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Cardamone Law- The Official
Partner of the American Worker ℠
Cardamone Law- The Official
Partner of the American Worker ℠
When an employee suffers a work-related injury and is unable to work, they should start to receive workers’ compensation benefits immediately. But it doesn’t always happen. While the PA Workers’ Compensation Act is a strong and comprehensive law that defends injured workers, its full and true implementation requires intelligent legal sense and representation. And that starts with understanding the law to its core.
In this article, we’ll try to answer your most significant questions about the PA Workers’ Compensation Act.
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If a workers’ compensation claim is granted, can you continue to get benefits for the rest of your life? While this is theoretically possible, in reality, this very rarely happens since the workers’ compensation carrier has many weapons in its arsenal to terminate or reduce benefits.
An experienced workers’ compensation attorney has the knowledge and experience to evaluate the worth of a claim properly and to know whether to settle or continue to litigate a case.
The workers’ compensation carrier will often try to find reasons to deny a claim (if a claim is denied, a Claim Petition must be filed within three years of the date of injury, or the claim is forever barred) and an experienced workers’ compensation attorney can often intercede to get the carrier to commence payments.
A worker can receive “total disability benefits” when they are totally disabled, and theoretically, these benefits can continue for the rest of the worker’s life, but that’s extremely unlikely. Also, it may be in the best interests of the worker to settle the case for a lump sum since there are no cost-of-living adjustments made to the compensation rates.
An employee is entitled to be paid benefits at the total disability rate when the employee is either totally impaired from performing any and all occupations or is unable to perform the job held at the time of injury. When an employee proves an inability to do the same work as at the time of injury, the employer has the burden to prove that other work is reasonably available that the employee is physically and vocationally capable of performing.
An employee who voluntarily retires from the workforce, rather than being forced into a compulsory retirement because of a disabling injury, is not entitled to benefits.
If an employee goes back to work, either for the time-of-injury employer or another employer, the employee will no longer be entitled to receive total disability benefits.
If the employee returns to work making as much money as before the injury, indemnity benefits are suspended.
If an employee returns to work making less money than before the injury, benefits will change from total disability to partial disability, which is usually two-thirds of the difference between the pre-injury average weekly wage and the new weekly wage of the employee. These partial disability benefits are allowed for a maximum of 500 weeks.
The insurance company may try to terminate workers’ compensation benefits if the employee fails to comply with medical treatment ordered by a doctor. If it is proven that reasonable medical treatment ordered by a doctor is essential for the patient’s recovery and if the patient refuses to undergo the treatment, a Workers’ Compensation Judge may terminate or suspend benefits.
A Judge will often weigh the benefits versus the risks of the proposed treatment.
Another way that insurance companies use to avoid paying benefits is when the employee ignores a request to have a medical examination. Under Pennsylvania law, the injured worker is required to submit to an independent medical examination by a physician chosen by the employer every six months.
The insurance company can petition to suspend benefits if the employee refuses to comply with the request.
The workers’ compensation carrier can also suspend benefits if an employee is sent to jail after a conviction. This is based on the theory that a person who commits a crime has voluntarily removed himself from the workforce. However, pre-trial incarceration does not preclude the receipt of benefits.
Another standard method that insurance companies use to suspend benefits is when an employee does not complete and return employee verification forms to the carrier within 30 days.
These forms require that the employee report any jobs obtained after the injury. Both sides of the forms must be completed and signed and returned to the insurance company within 30 days or the company can stop workers’ compensation benefits until the forms are completed and returned.
Benefits can also be terminated, suspended, or modified by a Workers’ Compensation Judge if it is proven that the employee has fully recovered or is capable of gainful employment. An experienced workers’ compensation attorney should be retained to defend against such petitions since this often involves complex issues and litigation.
Employees should consult an experienced workers’ compensation attorney before they agree to sign a “Final Receipt” or “Supplemental Agreement” by the insurance company. When an employee signs a Final Receipt, it means that he or she agreed to stop receiving benefits.
Similarly, signing a ‘Supplemental Agreement” may give up the employee’s rights to continued benefits even if the employee should have been entitled to continue to receive benefits had the Agreement not been signed.
An employer seeking to terminate workers’ compensation benefits bears the burden of proving that the employee’s disability has ceased, or that any current disability arises from a cause unrelated to the employee’s work injury. An injured employee is no longer entitled to compensation benefits when disability has ceased.
After a worker has received total disability benefits for 104 weeks, the workers’ compensation insurance company is allowed to require the employee to submit an Impairment Rating Evaluation. If the evaluating physician determines that the degree of total body impairment is less than 35%, the insurance company can convert benefits to partial disability even though the employee has not returned to work, and indemnity benefits can only continue for an additional 500 weeks.
Never agree to accept a lump-sum settlement from the insurance company before talking to an experienced workers’ compensation attorney. This is another common method that insurance companies use to pay an employee less than what they should be entitled.
Entering into a “Compromise and Release Agreement” will usually preclude an employee from ever re-opening the claim, even if the employee’s condition worsens or even if the employee discovers that the injury was much more serious.
Finally, in case of a fatal injury or illness, does that mean that no further benefits are payable?
Of course, the death of an injured worker will preclude the employee’s receipt of future indemnity or medical benefits, however, an attorney should be consulted to determine whether the employee’s family is entitled to survivor benefits.
Injured workers do much better when they are represented by competent workers’ compensation attorneys. The insurance company has experienced adjusters and attorneys to find ways to either modify, suspend, or terminate workers’ compensation benefits. Workers’ compensation attorneys who represent injured workers work on a contingency basis, so they only get paid if you get paid.