take a credit of 20% of your weekly pension benefits to be deducted from your weekly PA Workers’ Compensation benefit check. The employer and their PA Workers’ Compensation insurance carrier are required by law to provide you with twenty days’ notice before taking such a credit from your PA Workers’ Compensation benefits. They must also provide the injured worker with an accounting of the amount they are entitled to credit and proof of their payment of the exact percentage of the pension they funded for the injured worker.
Yes, you may receive PA Workers’ Compensation benefits and Unemployment Compensation (UC) benefits at the same time. You may be totally disabled from the job you were performing at the time of injury, but able and available for other lighter duty work that your current employer cannot provide. Therefore, you will be eligible for Unemployment Compensation benefits under the law for UC benefits. However, the amount you receive will be counted against your PA Workers’ Compensation benefits and your PA Workers’ Compensation benefits will be reduced by the amount of the UC benefits you are awarded on a weekly basis. Receiving both PA Workers’ Compensation benefits and Unemployment Compensation benefits can involve you in two separate courts within the PA Department of Labor and Industry. An Unemployment Compensation Referee decides the unemployment matters. A PA Workers’ Compensation Judge decides the Workers’ Compensation benefits. Each of these courts has different rules and standards that must be met in order for an individual to receive the benefits they are seeking.
You may, at the expiration of the 500 weeks of partial disability benefits, petition within three years to reinstate your benefits to total disability benefits. If your benefits were suspended at the end of the 500-week partial disability period and you received benefit payments within the last three years, you may file for a reinstatement to total disability benefits within three years of the last date of payment. Reinstating benefits to total disability benefits after receipt of partial disability benefits or a suspension of benefits can be a complicated matter. We can help.
Pennsylvania Workers’ Compensation benefits are separated in two parts. The first benefit is for wage loss. The second benefit is for payment of reasonable, necessary, and related medical expenses that you incur because of the work related injury in Pennsylvania. Wage loss benefits are typically calculated at 2/3 of your pre-injury average weekly wage (AWW). After receiving full or temporary total disability (TTD) benefits for two years, the employer’s compensation insurance carrier is allowed to request an Impairment Rating Evaluation. If this medical evaluation determines that you are less than 50% disabled because of your PA Workers’ Compensation injury, then your benefits will change in name, not in amount, to partial disability benefits (PDB). The PA Workers’ Compensation Act allows the injured worker to collect partial disability benefits for up to 500 weeks or 9.6 years. As a result, the injured worker can receive up to 11.6 years of Workers’ Compensation wage loss benefits. This includes the first 2 years of benefits and the additional 9.6 years of benefits after a rating evaluation. The workers ‘ compensation insurance carrier can pay medical bills that are reasonable, necessary, and related to the work injury for life. There are several exceptions to the duration in which an injured worker can receive wage loss benefits, but we can help.
If you are injured on the job and continue to work in any capacity, your treatments for your work injury including physical therapy will often occur during regular working hours. It is advisable that the injured worker attempt to schedule medical appointments outside of regular working hours in order to avoid this type of conflict with the employer. However, there are circumstances wherein treatment must occur during working hours. If this circumstance arises, certain factors must be met to allow the injured worker to attend such appointments and there will be issues over payment of wages and possible partial disability benefits for the earnings loss due to medically required treatments that cause an earnings loss in any particular workweek. The issue of attending medical appointments during the workweek for a work related injury should be discussed with an experienced attorney. Any miscalculation of these Partial Disability benefits could cause the injured worker in Pennsylvania to lose a good amount of money that they are rightfully entitled to receive.
Can I treat for my PA Workers’ Compensation injury with my family doctor if I do not like the company doctor’s treatment and recommendations?
If your PA Workers’ Compensation claim has been denied, oftentimes your employer will request and, and perhaps even insist, that you make application for short-term disability. When faced with this situation, the injured worker needs to be very careful in completing the application for short-term disability benefits. In most cases the application will ask the injured worker “if their disability is work-related or a result of a work injury?” The employer will often inform the injured worker that their PA Workers’ Compensation claim has been denied and, therefore, the injured worker should answer “no” to the question “is your disability work-related or as a result of a work injury?” While answering “no” will likely help your short-term disability to be awarded, it can conversely cause problems with the filing of a claim petition to appeal your denial of your PA Workers’ Compensation claim. There will be a written signed statement from you, the injured worker, stating under penalty of fraud that your condition was “not” a result of a work injury. Be very cautious when asked by the employer to complete an application for short-term disability benefits.
