What is work comp.?
“Work Comp.” is a shorthand term for workers’ compensation.
Prominent Claimants’ Counsel use the proper term - “Workers’ Compensation.”
The former term, “Workmen’s Comp” was changed by the 1972 Amendments to reflect the entry of increased numbers of female workers into the labor force. It was obviously an antiquated term. In some cases, the usage shows extreme longevity of the practitioner - kind of like the yellowed hair on a British Barrister’s wig.
If you suffer a job injury or disease, the Pennsylvania Workers’ Compensation Act provides for your medical expenses and wage-loss compensation benefits until you’re able to go back to work. Attorney Valko often seeks interest, attorney fees, and even his Clients’ medical-related travel expenses as part of his Workers’ Comp. advocacy.
Benefits are paid by private insurance companies or the State Workers’ Insurance Fund (the Commonwealth’s comp insurer of last resort — known as SWIF) or by large self-insured employers.
Am I covered?
You are, or else your employer has already violated the Law. Employers must provide workers’ compensation coverage for all of their employees, including seasonal and part-time workers. The only employees who may not be covered are volunteer workers, agricultural laborers, casual employees, domestics and those who have been granted a personal religious exemption from the Act.
Federal workers are treated under a separate law. Non-profit corporations, unincorporated businesses, and even employers with only one employee, must comply with the Act under penalty of prosecution. Guilty Employers typically are sentenced to several years’ probation, a hefty fine and have to pay restitution to the injured worker or on his behalf anyway. Workers’ Comp. is a real bargain in most industries - with ultra-hazardous industries like roofing and cell tower construction being two exceptions.
How Am I covered?
If somthing at your work caused and is related to your injury, illness or disease, you will be entitled to WC. If you hurt yourself intentionally, you are out of luck. An injury or death caused by intoxication may not be covered; otherwise you may have a good case.
If the carrier thinks you may not work for awhile in your regular job, you may be able to settle your case for an attractive lump sum.
When am I covered?
Right away - no waiting periods. Coverage begins on the date of hire. Medical benefits are payable from the first day of injury; payment of lost wages begin the second week of disability and relate back once your Doctor says you cannot Return to Work.
How much are the payments for lost wages?
Wage-loss benefits for Temporary Total Disability are approximately two-thirds of your average weekly wage, up to a weekly maximum approaching $800 per week.
WC wage-loss benefits can be offset for 50% of Social Security “old age” benefits, the employer-paid portion of a retirement pension, severance pay, unemployment compensation or earnings the employee receives.
There are several different ways of calculating the average weekly wage. The minimum compensation rate is the lower of 90% of the workers’ average weekly wage or 50% of the Statewide average weekly wage.
Reporting Wages & Other Benefits Received
Under the Act, any worker who has filed a petition for total or partial disability benefits or who is receiving such benefits is required to fill out forms in the nature of progress reports. Take that responsibility seriously, and call the Office if you need any help. Unfortunately you must cooperate with the carrier regarding matters of employment, self-employment, wages and physical condition. No biggie.
Practice Tip: NEVER withdraw from the labor market. You are NOT even considering retiring. Your wage loss must be made up by your employer and its compensation carrier. Your Attorney will see to that.
When are wage-loss payments made?
You must be disabled more than seven calendar days (including weekends) before WC payments for disability are payable. Benefits for time lost from work are payable on the eighth day after injury. Once you have been off work 14 days, you receive retroactive payment for the first seven days.
If you report the injury promptly, miss more than seven days of work and your claim is accepted by the insurance carrier, you should receive your first compensation check within 21 days of your absence from work. After that, you will receive a check on a regular basis.
Payments of compensation may be made by your employer or the insurance carrier for up to 90 days, even if your claim is not accepted by your employer or its insurance carrier. If your employer or their insurance carrier advises you that it will not continue your temporary compensation checks past 90 days, you have the right to file a Claim Petition.
The Defense Medical Exam.
If your employer has evidence to prove that employment is available to you within your medical restrictions and in your local area, you may receive an offer of employment. Typically, you will first be asked to get an Independent Exam. This is not truly impartial, as the deck has been stacked against you. The doctor will take a few thousand dollars to spend a few moments with you and then dictate a Report to the Insurance Carrier informing them how wonderfully you have healed and that you are a fit specimen. My emphasis is on measuring the time the “independent” doc actually spends with you, what tools and devices he utilizes in making his objective findings about your recovery, and whether he says you overstate your symptoms.
Insurance companies are guilty of ripping off consumers after every disaster, flood, hurricane and work injury. They make their money by taking in more and paying out less. The Insurance Industry Credo: “No Premiums Refused, No Benefits Paid.” Just verbalize whatever pain you experience on a scale up to 10 and don’t try to be anything other than what you are.
You have the right to either accept or decline any resulting job offer. It is important to seek counsel at this critical stage unless and until you are completely recovered.
If you are too injured to work, or the job is outside your physical ability level, the insurer/employer must continue to pay benefits during the hearing process unless and until a judge orders otherwise. These are the fights I fight (Unless I first obtain favorable terms for a full and satisfactory resolution).
The WCJ will evaluate medical evidence, both from you and your insurer/employer, on the availability of the work and your ability to do it, before rendering a Decision. Never try to buffalo a WCJ - they see more litigants than the Black Robes of Common Pleas Court, and as a result can make credibility determinations with uncanny accuracy. You will be prepared and protected should the employer want a legal fight.
Section 413 Governs
Wage-loss benefits can be stopped by an employer/insurer who has evidence that you have returned to work at wages equal to or more than your earnings level prior to the injury AND after providing a timely notice of that fact. So don’t go back to work unless you are completely, permanently, recovered! In addition, if you are receiving temporary compensation benefits during the 90 days following the report of injury, the insurance carrier/employer may notify you they are stopping benefits because they are not accepting the claim of a work-related injury.
Other ways in which benefits may be stopped include: a WC judge freezing benefits after a Hearing; the employee signing either a Supplemental Agreement or an Agreement to Stop Workers’ Compensation (commonly referred to as a Final Receipt); or the 500-week period of partial disability status expires.
Short Answer: No one except a Judge can legally stop your Workers’ Compensation benefits for Temporary Total Disability so long as you are unable to work. If the Employer or its Carrier attempt to do so, then you never received a Notice of Compensation Payable (NCP), you Returned to Work (RTW) prematurely, or they violated the Act, as amended and re-enacted.
What if there is a problem?
If you think you haven’t received benefits to which you are entitled, contact Attorney Valko for an appointment. You will receive a Twenty per cent Fee Contract plus a HIPAA medical release form to sign.
Place your Comp. problems on Attorney Valko’s shoulders and concentrate on getting healthy again - and start figuring out what you might like to do with the rest of your life. It’s time for your Second Act. And this time, you may have a little extra money jangling in your purse or pocket.
Time Limits
Unless an employer has knowledge of the injury or the employee gives notice to the employer within 21 days of the injury, no compensation is due until that notice is given. Notice must be given no later than 120 days after the injury for compensation to be allowed, but the notice and be in writing, spoken, constructive (like after the employer received a medical bill for your injury), or in one of many other ways, apparent.
If your request for TTD is denied by your employer or carrier, you have three years from the date of injury to file a Claim Petition. This is only one year longer than most regular negligence-based accident claims with their common two-year S/L.
In occupational disease cases, injury/disability must occur within 300 weeks from the date of last employment in an occupation in which you had exposure to a hazard, and a Petition must be filed no later than three years from the date of injury/disability. I think of such cases as involving more of an exposure (like to silica dust, black lung, asbestos, etc.) than an injury. Remember: an accident is not required - just an injury arising out of, and in the course of, employment. It even may be a gradual disease, like repetitive motion disorder (carpal tunnel, thoracic outlet, reflex sympathetic dystrophy, etc.) where the last day of work is the Date of Injury.
Failure to file a petition on a timely basis may result in forfeiture of your right to benefits, so No Napping on your rights, please.
If your benefits were terminated, you may file a Petition to Reinstate WC benefits within three years after the date of your most recent WC check.
If your benefits were suspended, you may file a petition to have benefits reinstated. This petition must be filed within 500 weeks from the date of suspension.
Payment of medical benefits by your employer does not mean that your claim has been accepted or reopened.
Is that all?
That’s enough for now. Attorney Valko has forgotten more about Workers’ Comp than some lawyers ever care to know. He will answer your individual questions personally during your Office Visit.
