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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Can my employer require me to use my leave under the Family and Medical Leave Act (FMLA) while I receive workers' compensation benefits?
Yes. Under the Family and Medical Leave Act, certain employees are entitled to 12 weeks of unpaid leave during any 12‑month period, if you have worked a sufficient amount of time worked to qualify for the benefit and your employer is large enough to be subject to the Family and Medical Leave Act. Though the Family and Medical Leave Act provides for unpaid sick or family leave, employers may require you to take FMLA time while you are out on a workers' compensation injury leave. Keep in mind that if you exhaust your FMLA time while on workers' compensation, your employer does not have the obligation to offer you your job back, unless you are covered by a union contract or employment contract that provides otherwise. For more information on Pennsylvania Workers' Compensation and the Family and medical leave Act, click here.
Should an attorney who has settled the wage-loss portion of a Pennsylvania workers' compensation claim continue to represent a claimant in dispute over medical treatment?
Yes. Unfortunately, however, there are many firms that refuse to perform any work on behalf of an individual once they have settled the wage-loss portion of a claim. With open medical coverage, the insurance company still has the right to challenge the reasonableness and necessity of medical treatment. There are times when insurance companies will just stop paying medical expenses without any basis to do so. If you're represented by the type of firm that takes the money and runs, you may be out of luck.
I am a retired airline employee collecting my PBGC pension and paying for COBRA benefits. Do I have to pay my entire premium?
No. For all American Airlines and US Airways flight attendants and other eligible airline personel between the ages of 55 and 65 years old who are collecting their pensions through the Pension Benefit Guarantee Corporation (PBGC), they can take advantage of the Health Coverage Tax Credit (HCTC), which pays 72.5 percent of qualified health insurance premiums for eligible individuals and their families.
This is how it works. If you are collecting your PBGC pension and you are paying premiums for your health insurance coverage, you will be required to pay 27.5 percent of the premium and the IRS will give you a tax credit equal to 72.5 percent of the cost of your premiums. If, for example, your health insurance premiums are $20,000.00 a year, you would get an IRS tax credit equal to $14,500.00, which is deducted dollar for dollar from any federal taxes you owe.
The credit can be taken only if you are receiving your PBGC pension or you are a qualifying family member of a PBGC pension payee who passed away or finalized a divorce with you.
The health insurance plans that qualify for the HCTC include coverage under a COBRA continuation provision, coverage under a group health plan available through the employment of your spouse, coverage obtained in the non-group (individual) health insurance market other than coverage offered through the health insurance marketplace, and coverage under certain state-qualified health plans established prior to January 1, 2014. It does not include any insurance marketplace coverage.
As a practical matter, this means that flight attendants who are receiving COBRA coverage and are collecting their PBGC pensions may take advantage of this credit for as long as they are receiving COBRA coverage. They may be able to do so after COBRA expires, but only if they are then covered under a qualifying health insurance plan for the HCTC. For more information concerning the health coverage tax credit, click here.
May American Airlines Flight Attendants be disciplined for time lost from work due to a work injury (OJI)?
Answer: No. Section 27 (M) of your contract provides that a "Flight Attendant who becomes ill or injured as a result of an occupational incident shall not be charged a sick leave occurrence for absences related to the occupational illness or injury."
What are the most common work injuries?
Most surveys show that the most common injuries are caused by overexertion associated with lifting, holding, carrying, pushing, pulling or throwing.
The remainder of the list is as follows:
2. Falls to the ground.
3. Falls from one level to another, such as from roofs, ladders and stairways.
4. Injuries resulting from tripping or falling without hitting the ground.
5. Getting struck by objects or
6. Getting struck against an object.
7. Automobile collisions.
8. Compression injuries caused by machinery in a factory.
9. Repetitive motion injuries, including carpal tunnel syndrome, which affects the hand, and cubital tunnel syndrome, which affects the elbow.
10. Assaults and violent acts.
What are the non-medical requirements a claimant must meet to be entitled to Social Security Disability benefits?
To qualify for Social Security Disability benefits, the claimant must have worked the required number of quarters and paid required social security taxes for generally five to ten years.
If I collect unemployment compensation benefits, will it hurt my application for Social Security disability benefits?
To be eligible for unemployment compensation benefits, you must be ready, willing and able to work. To be eligible for Social Security disability benefits, you must be disabled from all forms of employment. Claimimg that you are ready, willing and able to work is inconsistent with a simultaneous claim that you're disabled from all employment.
There are situations in which an application for unemployment compensation benefits is consistent with an applicant for Social Security disability benefits. If you are capable of working light duty work only and are 55 or older, you could be found disabled using rules from the Social Security Medical-Vocational guidelines.
Some administrative law judges understand that people need money to live and are willing to forgive an inconsistency between a claimant's receipt of unemployment compensation benefits and their application for Social Security disability benefits. Many judges, however, are not particularly impressed by application for Social Security disability benefits when the only reason you are not working is you were laid off because of a lack of work or a plant closing. Under the law, receipt of unemployment compensation benefits is not conclusive proof that you are not disabled. Nonetheless, you need to understand that if you apply for and receive unemployment compensation benefits (and you are not entitled to Social Security disability benefits under the medical vocational guidelines), a judge may view your receipt of unemployment compensation benefits as evidence that you are not disabled.
Will my Pennsylvania workers' compensation benefits always be reduced if I am receiving Social Security Disability benefits?
No. Eventually your entitlement to Social Security Disability benefits will expire and you will be entitled to receive full retirement benefits.
Effective December 15, 2015, your entitlement to Social Security Disability benefits will end on your 67th birthday. At that time you are entitled to full retirement benefits. How will that affect my Pennsylvania workers' compensation benefits? Under Pennsylvania law, your employer or its insurance company is entitled to reduce your workers' compensation benefits by an amount equal to 50 percent of your Social Security Retirement benefits, provided you were not already receiving Social Security Retirement benefits at the time you suffered your work injury.
Let's assume that as a result you begin receiving Social Security Retirement benefits after you suffer your work injury. Once again assume that you have an ACE of $4,000.00, a PIA of $2,200.00, and retirement benefit of $2,200.00. (For an explanation of these terms, see the prior FAQ).
The workers' compensation insurance company will be entitled to reduce your workers' compensation benefits by $1,100.00 monthly, reducing your weekly workers' compensation benefits from $500.00 to $246.15 weekly. You will thereafter be entitled to $1,066.67 in monthly workers' compensation benefits and $2,200.00 in monthly Social Security Retirement benefits (weekly workers'' compensation benefits $246.15 times 52 equals $12,800.00 in yearly workers'' compensation benefits divided by 12 equals $1,066.67 in monthly workers'' compensation benefits plus $2,200.00 Social Security Retirement benefits equals $3,266.67 in combined workers' compensation and Social Security Retirement benefits).
I have been approved for Social Security Disability benefits. How will this affect my Pennsylvania workers' compensation benefits?
Under Federal law, the Social Security Administration is entitled to reduce your Social Security Disability benefits for workers' compensation benefits you receive, but this is not a dollar-for-dollar offset.
To calculate the reduction in Social Security Disability benefits that may result from an award of workers' compensation benefits, you need to contact your local Social Security office to get two numbers: your ACE (Average Current Earnings) and your PIA (Primary Insurance Amount).
Your combined entitlement to workers' compensation benefits and Social Security Disability benefits is not supposed to exceed 80 percent of your ACE. Your PIA is the maximum you are entitled to receive in disability benefits.
For example, let's assume you have an ACE of $2,300.00, a PIA of $1,500.00, and you have been awarded workers' compensation benefits of $500.00 per week. Your monthly workers' compensation benefits equals $2,166.67 (workers' compensation benefits $500.00 weekly times 52 weeks equals $26,000.00 divided by 12 months equals $2,166.67). Because 80 percent of your ACE is $1,760.00, there would be a complete offset of your Social Security Disability benefits and you would not receive any Social Security Disability benefits while you continue to receive worker's compensation benefits of $500.00 weekly.
Let's suppose instead that your ACE was $4,000.00 per week, your PIA was $2,200.00, and you have again been awarded $500.00 in workers' compensation benefits.
In this instance, 80 percent of your Average Current Earnings equals $3,200.00. You are receiving $2,166.67 in monthly workers' compensation benefits, and thus you would be entitled to additional benefits of $1,033.33 in Social Security Disability benefits (80 percent of $4,000.00 equals $3,200.00 minus monthly workers'' compensation benefits $2,166.67 equals $1,033.33).
You are obviously not receiving the maximum that you would be entitled to receive under the Social Security Act if you weren't receiving workers' compensation benefits, but you're earning more than you would get if you qualified only for Social Security Disability benefits or only for workers' compensation benefits.
For more information from the Social Security Administration, click here.
May I submit medical bills to my health insurer if my workers' comp claim is denied?
Yes. The health insurance company may, however, require some type of documentation that the claim has been denied. If you have received a Notice of Workers’ Compensation Denial, send it to your health insurance company or give it to your medical provider with instructions to send it to the health insurer with the bill. If you have not received a denial, contact the Workers' Comp insurance company to get a written denial of the claim. Once the health insurance company has received evidence of a denial, it will be responsible for payment of medical bills in accordance with the terms of the health insurance contract. If your health insurance requires you to treat within a netwok, you must get this issue clarified as soon as possible to avoid being charged out-of-network prices for medical treatment that should have been paid by the workers' compensation inusrance company.