Workers Compensation

FAQ

1Q. Am I entitled to compensation for a pre-existing condition that is aggravated by a work injury?
A. Yes. The definition of a compensable work injury includes a condition directly caused by a work accident, activity, or exposure, as well as a pre-existing or underlying condition which becomes aggravated, accelerated, and/or symptomatic as the result of a work accident, activity, or exposure. Therefore, injuries or diseases that are aggravated as the result of your employment are covered under workers’ compensation, regardless of your previous physical condition.
2Q. Am I entitled to compensation for work injuries in the nature of heart attacks and related heart problems caused by physical exertion or trauma related to my employment?
A. Heart attacks, episodes of angina, and other heart related problems are compensable work injuries provided these conditions are caused by physical exertion or trauma related to injured workers’ employment. This also includes pre-existing heart conditions that are aggravated or accelerated as the result of physical work exertion or trauma. Accordingly, even if you have an underlying disease or condition that affects your heart and is not caused by your employment, you will not be disqualified from receiving workers’ compensation benefits. If work related physical exertion or trauma causes you to have a heart attack, angina, or other conditions and symptoms, you may still qualify.
3Q. Am I entitled to compensation for work injuries and illnesses that are caused by exposure to chemicals, fumes or other substances in my work environment?
A. Yes. Injured workers’ injuries, diseases, and illnesses that are causally related to exposure to chemicals, fumes, or other substances in the work place are compensable work injuries. These types of work injuries can immediately manifest as a rash or some type of skin anomaly, difficulty breathing, feeling sick, and/or other physical disorders, or may manifest as an underlying progressive illness that may not become apparent for years following exposure to the harmful agents.

Employers are required to maintain “Material Safety Data Sheets” (M.S.D.S.) where chemicals are used in the work place, detailing the nature and potential effects of chemicals used. If you have developed a condition which you believe may be related to exposure to chemicals, fumes, or other substances at work, or you are concerned about the nature and extent of your exposures in the work place, do not hesitate to immediately speak with your employer and your physician to attempt to obtain an understanding of your exposures in this regard. Also speak with an attorney to review your potential claim in this regard with you.

4Q. Am I entitled to compensation for psychological injuries resulting from stress associated with my physical work injuries?
A. Yes. Psychological conditions that are causally related to stress resulting from injured workers’ physical work injuries are compensable work injuries. It is not uncommon for injured workers to experience significant stress from pain, loss of function and productivity, concern of their injuries, shock of the occurrence of the injury, and financial distress as the result of their physical injuries. It is also not uncommon for injured workers facing these types of stress to be affected to the extent that psychological counseling or treatment is necessary. If you find yourself in this situation, you are not alone, and it is important that you know that these types of psychological conditions and necessary treatment are covered under injured workers’ compensation. To help yourself, do not hesitate to discuss this with your treating physician and your workers’ compensation attorney to ensure that you receive appropriate medical treatment and that the medical treatment is properly paid for by the insurance company.
5Q. Under what circumstances may my employer's workers' compensation insurance company stop or reduce the amount of my workers' compensation wage loss benefits?
A. Once your employer’s workers’ compensation insurance company has formally legally accepted liability for your workers’ compensation claim and has commenced payment of workers’ compensation wage loss benefits to you, the insurance company cannot legally stop or reduce payment of your benefits unless you have: signed very specific legal documents allowing such a stoppage or reduction, the insurance company has filed very specific legal documents with the Bureau (which you may challenge during a proscribed time period), or a Workers’ Compensation Judge has issued an official order directing that your wage loss benefits be stopped or reduced.

If the insurance company stops your wage loss benefits in an improper manner, you should consult your workers’ compensation attorney immediately so that the appropriate steps can be taken to seek the reinstatement of your wage loss benefits, with interest, and also the imposition of monetary penalties against the insurance company for the insurance company’s improper stoppage of wage loss benefits.

Also, if your workers’ compensation wage loss benefits have been stopped after you have signed an agreement, the insurance company filed official legal documents with the Bureau, or a Workers’ Compensation Judge issued an official order, and you are uncertain as to the basis of the signed agreement, filed documents, or official order, you should contact your workers’ compensation attorney immediately to make sure that your rights are protected and that you understand the status of your claim. These types of agreements, documents, and Judge’s orders can, in some cases, be reviewed and corrected, or challenged, if necessary. However, it is important that you act immediately in this regard.

6Q. Even though I have returned to work after my work injury, is my employer's workers' compensation insurance company required to pay me partial disability wage loss benefits?
A. Yes, if you continue to experience a loss of earnings after you have returned to some type of work but your wages are less than your pre-injury average weekly wage, and your loss of earnings is related to your work injury.

Partial disability benefits, equaling two-thirds (2/3) of the difference in wage loss measured between your return to work earnings and your pre-injury average weekly wage, are payable up to a maximum of five hundred (500) weeks of partial disability. If you have returned to work following a work injury, continue to experience residual medical disability from your injury (that is, you have not yet reached a full and complete recovery from all effects of your work injury), and are earning less weekly wages than you earned prior to your work injury, you may be entitled to ongoing partial disability wage loss benefits. In such circumstances, you should properly file for partial disability benefits promptly and well within your statutory maximum period of five hundred weeks of partial disability, and (to be safe) within three (3) years of the period of the last payment of wage loss compensation you receive for the work injury at issue.

7Q. May I continue to be entitled to workers' compensation wage loss benefits if I apply to receive additional benefits such as retirement benefits, severance payments, unemployment compensation, and/or social security benefits?
A. Yes, however, a credit may apply under certain circumstances. An offset may be taken by the employer against workers’ compensation benefits on the basis of the injured workers’ receipt of severance benefits from a self-insured employer.

It must first be noted that the offset for severance benefits does not apply to work injuries occurring before June 24, 1996, where, in such cases, injured workers are entitled to receive workers’ compensation benefits and severance benefits at the same time without being subject to any type of credit or offset. For work injuries occurring on or after June 24, 1996, workers’ compensation benefits otherwise payable to injured workers are to be offset by the net after tax amount of severance benefits paid by a self-insured employer, and received by the injured worker subsequent to the work injury. An offset may also be taken by the employer on the basis of the injured worker’s receipt of unemployment compensation benefits.

It must first be noted that the offset for unemployment compensation benefits does not apply to work injuries occurring before August 31, 1993, where, in such cases, injured workers’ are entitled to receive workers’ compensation benefits and unemployment compensation benefits at the same time without being subject to any type of credit or offset, even where the receipt of unemployment compensation benefits occurs on or after August 31, 1993. For work injuries occurring on or after August 31, 1993, injured workers’ compensation benefits otherwise payable to the offset by the net after tax amounts of unemployment compensation benefits received by the injured worker subsequent to the work injury. An offset may also be taken by the employer on the basis of the injured workers’ receipt of Social Security (Old Age) benefits.

It must first be noted that the offset for Social Security (Old Age) benefits does not apply to work injuries occurring before June 24, 1996, where, in such cases, injured workers are entitled to receive workers’ compensation benefits and Social Security (Old Age) benefits at the same time without being subject to any type of credit or offset. For work injuries occurring on or after June 24, 1996, workers’ compensation benefits otherwise payable to injured workers are to be offset by fifty percent (50%) of the net after tax amount of Social Security (Old Age) benefits received by the injured worker subsequent to the work injury. Importantly, the offset does not apply to Social Security (Old Age) benefits that commenced prior to the work injury that the injured worker continues to receive subsequent to the work injury. Also, the offset does not apply to Social Security (Old Age) benefits to which an injured worker employee may be entitled, but is not receiving. An offset may also be taken by the employer on the basis of the injured workers’ receipt of pension benefits from the employer.

It must first be noted that the offset for pension benefits does not apply to work injuries occurring before June 24, 1996, where, in such cases, injured workers are entitled to receive workers’ compensation benefits and pension benefits at the same time without being subject to any type of credit or offset. For work injuries occurring on or after June 24, 1996, workers’ compensation benefits otherwise payable to injured workers are to be offset by the net after tax amount an injured worker receives in pension benefits to the extent the pension benefits are funded by the employer directly liable for the payment of workers’ compensation benefits.

8Q. Even though I have received compensation for my actual loss or use of a body part affected by my work injuries or disfigurement of the head and neck, is my employer's workers' compensation insurance company required to pay me separate wage loss benefits for my loss of earnings?
A. Injured workers are entitled to “Specific Loss” compensation benefits, that is, compensation for an actual loss or loss of use of a body part or disfigurement of the head and neck, and wage loss benefits for the same work injury occurrence if, in addition to the Specific Loss injury, the injured worker also sustains disabling injuries separate and distinct from the Specific Loss injury. This is not an uncommon occurrence, and in fact, happens quite frequently.
9Q. If I am receiving disability benefits through a sickness and accident plan or other program sponsored by my employer, is this considered the equivalent of workers' compensation, and are my rights protected?
A. No, Sickness and Accident benefits, Short Term Disability, and/or Long Term Disability benefits are not the same as workers’ compensation benefits. Moreover, if you are receiving Sickness and Accident benefits, Short Term Disability and/or Long Term Disability benefits for a work related disability, your rights are not protected.

An employer pays these types of benefits where the employer has not accepted liability for a workers’ compensation claim as the basis for the disability. Accordingly, your receipt of these types of benefits does not equal your employer’s acceptance of liability for your work injury. In fact, it is not uncommon for employers to assert in subsequent Claim Petition proceedings that an injured worker’s request for Sickness and Accident benefits constitutes an admission on the part of the injured worker that the disabling condition at issue is not work injury related. For this reason, wherever you apply for Sickness and Accident benefits, or benefits of the like, for a work related disability, you should make sure to document that you believe the condition is indeed work injury related. In addition to these significant issues, it must also be emphasized that Sickness and Accident benefit programs typically pay less than you would be entitled to received in injured workers’ compensation benefits both in the amounts and duration of benefits.

Also, Sickness and Accident benefits, and benefits of the like, are taxable income as opposed to workers’ compensation benefits which are not taxable income. Accordingly, both in terms of properly establishing the liability of your employer for your work injury so as not to waive any of your rights to workers’ compensation benefits, and out of concern for your level of financial income, you should not hesitate to take the appropriate steps to establish your work related disability – past, present and future.

10Q. If my employer terminates my employment or lays me off after I sustain a work injury, am I entitled to workers' compensation wage loss benefits?

A. If you sustain a compensable work injury, have returned to work with physical restrictions performing modified or light duty work and then sustain a loss of earnings through no fault of your own, you are entitled to the reinstatement of your workers’ compensation wage loss benefits.

To protect yourself in this regard, upon returning to work following a work injury, it is extremely important to document the specific nature of your physician’s recommended physical restrictions and limitations, the fact that you are performing modified or light duty work, and a strong work record. Do not give your employer reason to terminate your employment for reasons that would be considered your own fault. If all of the above is documented, your attorney should be very able to demonstrate your entitlement to the reinstatement of workers’ compensation wage loss benefits as of the date of your discharge.

11Q. How long will my employer's workers' compensation insurance company be required to continue to pay for my medical bills?
A. The insurance company is responsible for the payment of all work injury related medical treatment which is reasonable and necessary until it is legally established that you have fully and completely recovered from your work injury.

As indicated above, the medical billings for your medical treatment must be properly submitted by your healthcare provider to the insurance company for the treatment to be considered compensable. Following proper submission of the medical billings to the insurance company, the insurance company must pay for the treatment within thirty (30) days of submission. During this thirty (30) day period, the insurance company may contest the reasonableness and necessity (and not causality) by filing a Request for Utilization Review with the Bureau of Workers’ Compensation. If the insurance company fails to file the Utilization Review Request during this thirty (30) day period, the insurance company waives its right to contest the reasonableness and necessity of the treatment at issue.

12Q. Am I required to treat with the company doctor for my work injuries, or may I treat with a doctor of my own choice?
A. Employers have the option to establish a list of designated health care providers. If the list is properly posted and noticed to you by the employer, you are required to receive medical treatment from one of the designated health care providers for the work injury for a period of ninety (90) days from the date of the first treatment for the work injury. If such a list is established, the employer must provide you with a clearly written notice of your rights and responsibilities with regard to medical treatment following a work injury. Your employer may not require you to treat with any one specific provider on the list. Your employer may also not restrict you from switching from one designated provider to another designated provider during the ninety (90) day period. You are free to choose to treat with any provider on the list.

Emergency medical care is exempt from the designated health care provider requirement, but only for the period of emergency. That is, once the emergency condition no longer exists, you must treat with one of the designated providers. The posted list must designate at least six health care providers, of which at least three (3) must be physicians. Each health care provider name, address, telephone number, and area of medical specialty must be included on the list. The designated providers must also be geographically accessible, and their medical specialties must be appropriate for the anticipated work injuries of the workers. If the posted list of designated providers does not contain a provider with the specialty necessary for the treatment of the injured worker, including chiropractic treatment, the injured worker may treat with a non-panel healthcare provider of his or her choice of the necessary specialty, and the insurance company will be required to pay for the treatment provided if it is reasonable, necessary, and causally related to the work injury.

If there is no posted list of designated providers, or if the list has not been properly posted and noticed to the injured worker prior to your work injury, the injured worker may treat with any non-panel healthcare provider, and that treatment must be paid for by the insurance company, again provided the treatment is reasonable, necessary, and causally related to the work injury.

13Q. Even though I have received wage loss benefits, is my employer's workers' compensation insurance company required to pay me separate additional compensation for my actual loss or loss of a body part affected by my work injuries?
A. Injured workers are entitled to Specific Loss compensation benefits, that is, compensation for an actual loss or loss of use of a body part or disfigurement of the head and neck, and wage loss benefits for the same work injury occurrence if, in addition to the Specific Loss injury, the injured worker also sustains disabling injuries separate and distinct from the Specific Loss injury.

Injured workers must be aware that this is not an uncommon occurrence, and in fact, happens quite frequently. An example of this situation would be where a worker sustains a crushing injury to his or her hand resulting in an amputation of a finger and additional injuries to the hand. In addition to workers’ compensation Specific Loss benefits for the loss of the finger, the injured worker may also be entitled to wage loss benefits due to the disability resulting from the additional separate and distinct injuries to the hand. As with all aspects of your workers’ compensation claim, it is very important that the official legal documents concerning the nature of your work injuries and the extent of your disability be prepared carefully to accurately reflect the different types of compensation benefits that you are entitled to.

14Q. Even though I've received wage loss benefits, is my employer's workers' compensation insurance company required to pay me separate additional compensation for scars or other disfigurements resulting from my work injuries (including surgical scars)?
A. Yes. As referenced above, “Disfigurement Benefits” are a type of workers’ compensation Specific Loss benefit. Disfigurement benefits are payable to injured workers who sustain permanent burns, scarring, discoloration, or other disfigurement of the head and neck only.

You are entitled to disfigurement benefits if your disfigurement is a direct result of an acute injury, such as a blow to the head resulting in lacerations that leave permanent scars or other disfigurement. It is important to emphasize that you are also entitled to disfigurement benefits if your scarring or other disfigurement is the result of surgical procedures or other medical treatment undergone for your work injury that causes you to have scars, discoloration, or other disfigurement of the head and neck.

15Q. Am I entitled to compensation for my partial hearing loss due to exposure to loud noise at work?
A. Yes. Injured workers who sustain a permanent total or partial loss of hearing as the result of exposure to long term hazardous occupational noise may be entitled to “Hearing Loss benefits,” a type of workers’ compensation Specific Loss benefit.

In addition, injured workers who sustain a permanent partial or total loss of hearing which is not caused by long term exposure to occupational noise but is the result of other work related causes such as acoustic trauma or head injury, may also be entitled to workers’ compensation hearing loss benefits.

For each of these situations, to be compensable, the level of hearing impairment in both ears as calculated under the American Medical Association’s Guides to the Evaluation of Permanent Impairment must be greater than ten percent (10%). A three (3) year statute of limitation exists for filing a hearing loss claim that begins to run immediately after the last date of the injured worker’s exposure to hazardous occupational noise with his or her employer.

16Q. Are my family members and dependents entitled to compensation if my work injuries or illness prove fatal?
A. Yes. As referenced above, a work injury resulting in an injured worker’s death is compensable provided that death occurs within three hundred (300) weeks from the date of the injury.

In this situation, the class of dependents that generally may be entitled to workers’ compensation “Death Benefits” includes the widow, widower, children, parents, and brothers and sisters. It is important to note that the class of children covered in this regard includes both legitimate and illegitimate children, as well as adopted children and children to whom the injured worker decedent stood in loco parentis and children of the injured worker born after the injured decedent’s compensable fatal work injury.

Also, as indicated above, the Pennsylvania Workers’ Compensation Act provides a schedule of workers’ compensation death benefits as applicable to the particular classes of the injured worker decedent’s family members and dependents.

17Q. How can I make sure the attorney I select to represent me on my workers' compensation claim is a skilled workers' compensation attorney?
A. It is very important that the attorney that you choose to represent you in your workers’ compensation claim is a skilled and experienced workers’ compensation attorney. As emphasized above and below, the Pennsylvania Workers’ Compensation Act, the applicable Departmental Rules and Regulations, and the interpretive case law are significant, complex, and subject to frequent change. You can be certain that your employer’s insurance company may have attorneys working for the company against you that are skilled in the area of workers’ compensation insurance defense. You owe it to yourself to obtain representation by a skilled workers’ compensation attorney, which should give you the best chance of obtaining a favorable result in your workers’ compensation claim.
18Q. Even if I am already receiving workers' compensation benefits for my work injuries, unless I have received definitive confirmation from my workers' compensation attorney, should I assume that my employer's insurance company has formally and properly accepted liability for my work injuries?
A. No. As referenced throughout this section, it is very important that the official legal documents concerning the nature of your work injuries and the extent your disability be prepared carefully to accurately reflect and acknowledge the insurance company’s acceptance of your workers’ compensation claim and the types, amounts, and duration of compensation benefits that you are entitled to.

It is not uncommon for an insurance company to prepare and issue no official legal documents at all concerning your claim, despite the insurance company’s legal responsibility to do so. It is very common for insurance companies to prepare and issue official legal documents that do not accurately reflect and acknowledge the insurance company’s proper acceptance of your claim and the types, amounts, and duration of compensation benefits to which you should be entitled.

The only way that you can be sure that the official legal documents concerning your workers’ compensation claim have been properly prepared and filed by the insurance company is to have your claim thoroughly reviewed by a skilled workers’ compensation attorney.

19Q. How long may I wait to formally file a claim with the Bureau of Workers' Compensation for my work injuries?
A. You have three (3) years from the date of the occurrence of your work injury to file a claim with the Bureau of Workers’ Compensation for your work injuries. Unless liability for your work injury has been legally accepted by your employer’s insurance company, if you do not file a claim with the Bureau of Workers’ Compensation for your work injury within three (3) years of the occurrence of your work injury, you will lose all of your rights and entitlements under the Pennsylvania Workers’ Compensation Act for the specific work injury at issue.

Filing a claim with the Bureau in this regard does not mean simply notifying your employer and its insurance company of your work injury or merely submitting an accident report to your employer and its insurance company. “Filing a claim within three (3) years” means filing a detailed and descriptive Claim Petition with the Bureau of Workers’ Compensation within three (3) years of the occurrence of your work injury, which begins the process by which a Workers’ Compensation Judge will decide your case.

20Q. Should I sign any forms or documents regarding my workers' compensation claim, which are sent or given to me by my employer or my employer's workers' compensation insurance company, without first having my workers' compensation attorney review them?
A. No. You should not sign any document regarding your workers’ compensation claim without first having your workers’ compensation attorney review it to make sure that the document is relevant, and is legally and factually correct.

Any document that you sign pertaining to your workers’ compensation claim will most likely affect the nature, amount, and duration of benefits to which you may be entitled. Even if a document would appear on its fact to be factually accurate, signing the document may have legal implications that are adverse to your workers’ compensation claim which need to be explained to you by your attorney. By signing a document that adversely affects your claim, you may substantially alter the leverage between you and your employer, and place you in a situation where it may take a year or longer to remedy the situation, if the situation can be remedied at all. Don’t sign anything!

21Q. Is my employer's workers' compensation insurance company required to pay me a lump sum settlement for future compensation for my work injuries?
A. Your employer/insurance company is not legally required to pay you a lump sum settlement for future compensation for your work injuries. You cannot force a settlement in this regard on them, and likewise, they cannot force such a settlement on you.

However, in many cases, the employer/insurance company and the injured worker can reach an agreement on the terms of future payment of compensation. A lump sum settlement for future compensation for your work injuries, also referred to as a Compromise and Release Agreement, is the result of a mutual agreement between you and the employer/insurance company as to the nature and extent of the future compensation that you will be paid as compensation for your work injuries. This type of settlement agreement is usually arrived at after a series of negotiations take place between you (through your workers’ compensation attorney) and the employer/insurance company, and the settlement agreement and its terms are only finalized after a hearing before a Workers’ Compensation Judge and the Judge’s approval of the settlement agreement.

It is not a matter to be taken lightly, and you should have a skilled workers’ compensation attorney represent you in pursuing and obtaining your workers’ compensation lump sum settlement for future compensation to make sure that you are properly compensated for your work injuries and that you are not unknowingly waiving any of your rights.

22Q. If I am receiving workers' compensation wage loss benefits, may I also file to receive social security disability benefits?
A. Yes. If your medical disability (including all disabilities, not just your work injury) is severe enough to support a determination that you are disabled from all substantial gainful employment for a period of at least six (6) months, you may be entitled to Social Security Disability benefits from the Social Security Administration.

The amount of Social Security Disability benefits to which you may be entitled will depend on the amount of other income you may have, including your workers’ compensation wage loss benefits. However, your qualification for and receipt of Social Security Disability benefits will have no adverse effect on your workers’ compensation claim, and you should not hesitate to apply at the Social Security Administration field office closest to your home. You are not required to have an attorney represent you in Social Security Disability proceedings, but it is strongly recommended that you also have representation in this regard.

Since workers’ compensation attorneys routinely have many clients that qualify for both Social Security Disability benefits and workers’ compensation benefits, and are therefore familiar with this process, your workers’ compensation attorney may be able to assist you in this regard.

23Q. May my employer terminate my employment, punish me, or retaliate against me for pursuing a workers' compensation claim?
A. No. Although different rules may apply depending on the existence of an employment contract between an employee and employer, generally, an employer may not terminate your employment, punish you, or retaliate against you specifically for filing and pursuing a workers’ compensation claim for injuries occurring in your employment. An employer who engages in such conduct may be subject to an unlawful discharge claim and/or other remedial action brought by the injured worker on the basis of such employer conduct.
24Q. Do I have a right to sue third parties for their negligence or wrong doing which cause my work injuries?
A. Yes. Often times, an injury that occurs during the course of employment is the result of some negligence or wrongdoing by a third party.

For example, if you are injured in an automobile accident, and a third party who is not your employer or co-employee is solely or partially at fault, you may have a right to claim and recover damages separate from your workers’ compensation benefits. Also, if you are injured due to a hazardous condition on premises in the possession and control of a third party who is not your employer or co-employee, you may have a right to make a claim for damages separate from your workers’ compensation benefits. In addition, if you are injured due to a defect in equipment which was manufactured or maintained by a third party who is not your employer or co-employee, you may have a right to recover damages separate from your workers’ compensation benefits.

Also, if you are injured due to medical negligence for injuries you sustained in a work-related injury, you may have a right to recover damages from the medical professional who committed the medical negligence.