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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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.
Are most cases settled out of court or do they go to trial?
Most cases settle out of court. However, cases can settle at different points in time. For example, some cases may settle early on, whereas other cases settle just before the trial is about to begin. We prepare every case as if we are going to court, even though we know that most cases will end up being settled.
We do this because we never know exactly which cases will end up in court. The better we prepare your case, the larger the settlement we are usually able to obtain.
Who pays for court costs or litigation expenses?
We usually do not require clients to pay for costs or expenses out of their own pocket. Instead, we typically will advance the costs associated with your case. If we are successful, then we are reimbursed for the costs we have spent on your behalf. If the case is not successful, we generally do not ask to be reimbursed.
What are typical examples of litigation expenses?
Litigation costs refer to expenses charged by somebody not connected with our law firm. For example, if we request your medical records from a doctor or hospital, they usually charge a fee. Also, there may be filing fees at the time that we file a lawsuit. The case may require us to hire expert witnesses who charge for their time on an hourly rate basis.
When should I call a lawyer?
Immediately after your injury would be ideal. If it’s past that point and you haven’t already contacted a lawyer, the second best time would be right now. You may contact a Philadelphia personal injury attorney at The Boles Firm, and we’ll set up a free consultation.
What are our fees?
We do not typically charge people a retainer, nor do we charge by the hour. Instead, we work on what is known as a contingent fee basis. That means earning our fee is “contingent” on the result we obtain in the case. We will investigate your case at no cost to you. If we determine that you do not have good grounds for a lawsuit, you’ll owe us nothing -- regardless of how much time and money we spent doing the investigation.
If we take your case, and are successful in obtaining an award or settlement for you, then we earn a fee by sharing in a certain percentage of that recovery. The specific percentage that we earn depends on the type of case. If we do not succeed in getting an award or settlement for you, then we earn no fee at all in the case.
Should I try to settle my claim with the insurance company on my own?
Insurance companies are mainly concerned with their own interests rather than your best interests. The business of the insurance company is to take in as many premiums as possible while paying out as few claims as possible.
Their representatives are trained to minimize or deny your claim, and they employ a variety of tactics to accomplish that. They may well ask you questions that may hurt your claim. At other times, the representative may act as if he or she is on your side and encourage you to resolve your claim quickly for far less than the value of the claim. Consult an attorney before considering settlement, a topic I discuss in more detail here.
What should I do if I am hurt in an accident?
First, get medical attention. At the same time, if you are able to do so, you should create a record that will help you protect your claim. File a police report, either at the scene or as soon as possible afterward. Try to get names and contact information from any witnesses. If you can, write down exactly what happened as soon as possible after the event. Accident scene photographs often provide valuable evidence that can’t be duplicated after the fact.
What is the difference between compensatory and punitive damages, and which can I get in a personal injury case?
Compensatory damages are damages meant to compensate you for your losses. These damages cover actual economic losses, like medical bills and lost income. They can also include compensation for pain and suffering and loss of enjoyment of life. The purpose of compensatory damages is to put you as nearly as possible back in the position where you would have been if the defendant’s negligence had not occurred.
Punitive damages, on the other hand, are intended to punish the defendant and to discourage others from engaging in the kind of negligence. An award of punitive damages requires a showing of something more than mere negligence.