Find the Answers to Your Pennsylvania Workers’ Compensation and Disability Benefits Questions
Most people navigating the workers’ compensation and disability benefits application processes come to us with questions and confusion. Here, we share some of the questions that we answer most about the disability and workers’ compensation application and appeals processes. If you have a question for us, check out this page to see if we have answered this question for others!
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May I sue my employer for negligence?
In general, your employer is immune from liability for negligence causing a work injury, though there are exceptions. Accordingly, you may only receive benefits under the Workers' Compensation Act. However, you may be able to sue other people or companies that are responsible for those same injuries.
My employer filed a petition against me. What happens next?
Every petition filed with the Bureau of Workers' Compensation is assigned to a workers' compensation judge. It is crucial that you retain the services of an experienced workers’ compensation attorney to represent you at that point, if you have not already done so. The workers' compensation lawyers at The Boles Firm have been representing claimants before workers' compensation judges for many years. Our specialized experience and knowledge will be vital in ensuring that you are successful in combating the employer's attempts to limit your right to ongoing benefits.
In general, there will be a series of hearings in which evidence in the case will be presented. If your employer has filed a petition to terminate, modify, or suspend your benefits, the judge will ordinarily take the employer’s written evidence at the first hearing in the case. The judge will then consider the employer's motion for suspension or modification of your benefits pending the final outcome of the case. It is crucial that you produce evidence at that hearing, or your benefits will be modified within a matter of weeks. Only an experienced workers' compensation attorney, such as the attorneys at The Boles Firm, can properly prepare the evidence needed to combat the employer at that point.
Further hearings will be scheduled in order to collect evidence from you and your employer. At a final hearing, you will testify. All through the process, you will need an experienced workers' compensation attorney to represent your interests.
What should I do if my claim is denied?
If your claim is denied, you have three years from the date of injury to file a claim petition for workers' compensation benefits. If you do not file the petition with the Bureau of Workers' Compensation within the time period required by law, you will lose forever your right to receive benefits. Under most circumstances, you should seek the assistance of an attorney in pursuing a claim for benefits.
My claim was denied. I have no income and no savings. What should I do?
If you are disabled and have children under the age of 18, have a very limited family income, and have few liquid assets, you may be eligible for temporary assistance to needy families through the Department of Public Welfare.
Adults without children must rely on general assistance benefits. Applications are made through the Department of Public Welfare or the County Board of Assistance. Food stamps may be available to supplement the money available for buying groceries and some household goods.
You may also be eligible for Medicaid and/or Medicare benefits to cover medical expenses. Medicaid is administered by the Department of Public Welfare. Medicare is administered by the Social Security Administration, but is only available to retired workers or persons receiving Social Security disability benefits for two years or more. For more information, download a copy of Battered and Broke: Making Ends Meet While Your Workers' Comp Claim is Denied.
May the parties settle a workers' compensation claim?
The Act permits employer and injured workers to settle claims for workers' compensation benefits, including medical expense benefits, and in the final analysis, unless an employee is fully recovered, most cases do settle. The issue is one of timing and amount. For example, if your treating doctor has recommended surgery, the insurance company may try to get you to settle your claim in the hopes of avoiding liability for the proposed treatment. However, you need to be very careful before settling the medical expense portion of your claim if you still require significant treatment, as any subsequent medical insurance company may refuse to pay for the treatment, claiming that it was part of your work injury. If your treating physician has concluded that your condition is permanent, the insurance company may try to get you to settle your claim, and the main issue for which you really need an experienced attorney is to figure out what a fair settlement would be.
If I am receiving total disability benefits and I am not working, is there any way that my employer or its insurance company can demonstrate that I am only partially disabled?
For injuries occurring after June 24, 1996, if the insurance company receives medical evidence that indicates that you are capable of returning to perform some form of work, you may receive a form entitled “Notice of Ability to Return to Work.” This document states that you have an obligation to look for available employment, that proof of available employment may jeopardize your right to receive ongoing benefits, and that you have the right to consult with an attorney to obtain evidence to challenge the insurer's contentions.
To reduce or eliminate your workers' compensation benefits, the insurance company must establish that you have “earning power.” The Workers’ Compensation Act states that earning power is to be determined by analyzing work that you are capable of performing and will be based upon expert opinion evidence, including job listings with agencies of the Department, private job placements, agencies, and advertisements.
Your disability will be considered “partial” if you are able to perform previous work, or considering your residual “productive skill, education, age, and work experience, can engage in other substantial gainful employment which exist in the usual employment area where you live in Pennsylvania.” The Act also states that if the employer has a job that you are capable of performing, it must be offered to you.
Are there any additional benefits available to injured government employees?
There are a number of state statutes and local ordinances which impose upon governmental entities the obligations to pay benefits to employees who have suffered work injuries. The two most commonly invoked statutes are the Heart and Lung Act and Act 534. Under both the Heart and Lung Act and Act 534, the injured employee is paid a full salary.
The Heart and Lung Act applies to all state police and enforcement officers; investigators of the Pennsylvania Liquor Control Board; enforcement officers and investigators of the Pennsylvania Board of Parole; members of the Delaware River Port Authority; and police, firefighters, or park guards of any county, city, borough, town, or township injured in the performance of duties. If you qualify, these benefits are available for any temporary incapacity. Benefits are not available if you are permanently incapacitated.
Act 534 covers employees of a state penal or correction institution under the Department of Corrections and employees of a state mental hospital or youth development center under the Department of Public Welfare.
The Act covers injuries that occur during employment by an act of any person confined in such an institution, or by any person who has been committed to an institution by any Court of the Commonwealth, or pursuant to any provision of the Mental Health Act. With respect to any employee of the County Board of Assistance, the injuries are covered if they result from the Act of an applicant or recipient of public assistance. Under Act 534, the injured employee is entitled to receive benefits until he or she returns as an employee of the respective department or institution at a salary equal to that earned at the time of the injury. Act 534 benefits are also available for the widow or widower and minor dependents of any employee who dies within one year as a result of an injury.
How are wage-loss benefits calculated?
Wage-loss benefits are calculated by analyzing the four 13-week periods preceding the date of your injury. The calculation is based on wages and other compensation from all forms of employment. Accordingly, if you have a second job, those wages are included in calculating your benefits. The average weekly wage is calculated by averaging your wages during the three highest 13-week periods; a different calculation may be used if you have worked less than 39 weeks. You are entitled to receive approximately two thirds of your pre-injury average weekly wage up to a statewide maximum that increases every year. Low-wage employees may be entitled to receive more than two thirds. Unfortunately, your wage-loss benefits are fixed at the date of injury and do not increase to reflect inflation or wage increases you otherwise would have received had you not been injured.
Can I use my sick time while my claim is being reviewed?
Because it takes several weeks to process the claim, it is generally reasonable to use accumulated sick time. Your employer, however, may have a policy that prohibits you from using your sick time. Alternatively, you may be required to repay your sick time if your claim is accepted.
May my employer pay me wage-loss benefits without accepting responsibility for my claim?
If your employer issues a Notice of Compensation Payable in connection with your work injury, it formally accepts responsibility for your claim and must continue paying wage-loss benefits unless certain conditions are met. An employer may, however, pay wage-loss benefits to you for up to 90 days without formally accepting responsibility for the claim. To do so, the employer must file a Notice of Temporary Compensation Payable. The employer has the right to stop making payment of wage-loss benefits at any time following the issuance of a Notice of Temporary Compensation Payable by issuing a Notice Stopping Compensation Benefits. However, if benefits are paid for a period longer than 90 days, the employer automatically accepts responsibility for your claim.