HAPPY 100TH BIRTHDAY TO WORKERS COMPENSATION IN PA
2015 marks the 100th anniversary of the Pennsylvania Workers’ Compensation Act. While the Act has gone through many changes in its 100-year history, its purpose of helping workers injured on the job remains the same. However, even a law designed with a humanitarian purpose in mind does not always protect the rights of the most vulnerable.
If you’re hurt on the job, you may automatically assume that your employer will take care of your bills and make sure you’re paid for any time you miss from work as a result of your accident. What most people in Pennsylvania don’t realize, however, is that it’s rare for your employer to be involved at all with the Workers’ Compensation process. Employers are required to carry Workers’ Compensation insurance, and most of them do. When someone is injured on the job, the boss has to report that injury right away to his or her insurance carrier.
Once that’s done, almost all of the decisions are made by an insurance company which knows little to nothing about the injured employee personally. The insurance company gets to decide whether your claim for benefits is accepted or denied, and even what doctors you see for months after your injury. If your claim is denied, you need to speak with an attorney immediately so that the proper legal document – called a Claim Petition – can be filed with the Bureau of Labor and Industry. In 2013, 9,280 Claim Petitions were assigned to Workers’ Compensation Judges in Pennsylvania.* This means that more than 9,000 injured workers were denied benefits, and that doesn’t take in to account all those who let the matter drop after being denied.
Even if your claim for benefits is accepted right away by the insurance company, it is still in your best interest to consult with us here at Goodrich & Associates early in your case so that he or she can help assure that your rights are being protected. The pitfalls of the Workers’ Comp system are many, and you may not know you have done something wrong or missed an opportunity until it’s too late. The insurance companies deal with these cases every day and know far more about the system than you do – have someone in your corner to make sure you’re getting what you deserve.
If your employer is not properly insured as required under the Act, it is still possible for you to obtain benefits through the Uninsured Employers Guarantee Fund (UEGF).
Under the Pennsylvania Workers’ Compensation Act, your employer’s insurance company is only liable for your lost wages, medical treatment that is reasonable, necessary and related to your accident, and certain types of injury which cause a “specific loss,” which is discussed in more detail below. There are no claims for pain and suffering allowed under the Act. This was done as a compromise for permitting workers injured on the job to claim Workers’ Comp regardless of how their injury occurred – you likely have a claim for benefits even if the accident in which you were injured was your fault.
Construction worker has an accident while working on new house
Also keep in mind that even if your claim for benefits is approved, you will not be paid at your full hourly rate or salary. If you were injured in 2015 and make below $528.32 per week, you will receive 90% of your pay in compensation benefits. If you make between $528.33 and $713.25, you will receive $475.50 weekly. If you earn between $713.26 and $1,426.50 weekly, you will receive only 66 2/3% of your regular pay in wage loss benefits. If you make over $1,426.50 per week, the maximum amount you can receive is $951.00 per week. These numbers change yearly, and so are different for individuals injured in 2013, 2014 and so on. Workers’ Comp wage loss benefits are tax free and should not be reported as income on your tax returns.
Specific loss and scarring claims are the other two types of Workers’ Compensation benefits injured workers may be able to access. In order to make a claim for specific loss, the worker must have lost or lost all use of a body part. When this happens, payment should be made in a lump sum in accordance with a chart designed by the Bureau of Labor and Industry which specifies how many weeks of benefits each body part is “worth.” This is a gruesome system which can lead to skewed results. For example, if an injured worker loses his whole thumb in a work accident, he is entitled to 110 weeks of wage loss benefits. That thumb is “worth” significantly more if the injured party is a high wage earner rather than a low wage earner under the system currently in place. If only part of the thumb is amputated, the worker is entitled to even fewer weeks of benefits. Scarring claims can be made only for scars to the head, face and neck, and are similarly valued on a weeks-worth-of-benefits basis.
While you are receiving benefits, the insurance company has several avenues to use to attempt to stop or limit those payments. They can send you for an Independent Medical Evaluation (IME) with a doctor of their choosing who they pay to examine you. If this doctor says you have recovered from your injuries, the insurance carrier will file a Petition to try to stop your benefits. It is important that you treat regularly with doctors of your own so that you have an alternative medical opinion to stand against the one they have bought and paid for. If the IME doctor thinks you can return to work in some limited capacity such as light duty, the insurance company can request that your employer offer you a job within those restrictions, or they can hire a vocational evaluator to interview you and attempt to find work within your restrictions. If they find jobs you can do, the insurance company can Petition the court to modify your benefits even if you don’t actually get a new job!
Considering all of the maneuvering the insurance company can undertake to stop your benefits, if you have been receiving weekly wage loss benefits for a period of six months or more it may be in your best interests to think about settling your Workers’ Compensation claim for a lump sum of money through what is known as a Compromise and Release agreement. If you are considering settlement or if the insurance company has brought it up with you, you should contact us immediately to advise you of your rights under the Act as they relate to settlement. An attorney can help make sure you are being adequately compensated for your injury and all of the details of the settlement are ironed out appropriately, including what happens to future medical bills you may incur.
Finally, if a third party who is not a co-employee is involved in your injury, for example if you are driving for work and are hit by another car, you may have a personal injury claim in addition to your Workers’ Compensation claim. In that case, an experienced attorney at Goodrich & Associates can review all of the applicable insurance policies and determine whether additional wage loss coverage is available on top of you Workers’ Comp benefits. We may be able to see that you are paid 100% of your wages depending on the coverage available. Furthermore, in an action against a third party, a claim for your pain and suffering would be possible and could lead to a larger recovery to help protect your future.
Both Workers’ Compensation and personal injury claims are handled by Goodrich & Associates on a contingency fee basis – its risk free. No money, no fee! Contact us today for a no-charge consultation.
*Pennsylvania Workers’ Compensation and Workplace Safety 2013 Annual Report