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The Pennsylvania Workers’ Compensation Act safeguards the rights of the workers who are injured on the job. If a claim is accepted, it triggers two types of benefits in most cases- wage loss and medical benefits; however, the laws are complicated to handle without an attorney.
Here are a few important questions answered by Michael W. Cardamone, founder and president of Cardamone Law—a law firm for workers’ compensation in Pennsylvania in a recent Ask The Expert Podcast by WWDB-AM 860.
Yes. The sooner the better. If you fail to give notice of your injury within 120 days, the claim is forever barred. The best option is to give notice immediately, to a supervisor, owner, or manager, and state exactly what you were doing, when, and what you injured. Once you give notice, the employer/insurer has 21 days to accept, deny, or temporarily accept your claim and must issue a Notice of Compensation Payable, a Notice of Temporary Compensation Payable, or a Notice of Denial.
According to the Pennsylvania law, a written notice is not necessary. You can notify your employer by a verbal notice and write an email if you want. There is also something called an ‘Obvious Notice’—if the employee is injured in front of the supervisors or staff, they know that you’re injured and a written notice is not necessary. However, it is still preferred to speak to an owner, manager, or supervisor about what happened and how and when.
When an employee is injured, they often come under treatment of their employer’s panel of doctors. This treatment usually stretches to a period of 90 days. After this period, the injured worker, if the claim is accepted, can treat with any provider. However, the insurance carrier of work comp doesn’t have to pay for the medical bills unless they’re presented with the injury and an HCFA form along with treatment notes of the panel doctors, and the bills must be presented within 30 days of the treatment.
The testimonies from the doctors is usually done by deposition in Pennsylvania. The attorney takes the deposition and the attorneys go over their CV, their treatment and diagnosis, and opinions about the pending issues. This transcript is then given to the work comp judge at the end of the litigation. The process of deposition is a complicated one which requires the help of a Workmens comp lawyer. In some cases, a report can be submitted rather than deposition testimony.
Initially, the attorneys screen every case during the intake process. No reputable workers comp attorney in Philadelphia would want to work with an employee presenting a fake case. Moreover, there are a lot of people overseeing the case. The employer has an attorney at times; there’s an adjuster who oversees things that may not make sense; there are panel doctors who are cynical towards the worker and in favor of the employer. Moreover, you have an attorney at the insurance company end if there’s litigation to see if everything is adding up. All of these people are looking out for anything that doesn’t make sense. Therefore, it’s quite hard to get away with a fake work comp case.
Many a times, the case is not of fraudulence but misinformation, which is basically the finer line things. People often think that they won’t be able to find a new job. We often see cases where people did something for 20 years and now they don’t know where to start after hurting their back, they can’t go back to driving a truck or working at an assembly line etc. So it may appear some people on work comp are not trying as hard to get off of it.
A basic question session usually takes place. We ask about the details if it’s a work comp case. The intake is done then I get back to them quickly, often on the same day, or within minutes. If someone calls and it’s not a work comp case, we refer it out to a trusted colleague.
This involves a case by case analysis of all the events prior to the injury. A medical history is usually taken to see what injuries they had in the near past so as to make certain that the injury happened at work. If timely notice was given, the employer/insurer still has to accept, deny, or temporarily accept the claim within 21 days of notice.
Yes. If someone’s an employee at a place they’re still covered. Their wage loss benefits, if applicable, will be commensurate with their pre injury pay, usually in the 90% meaning the work comp check will often be 90% of the pre-injury average weekly wage, whereas with higher wage earners, it tends to be 2/3 of the average weekly wage.
No, there is no pain and suffering covered in the Pennsylvania work comp. This disappoints many injured workers, but it is a no fault system. Doesn’t matter if the injury was your fault, the employer’s fault, or no one’s fault- if you were injured in the course and scope of your employment, and you were an employee and not an independent contractor, then you’re covered. There are some exceptions such as self inflicted injuries, intoxication, or injuries that resulted from personal reasons, etc. But in general, it’s fairly easy to show a work injury, but there are no pain and suffering damages. The benefits are medical and wage loss benefits, death benefits, and sometimes what’s called specific loss benefits for the loss of use of a body part, amputation, or disfigurement of the head, face, or neck, that’s permanent, and unsightly, and not usually incident to the employment.
Pennsylvania Work Comp wage loss benefits are not taxable income. For many employees, their work comp check is similar to their regular pay check. However, for high wage earners, the work comp checks are often much less than their pre-injury pay check. There is a max comp rate each year, so even if you made a million dollars per week, you’re stuck at the max comp rate each week- for example in 2018, that max rate is $1025.00 per week. For low wage earners, the comp rate is often 90% of the pre-injury average weekly wage.
They can, but there’s an offset. One of the offsets against work comp is unemployment comp and the amount given will be the net amount. So there’s co reason to be on unemployment comp when you’re on work comp. Also, by applying for unemployment comp, an injured worker is admitting they are available to work in some capacity. This isn’t necessarily inconsistent with pursuing work comp benefits, because the employer may not have light duty work available.
Yes, you can be fired if the employer states that they can’t accommodate your restrictions from a doctor, or if there isn’t enough work available, etc. Many people believe that being on work comp protects their job. This isn’t true. If FMLA applies and you are accepted for that, then your job is safe for up to 12 weeks, usually 12 weeks of unpaid leave. An employer cannot retaliate and fire an employee because they are on work comp or because they are pursuing it. But they can terminate employment for non-discriminatory reasons.