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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What is a personal injury case?
Personal injury cases arise from a wide range of circumstances. Some of the most common are car accidents, slip and fall injuries, motorcycle accidents, and work injuries. But any time someone is harmed by the negligence of another person or company, there might be a personal injury claim.
What is negligence?
We are required by law to act with “reasonable care.” What constitutes reasonable care varies from situation to situation. When someone fails to act with the reasonable care required by a given circumstance, that is considered negligence. In order for you to recover for most personal injuries, you will have to prove that another person or a business was negligent, and that the negligence caused your injuries.
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.
Can my employer challenge the reasonableness or necessity of my medical treatment?
Yes. An employer has the right to challenge the reasonableness and the necessity of medical treatment by filing a Utilization Review Petition with the Bureau of Workers' Compensation. Bills submitted within 30 days of filing the petition may be reviewed. The Petition will be assigned to a Utilization Review Organization that will request your medical provider to send a copy of your medical records and will request a statement from you regarding your perspective on the treatment you received.
The Utilization Review Organization will assign your case to a doctor who practices in the same medical specialty as your treating doctor, and that doctor will issue a report that states whether your treatment was reasonable or necessary.
If your physician or medical provider fails to provide copies of your medical records to the Utilization Review Organization, the treatment will ordinarily be found to be unreasonable or unnecessary. It is therefore essential that your provider forward copies of your medical records to the Utilization Review Organization if your treatment is being reviewed.
If the Utilization Review Organization finds that your treatment was wholly or partly unnecessary or unreasonable, you as well as your doctor have the right to appeal this decision to a workers' compensation judge. You are not required to pay for any treatment that the Utilization Review Organization deemed unnecessary or unreasonable. The Utilization Review process is also discussed extensively in my free booklet, The Doctor's Guide to Pennsylvania Workers' Compensation Billing.
Should I continue to be treated by the employer-designated doctor after the required period?
After you have been treated by an employer-designated physician for 90 days, you have the right to be treated by the physician or medical provider of your choice. In general, you should exercise this right. While there are many employer-designated physicians who are competent, you should be treated by physicians and medical providers who exercise independent medical judgment.
How can I get the workers' comp carrier to pay my medical bills fast?
The workers' compensation insurance company has an obligation to pay only medical bills for treatment related to the work injury. The bills are supposed to be submitted to the insurance company on appropriate billing forms with an attached medical report form. This form should clearly identify the nature of the treatment and confirm that the treatment was rendered in connection with a work-related injury. In this article, we provide all the information and forms your doctors need to get paid quickly.
If you receive notice from your medical provider that bills have not been paid by the workers' compensation insurance company, make sure the bills have been submitted properly. If the bills are being denied, ask the reason why the bills are being denied. If necessary, request a written denial so that the bills can be submitted to your insurance carrier. For more information, review this article.