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 my employer recover an overpayment they made to me without my permission?
Recoupment of Overpayments from Workers' Compensation Benefits
Under the Pennsylvania workers‘ compensation act, employers are permitted to reduce Workers' Compensation benefits for one half of Social Security retirement benefits that are collected under an award granted after the work injury occurred, pension benefits, severance pay, unemployment compensation benefits and wages from employment or self-employment. Injured workers may receive reporting forms that require them to disclose the receipt of such benefits. If the insurance company is entitled to reduce the injured worker’s benefits because they are collecting these types of benefits, the injured worker may receive a Notice of Workers' Compensation Benefit Offset. This notice may also state that the insurance company intends to recoup overpayments made to the employee during a period when the employee employee was receiving these types of benefits while the insurance company was paying full Workers' Compensation benefits. Where recoupment causes a financial hardship, the terms of the recoupment may be modified by a judge, but in general an overpayment of less than six months will not be enough for a claimant to ask a judge to inquire into the hardship.
Recoupment of Overpayments from Wages
Deductions from wages permissible under Pennsylvania law are governed by the Pennsylvania Wage Payment and Collection Act, 43 P.S. § 260.1 et. seq. The Act provides that wages are to be paid on a regular pay day in full except for deductions provided by law or as authorized by regulation of the Department of Labor and Industry for the convenience of the employee. Regulations passed by the Department of Labor do not specifically permit the deduction of anything from wages to collect a prior overpayment. Any such deduction would have to be authorized by the employee in writing and/or authorized by the Department of Labor and Industry pursuant to 34 PA. Code. § 9.1(13).
This is different from garnishment, which is the process by which creditors obtain a court order permitting the deduction of all or a portion of an employee's wages to satisfy a debt that has been reduced by court order to a judgment. Without a court order, no garnishment is permissible.
If you are overpaid Workers' Compensation Benefits, your employer is supposed to comply with this act if your employer is trying to collect the overpayment from wages. In Most circumstances, the employer will not attempt to collect an overpayment after you return to work but the insurance company may seek to recoup overpayments if your benefits are reinstated.
Must I sign an authorization to release medical records to the insurance company if I've suffered a work injury in Pennsylvania?
Under Pennsylvania law, injured workers have an obligation to help the insurance company investigate their claims, which means that you must provide the insurance company with medical records proving you are disabled due to a work injury. Although the Health Insurance Portability and Accountability Act (HIPAA) ordinarily protects the privacy of medical records, it does not apply to medical records sent to an insurance company regarding a work injury.
Because it is in your interest to ensure that the insurance company has medical proof that you suffered a disabling work-related injury, you need to do everything you can to get medical records supporting your claim to the insurance company as quickly as possible. This may mean that you are better off signing a medical records authorization.
You should, however, take a careful look at the authorization. The authorization may give the insurer or the insurer's representative the right to speak directly with your medical providers. This is not a wise idea. The authorization may grant the insurance company the right to send a vocational nurse to your medical evaluations. You should avoid signing a document that allows them to do so.
The most common problem that we see in medical records authorizations issued by workers' compensation insurance companies in Pennsylvania is their wide scope. For example, many authorizations permit the insurance company to obtain copies of HIV/AIDS, drug and alcohol abuse, and psychological treatment records.
We always tell people not to authorize the insurance company to obtain such records. If necessary, you should cross out the portions of the authorization that permit the recovery of such records, initialing the sections that you crossed off. When your psychological condition is not at issue, requests to obtain copies of your psychological records are particularly reprehensible. Any information contained in the records the insurance company obtains will be used against you. The last thing you want to do is permit the insurance company to obtain records that document a sexual affair, alcoholism, drug use, history of psychological problems, or personal difficulties in your life.
On the other hand, you do not want to make the authorization too narrow. If you do not care about the production of medical records, it makes little sense to get into a dispute with the insurance company over these records. Furthermore, the insurance company is entitled to, at least some extent, determine whether you are disabled for reasons unrelated to the work injury. Finally, the insurance company is legally entitled to know about your past medical history as it pertains to the work injury that you suffered.
When signing a medical records authorization, use your common sense.
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).
May I still receive benefits if I do not meet the earnings test of the Social Security Administration?
Yes. You may be entitled to Supplemental Security Income (SSI) benefits. To qualify for these benefits in Pennsylvania, you have to have very little income and very few assets. The value of everything you own may not be more than $2,000.00 if you’re single or $3,000.00 if you’re married, though the value of your home does not count in determining eligibility. You will also have to apply for any other benefits that are available to to receive SSI benefits. In general, these benefits are quite low.
I have not worked in many years. Can I qualify for Social Security disability benefits?
There are earnings requirements that must be met in order for someone to qualify for Social Security disability benefits. If you are 31 or older, you have to work five years out of the ten-year period ending with the quarter before your disability began. If you become disabled under the age of 31, different rules apply.
Furthermore, to be eligible for benefits, you must have worked a total of 1.5-to-9.5 years during your lifetime. The amount that you need to have worked under the “duration of work” test increases with age.
Can I receive compensation for more than medical expenses and wages?
Yes, a personal injury claim can include damages for a wide range of issues. While injuries are physical, claims can be made for numerous emotional and relational damages. You may pursue compensation for loss of companionship, emotional distress or mental anguish, or wrongful death (loss of a loved one).
What does "assumption of risk" mean?
A defendant can try to prove that a plaintiff suffered injuries under an assumption of risk. This means that they should not be given as much or any compensation due to their personal negligence. It contends that a plaintiff assumed risk due to discovering the danger and disregarding it, failing to properly maintain the item that caused damage, or ignoring provided directions.
I have been accused of contributory negligence. What does that mean?
When a plaintiff is accused of contributory negligence, it means that the defendant is claiming that they contributed to their own injuries in some manner due to their own negligence.
How will negligence be determined in my case?
Negligence can manifest in many different ways depending on the type of case. It does not simply mean acting in a reckless manner, but could also include failing to act or correct a problem .
The following must exist for an act to be deemed negligent:
- Breach of duty
- Failure to provide reasonable care
- Injuries to a victim or victims
- Knowledge that the injuries would or could occur
- Additional damages
Can I receive compensation for pain and suffering?
When an individual's injuries are severe, their damages from a personal injury accident can go beyond physical pain. Pain and suffering damages can be awarded over and in addition to medical costs, property damages, and lost wages.