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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How can I avoid payment delays or denials?
Although it is the insurer’s responsibility to investigate and process your claim within 21 days of the date that you provide notice to your employer of your work injury, the 21-day deadline is frequently missed. If you want to ensure speedy claims handling, you should obtain copies of your medical records from your physician and send them directly to your adjuster. You should send these records to the adjuster even if you are being treated by an American Airways physician. Contact our office immediately concerning your rights and responsibilities if the 21-day deadline is missed.
To ensure that medical bills are paid, your doctor should submit bills in an organized and timely fashion. The bills must be made either on the HCFA 1500 form or the UB42 form (HCFA 1450), which your doctor or medical provider should already have. The bills should contain complete and adequate information, including correct names, dates and treatments, services provided, and cost of treatment. Finally, a “Medical Report Form,” should accompany the bills. Call us at (215) 259-5879 to oget copies of the required forms.
If your claim has been accepted, the insurance company is obligated to pay bills within 30 days of receipt. If the bills are not paid within 30 days, your doctor or other medical provider should file a petition with the Bureau of Workers' Compensation for payment.
If the insurer denies your claim or refuses to pay some or all of your medical bills, you may be able to use your health insurance coverage. Your physician may obtain free assistance regarding payment for the treatment rendered to you by calling (215) 259-5879 and asking to speak with an attorney at our office.
How much will I receive in wage loss benefits?
All Pennsylvania-based flight crews who are injured in work accidents are entitled to workers' compensation wage benefits pursuant to the Pennsylvania Workers’ Compensation Act. This portion is generally two thirds of the average weekly wage you earned in the year prior to your injury and is tax free. Your workers’ compensation wage loss benefits are calculated by adding up the wages from all sources of employment. Accordingly, if you work for more than one employer, you should gather your wage stubs for a full year preceding the date of injury. You may also be entitled to Salary Continuation benefits pursuant to Section 27 of the American Airlines/APFA contract, which is discussed in response to another frequently asked question.
Under the Pennsylvania Workers' Compensation Act, you are entitled to continue to receive workers' compensation benefits even after your right to salary continuation expires. Although your workers' compensation benefits are tax-free, the "salary continuance" portion is taxable. You may have to file a grievance under your contract if the company pays workers’ compensation benefits but refuses to pay salary continuation. A workers’ compensation judge does not have the power to order American Airlines to comply with the contract.
When am I entitled to receive benefits?
Under the Workers' Compensation Act, you are entitled to receive reimbursement for all reasonable and necessary medical expenses that are causally related to your work injury, regardless of whether you have lost time from work. These expenses are payable pursuant to a schedule set forth in the Workers' Compensation Act. You are entitled to receive wage loss benefits only if you are disabled for seven days or more, including weekends. It is not necessary that these days be consecutive. To receive compensation for the first week, you must be disabled for 14 dys or more. The carrier has 21 days from the date your disability begins to begin paying wage loss benefits. Salary Continuance beneifts paid pursuant to section 27(D) of the contract are offset by workers' compensation benefits.
A medical provider providing treatment for a work injury covered under Pennsylvania law may only bill the workers' compensation insurance company for these services and is not legally entitled to bill you for treatment for your work injury. When treating with a medical provider outside of Pennsylvania, discuss billing prior to beginning treatment. Although the Pennsylvania Bureau of Workers’ Compensation takes the position that Pennsylvania law binds medical providers outside the state, such providers may refuse to honor the law and might bill you for the difference between their normal charge and the amount paid by the workers’ compensation insurance company.
Do I have to be treated by a company physician?
Under the Workers’ Compensation Act, "[i]f your employer has posted a list of six or more physicians or health care providers in your workplace, then you are required to visit one of them for initial treatment. You are to continue treatment with that provider or another on the list for a period of 90 days following the first visit." If you do not seek treatment with a company physician, the workers’ compensation insurance company will not pay the medical bills that you incurred during those 90 days.
You are perfectly free to be treated by any medical provider at any time, but you may be responsible to pay the provider’s bills during this 90-day period if the provider is not on the company's list. To obtain a copy of "Physicians’ List Defined," contact our office. Please note:
- You have a right to choose from among the physicians or medical providers on the list.
- The company does not have the right to require you to be treated by a particular physician or medical facility.
- You have the right to switch to other providers on the list at any time during the 90 days.
- You have no obligation to inform the company that you are switching to another provider on the list, though you may wish to inform the claims representative.
Our law firm has been monitoring treatment received by American Airlines employees from physicians on the physicians list. If you wish, you can call us directly to obtain information concerning the past experience of flight attendants dealing with some of the physicians on this list. This service will be provided to you at no charge.
What do I do if I think I am injured?
The first step is to get medical attention as soon as possible and contact your supervisor. For emergencies during off hours, contact crew scheduling. They will put you in touch with a supervisor on duty.
From this point forward, take extensive notes and retain copies of all forms and correspondence. If possible, take photographs and seek medical attention within 24 hours of the incident. Even if you do not think you need a doctor, file an incident report to document the event and get the names and phone numbers of any witnesses.
What will happen if I refuse to sign a Final Receipt or Supplemental Agreement?
Sometimes nothing. However, your employer has the right to file a Notice of Suspension of Benefits when you return to work at wages equal to or greater than your pre-injury wages. In filing this notice, your employer or your insurance company must send written notice of the suspension to you. Once you have received notice of suspension, you have 20 days to file a challenge to the notice. If you do not do so, the notice of suspension will have the same effect as a Supplemental Agreement, and your benefits will be suspended.
What information am I obligated to report to the insurance company?
You must report employment and self-employment information to the insurer when you are seeking or receiving compensation. You are also obliged to cooperate with efforts by your employer or its insurance company to investigate employment, self-employment, wages, and physical condition. You may be required to complete forms that provide this information. If you fail to return these forms to the insurance company within 30 days of receipt, your benefits may be suspended until you provide the requested information.
Must I sign any forms once I return to work?
Your employer may ask you to sign a document called a Final Receipt when you return to work. If you sign a Final Receipt, you admit that all disability related to your work injury has ceased. Signing that document can have drastic consequences if your injury recurs or if you are laid off from your new lighter duty job. Therefore, if you continue to suffer from your work injury despite your ability to return to work in some capacity other than your time of injury job, you should insist upon signing only a document called a Supplemental Agreement. A Supplemental Agreement will act to suspend or modify your benefits but will not constitute an acknowledgment that you have fully recovered. The Supplemental Agreement should also set forth a modified benefit rate if you have returned to work at less than your pre-injury wages.
What happens if I recover enough from my work injury to be able to return to some type of employment?
Once you are disabled as a result of a work injury, the Pennsylvania Workers’ Compensation Act presumes that you remain totally disabled from all forms of employment unless or until your employer offers you employment that is consistent with your medical restrictions or the employer legally establishes that you are partially disabled.
If you are released to return to work after you have suffered a work injury, it is essential that you speak with your physician about whether you have any activity restrictions. If there are restrictions that have been placed on you because of your work injury, you may be entitled to receive partial disability. Partial disability benefits are equal to two thirds of the difference between your pre-injury average weekly wage and your return to work wages, up to a maximum of 500 weeks.
Am I required to submit to a vocational interview?
For individuals who have suffered injuries after June 24, 1996, the Act grants employers the right to insist that you undergo a vocational interview. However, you should not undergo an interview unless an attorney represents you and is present for the vocational interview. Generally, your employer or its insurance company will request a vocational interview as the first step in an attempt to relieve itself of the obligation to pay wage-loss benefits to you. Therefore, it is essential that you have secured the services of an experienced workers’ compensation attorney before participating in a vocational interview.