Workers’ Compensation FAQs
Readers are reminded that the following information is general and should not be relied upon to determine the course of action to take in your case. Every workers compensation case is different and many factors affect the answers to what appear to be simple questions. Therefore, to get answers to questions regarding your specific case, you should consult an attorney who specializes in the area of workers’ compensation.
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WORKERS’ COMPENSATION FREQUENTLY ASKED QUESTIONS
Q: My employer denied my claim for workers’ compensation benefits. Do I really need an attorney to get benefits or can I file a Claim Petition on my own?
A: Although the law allows you to represent yourself, under most circumstances you should hire an attorney experienced in workers compensation to handle petitions before a Workers’ Compensation Judge. Your employer and its insurance company will always have an experienced attorney representing their interests. Therefore, you will have a better chance of winning your case if you hire an experienced attorney to represent your interest.
Q: Since I am not working due to my work injury, and am not currently receiving benefits, how can I hire an attorney if I have no money?
A: If Richard files a claim on your behalf, you do not have to pay any fees unless we recover benefits for you. Further, Richard will front any costs incurred in litigating the claim, such as securing doctors’ records and transcripts. If we are successful, the attorney fee will be deducted from the benefits that are recovered, and the Insurance carrier will reimburse Richard for the litigation costs. The fee in most workers’ compensation cases is twenty percent (20%) of the amount awarded. In some instances we will be able to have the Insurance carrier pay Richard’s attorney fee if it can be established that there was no reasonable basis to contest your claim.
Q: I’ve been receiving benefits for my work related injury for a while and then suddenly my benefits were stopped out of the blue. Is the Insurance Carrier allowed to do this?
A: An employer or workers compensation Insurance carrier is not allowed to stop your workers compensation check without one of the following three things : 1)a supplemental agreement or Final Receipt that is signed by you; 2) a court order by a workers compensation judge authorizing the employer to stop your benefits or 3) you have returned to work and the Insurance carrier filed a Notification of Modification or Suspension in accordance with Section 413 ( C ) & ( D ) within seven ( 7 ) days of your returning to work. If none of those 3 things occurred and your checks were stopped, the employer may be subject to penalties payable to you in an amount up to 50% of the benefits that the employer is illegally withholding. To secure the penalties and the benefits that the employer is withholding, you must file a Penalty Petition which will be litigated before a Workers’ Compensation Judge. You should consult an attorney if the employer improperly stops your benefits to determine whether you should file a Penalty Petition. Further if you receive a Notification of Modification or Suspension and the information is incorrect, you should consult an attorney so that an “Employee Challenge” can be filed immediately. The Employee Challenge MUST be filed within 20 days of receipt if you believe it is inaccurate, or it will be considered binding, as if you signed a Supplemental Agreement agreeing to the stoppage of your check.
Q: I just received a petition in the mail from the employer stating that my benefits should be terminated as of the date I attended an independent medical exam. How can they say I am fully recovered when their doctor only examined me for ten minutes. Does this mean my benefits are going to stop?
A: You have received a Petition for Termination of your workers compensation benefits. The Insurance carrier believes that you have recovered from your injury as a result of the findings of the doctor who performed the independent medical exam ( IME ) and that you are no longer entitled to receive your workers compensation benefits. However, the employer cannot stop your benefits without a court order from the Workers Compensation Judge or a signed agreement by the parties. This petition will be litigated before a Workers’ Compensation Judge, and he or she will make an initial determination at the initial hearing known as a “Supersedeas Hearing” as to whether or not you shall continue to receive your checks. To effectively defend a Termination Petition you should consult an attorney, as far in advance of the initial hearing as possible.
Q: I suffered an injury at work but when I filed a claim for workers’ compensation my employer denied my claim because I did not provide “adequate notice.” What does adequate notice mean?
A: If you are injured at work or you are suffering from a condition that you think is work related, you should notify your supervisor as soon as possible that you suffered an injury in the course of your employment. Under the Pennsylvania Workers’ Compensation Act, an injured employee is required to provide notice to the employer of his or her work injury within 120 days of the injury. If you do not provide notice within this time period, no compensation will be allowed in your case, no matter how severe your injuries may be.
Q: If I cannot work due to my work injury, how much will my benefits be?
A: If you suffer a compensable injury that prevents you from working, you are entitled to wage loss benefits in addition to medical benefits. The rate of your workers compensation benefits is usually two-thirds (2/3) of your average weekly wage at the time of the work injury. However in certain circumstances it can be more than 2/3. For example if you were hurt in 2002 and earned between $ 367.78 and $ 496.48 per week you would receive $ 331.00 per week for a compensable claim, and if you earn less than $ 367.77 per week, you would receive 90 % of your salary. The compensation rate cannot exceed the annual maximum compensation rate set forth in the statute. (Currently $ 745.00 per week ).
Q: When I suffer an injury at work, do I have to treat with the company doctor?
A: An injured worker is obligated to treat with the company doctor for 90 days following the work injury only if the employer posted a list of at least six doctors or coordinated care organizations AND provided the employee with written notification of the employee’s rights and duties regarding the workers compensation Act which is signed by the employee. This verification form should be signed by you at the time of your hiring as well as shortly after the work related injury. If your employer chose not to establish a list of doctors, they can not tell you where to treat. If however, your employer has the list of doctors posted at work, and you do treat with the “company doctor” following the 90 day period you are entitled to seek medical treatment from any health care provider of your own choosing.
Q: If my employer is based in New Jersey and I was injured while working in Pennsylvania, can I recover workers’ compensation benefits in Pennsylvania?
Q: If I am injured in a state other than Pennsylvania but my employer is based in Pennsylvania, can I recover workers’ compensation benefits in Pennsylvania?
A: Yes. If your employment is principally localized in Pennsylvania you are entitled to benefits even though your injury occurred out of the state. Also, if your employment is not principally localized in any one state and you were hired in Pennsylvania, you are entitled to workers’ compensation benefits in Pennsylvania even though your injury occurred in another state.
Q: Can I recover workers’ compensation benefits if my injury did not occur on my employer’s premises?
A: Yes. You are entitled to workers’ compensation benefits as long as your injury occurred while you were in the “course and scope of your employment” even though you are not specifically on the employer’s premises when the injury occurs. For example, if you performing your job duties “on the road” at a customers place of business when you sustain your injury, your employer could be liable for your workers compensation benefits.
Q: Can I recover workers’ compensation benefits even if my work injury is my own fault?
A: Yes. The law provides for workers’ compensation benefits regardless of fault, even if it was no ones fault but your own. You are entitled to workers’ compensation benefits as long as your injury occurred while in the course of your employment.
Q: Can I recover workers’ compensation benefits if my work injury is caused by a co-worker or a third party?
A: Yes. As long as your injury occurred in the course and scope of your employment, you are entitled to medical benefits and to wage loss benefits if you cannot work due to your injury. For example, if you suffer injuries as a result of your co-worker not utilizing proper lifting techniques while you were making a delivery. Also, if your injury was caused by a “third party” such as another driver striking your car while you were making a delivery for your employer, you may also be entitled to sue the other driver in addition to your workers compensation benefits. You should consult an attorney to receive all of the benefits to which you are entitled.
Q: Can I sue my co-worker if he or she caused my injury?
A: No. Under the Pennsylvania Workers’ Compensation Act, you are barred from suing a co-worker who may have been responsible for your injuries. You also can not sue your employer for your co-workers actions that caused your injury.
Q: I have been receiving workers’ compensation benefits for an injury I suffered at work last year. Although I can’t return to my old job I think I can perform another job that does not require me to do the heavy lifting required by my pre injury job. If I return to work, will that affect my weekly benefits?
A: Yes. If you return to work and are earning wages greater than or equal to what you earned at the time you suffered your work injury, your wage loss benefits will be suspended. You will still be entitled to receive medical treatment for your injuries; however your workers compensation check will stop. If you return to work and are earning less than you earned at the time of your injury, you are entitled to “partial disability benefits”. Partial disability benefits are equal to 2/3 of the difference between your current earnings and your pre-injury average weekly wage and cannot exceed the maximum compensation rate for the year of your injury. As previously noted, the Insurance carrier must either file a Notification of Suspension or Modification, or have you sign a supplemental agreement before the checks will stop. It is suggested that you contact an attorney before signing any Agreements.
Q: I received unemployment compensation after my work injury. Now the employer is seeking a credit against my workers’ compensation benefits. Are they allowed to do this?
A: Under an amendment to the Pennsylvania Workers’ Compensation Act enacted 1993, the workers compensation carrier is entitled to a credit for unemployment compensation. This credit should be equal to the “net” unemployment compensation benefit you received, since you were required to pay taxes on your unemployment. This provision does not apply if your injury occurred before August 31,1993.
Q: The employer said I am not entitled to workers’ compensation benefits anymore since I started receiving my pension. Is that correct?
A: Determining the extent of the credit against your workers’ compensation benefits that an employer is entitled to for your pension benefits is very complicated and depends on many factors. You should consult an attorney regarding this issue.
Q: Can I apply for and receive Social Security benefits if I am receiving workers’ compensation benefits?
A: You can receive both benefits simultaneously. However, Social security will be reduced by the amount you are receiving in workers compensation, although this offset only applies to the money you actually receive and not the money you are paying to your workers compensation attorney. You should consult an attorney to determine if it is in your best interest to apply Social Security benefits or wait until your workers’ compensation case is resolved.
Disclaimer: The information/materials contained in this web site do not constitute legal advice, and contact with this web site does not establish an attorney/client relationship. We provide these materials for information purposes only. We strongly advise readers to seek competent legal counsel for solutions to individual problems. The links to other publicly available web sites are provided as a convenience; we make no claims, promises, or guarantees about the accuracy, completeness, or adequacy of the information.