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!
- Page 6
May I receive benefits if I suffer an injury from repetitive job activities?
Yes. It is generally accepted that repetitive motion injuries such as carpal tunnel syndrome, thoracic outlet syndrome, and other conditions are either caused, aggravated, or accelerated by repetitive job activities, and thus are compensable work injuries. However, employers generally do not accept these claims without litigation. In the litigation, the burden of proof will be on you, the injured worker, to prove through medical testimony that your problems originated from your repetitive job activities.
Are certain diseases presumed to be work-related?
In general, you may receive benefits for diseases that are caused by, aggravated by, or accelerated by work activities. However, the burden of proof lies with you and your attorney to show the connection between the disease and your employment.
However, in addition to that, for certain occupational diseases, there is a presumption that certain diseases are work-related. These include:
- Tuberculosis and hepatitis for nurses, blood processors, and related professions that involve exposure to these diseases.
- Diseases of the heart and lungs for firefighters who have four or more years of service.
- Pneumoconiosis and silicosis for any occupation that involves direct contact with or exposure to coal dust.
- Specific types of chemical poisoning (such as lead, mercury, phosphorus, and arsenic) for occupations involving direct contact or exposure to those chemicals, or to their preparations or compounds.
The Workers’ Compensation Act also has a catchall provision that entitles you to a presumption that your condition is work-related if you can demonstrate that:
- you have been exposed to the disease because of your job;
- the disease is causally related to your industry or occupation; and
- substantially more people working in your industry or occupation suffer from the disease than the general population.
If you fall into the category of occupational diseases that are presumptively related to your employment, the burden shifts to the employer to prove that in your particular case, there is a cause for your disease that is unrelated to your employment.
If I have a pre-existing condition which is aggravated by a work injury, am I entitled to receive benefits?
Yes. The aggravation, reactivation, or acceleration of an underlying or preexisting condition entitles you to benefits. For example, if you have degenerative disc disease and a work injury worsens the disease, you may receive benefits. Do not assume that your benefits will be denied merely because you have a preexisting condition.
For what injuries or diseases may I receive benefits?
If your injury or disease arises in the course of your employment, or if your preexisting condition, disease, or infection is aggravated, reactivated, or accelerated by a work injury, you are entitled to benefits.
May I recover any penalties against my employer's insurance company for excessive delays in paying the benefits?
The Pennsylvania Workers' Compensation Act imposes upon employers and insurance companies penalties of up to fifty percent on late or illegally suspended benefits, which may be obtained by filing a penalty petition with the Pennsylvania Bureau of Workers Compensation. However, the employer and insurance company may be able to avoid payment of penalties if they can show a reasonable basis for the non-payment. Attorney's fees may be recovered as well under certain circumstances, primarily involving a judge’s finding that the employer did not have a reasonable basis for contesting your claim.
How can I pay for any attorney?
The Workers' Compensation Act places limitations on how much an attorney can charge an injured claimant. Under most circumstances, you may be charged no more than 20% of any past due or on-going wage loss benefits. Most attorneys will charge this fee only if they are successful in obtaining or protecting your benefits.
What happens after the record in my case is closed?
After the record is closed, the judge will direct the parties to submit proposed findings of fact and conclusions of law. The proposed findings summarize the evidence, the legal conclusions that follow from the evidence, and the remedy that the parties wish to achieve. The parties may also submit a written brief in which they argue for their respective positions. The judge will then review all of the evidence and issue a written decision. A copy of the judge’s decision will be mailed to you and to your attorney. You will have 20 days from the date of circulation of the judge’s decision to appeal the decision to the Workers’ Compensation Appeal Board.
May I sue my employer for negligence?
In general, your employer is immune from liability for negligence causing a work injury, though there are exceptions. Accordingly, you may only receive benefits under the Workers' Compensation Act. However, you may be able to sue other people or companies that are responsible for those same injuries.
My employer filed a petition against me. What happens next?
Every petition filed with the Bureau of Workers' Compensation is assigned to a workers' compensation judge. It is crucial that you retain the services of an experienced workers’ compensation attorney to represent you at that point, if you have not already done so. The workers' compensation lawyers at The Boles Firm have been representing claimants before workers' compensation judges for many years. Our specialized experience and knowledge will be vital in ensuring that you are successful in combating the employer's attempts to limit your right to ongoing benefits.
In general, there will be a series of hearings in which evidence in the case will be presented. If your employer has filed a petition to terminate, modify, or suspend your benefits, the judge will ordinarily take the employer’s written evidence at the first hearing in the case. The judge will then consider the employer's motion for suspension or modification of your benefits pending the final outcome of the case. It is crucial that you produce evidence at that hearing, or your benefits will be modified within a matter of weeks. Only an experienced workers' compensation attorney, such as the attorneys at The Boles Firm, can properly prepare the evidence needed to combat the employer at that point.
Further hearings will be scheduled in order to collect evidence from you and your employer. At a final hearing, you will testify. All through the process, you will need an experienced workers' compensation attorney to represent your interests.
What should I do if my claim is denied?
If your claim is denied, you have three years from the date of injury to file a claim petition for workers' compensation benefits. If you do not file the petition with the Bureau of Workers' Compensation within the time period required by law, you will lose forever your right to receive benefits. Under most circumstances, you should seek the assistance of an attorney in pursuing a claim for benefits.