How can I get a settlement from my workers' compensation claim?

If your case is professionally handled particularly with a competent attorney and the insurance company believes you are going to have an ongoing injury that they will have to pay wage loss benefits or medical benefits for an unknown period of time into the future you can achieve a settlement of workers' compensation claim. You should never try to compare your settlement to someone else's because settlements are, to a large part, based upon what your AWW is (see blog of October 27, 2014) and other factors that in most instances are somewhat unique to each case. However, a general rule can be established that the larger your earnings at the time of your injury, the greater the settlement. Of course everybody's case is different, everybody's injury is slightly different and everyone's job duties are a little different. All of these factor into the size and nature of the settlement. One thing that must be borne in mind is that there is no way to "force" a workers' compensation insurance company into a settlement. An insurance company has to want to settle a case and a way you get them to want to settle a case is to keep your case strong from a legal perspective.

If I am hurt on the job what benefits am I entitled to?

You are entitled to have free medical benefits for the reasonable, necessary and related treatment of your work related injuries. If your work injury affects your earning capacity you will be entitled to wage loss benefits. Wage loss benefits are both for total disability and partial disability. Total disability is when you are unable to return to your pre-injury job or any other job on a light duty or partial basis. Partial disability occurs when you have an earning capacity, or you have returned to work with restrictions and earn less than you were making before you were hurt.

If I am receiving workers' compensation benefits can my insurance company just stop paying them without penalty?

No. The insurance company cannot stop paying your wage loss benefits unless a Judge approves or orders the stoppage, if you sign a legal document agreeing to it, or if you in fact return to work whether with your pre-injury employer or another employer at wages that equal or exceed the wages you were making before you were injured. This is why it is very important for you not to ever sign any document without first having an attorney review it for you. With medical benefits, the insurance company can always challenge whether or not the treatment that you are receiving is related to your work injury or whether or not the treatment you are receiving is reasonable and necessary. In either event, you will need an attorney to help protect your rights for continuing medical benefits. You should consult an attorney to protect your ongoing medical benefits.

Do I have to see the insurance company's doctors?

Yes/No. If the insurance company or your employer has had you sign a statement acknowledging that you have been provided a list of doctors that you must treat with, then you must treat with their doctors for the first 90 days following your work injury. The insurance company or your employer must also have had you sign a similar paper when you began employment with that particular employer. Unless you have signed both written acknowledgements you do not have to treat with their doctors for the first 90 days. After the first 90 days you are free to treat with whomever you wish. We do have doctors that we will refer you to who provide excellent medical care and are familiar with the legal system to better serve both your medical and legal needs.

An insurance company can require you to see a doctor of their own choice in addition to the doctors that you are seeing within the first 90 days. This is called an Independent Medical Exam. It is really not an Independent Medical Exam in the true sense of the words. After your case has been going the insurance company can have you go to a different "Independent Medical Exam" every six months whether you are on wage loss disability or simply receiving the benefit of medical benefits.

Am I entitled to damages for pain and suffering and/or can I sue my employer or coworkers for negligence?

No. You are not entitled to compensation for pain and suffering under the PA worker' compensation laws. You also cannot sue your employer for negligence, nor can you sue your co-workers if your co-worker caused your injury. There are certain limited exceptions which we can discuss in more detail if the issue arises.

Can I be fired for making a claim for workers' compensation benefits?

If you can prove that your employer purposely fired you because you made a claim for workers' compensation benefits you can sue your employer for wrongful discharge. However, under normal circumstances your employer does not have to keep you employed just because you made a claim for, or are receiving, workers' compensation benefits.

Does my employer have to hold my job open while I'm out on workers' compensation or have a work related injury?

No. The insurance company cannot stop paying your wage loss benefits unless a Judge approves or orders the stoppage, if you sign a legal document agreeing to it, or if you in fact return to work whether with your pre-injury employer or another employer at wages that equal or exceed the wages you were making before you were injured. This is why it is very important for you not to ever sign any document without first having an attorney review it for you. With medical benefits, the insurance company can always challenge whether or not the treatment that you are receiving is related to your work injury or whether or not the treatment you are receiving is reasonable and necessary. In either event, you will need an attorney to help protect your rights for continuing medical benefits. You should consult an attorney to protect your ongoing medical benefits

If my employer terminates my employment what happens to my fringe benefits?

Unfortunately your fringe benefits will rise and fall, and/or continue to be paid or not paid, depending upon whether you: have a contract with your employer, have a Collective Bargaining Agreement through a Union, or are a municipal employee with certain guaranteed rights. In the event that you none of these apply to you, your fringe benefits will be whatever your employer agrees to provide for the continuation of your health insurance and other fringe benefits after your discharge. So, there is a significant possibility that your health insurance or other benefits will stop if you are terminated after you are out on a work related injury.

How much time do I have to make a claim for workers' compensation benefits?

From the day that you are hurt you must notify your employer of your injury within 120 days that you in fact sustained an injury on the job. You must also provide information as to the general nature of that injury. This notice can be verbal, it can be in person, it can be on a telephone call, etc. However, it must be to your supervisor, manager, or the HR department. Additionally, you have three years from the date of the actual injury to file a claim with the Bureau of Workers' Compensation Benefits if your employer does not voluntarily pay your benefits that you are entitled to receive.

What happens to my workers' compensation benefits if I retire or take some other type of retirement benefits such as a pension or Social Security Retirement?

Because of the way the law is written, and the way recent court cases have interpreted the law, if you elect to take certain types of retirement or pension benefits it could have a significant impact upon your rights to continue to receive your workers' compensation benefits, and it is very, very important that you immediately seek services of a workers' compensation attorney. If you apply for and receive Social Security Retirement benefits after your work injury the workers' compensation insurance company will be entitled to a reduction or a credit of 50% of the amount of your retirement benefits. Additionally, the workers' compensation insurance company will make the argument that you have removed yourself from the labor market by retiring and may seek to have your benefits completely suspended or terminated. The same holds true with a pension benefit to the extent that your employer has funded the pension.

Why should I go to an attorney if I am receiving my benefits without any problem?

You should go to an attorney early on because our office does not charge any additional fee for getting involved with your case early. It is important that we become familiar with your medical conditions, refer you to the right type of physician, and make sure that you don't take any action or apply for any benefits that can affect your workers' compensation benefit and/or otherwise help you coordinate your benefits that you may be entitled to. Our fee is the same, it is only 20% of whatever we maintain coming for you or whatever we get for a lump sum settlement. If you come to our office after you have made a mistake and the insurance company is now trying to reduce or end your benefits you will pay a legal fee whether to our office or any other workers' compensation attorney sooner than later. So, your best bet is to go an attorney as soon as possible so that you have professional advice through these murky waters.

What happens if I lose a particular body part like a hand or a finger or have hearing loss or something of that nature?

The law provides certain "specific loss benefits," which is a schedule of a certain number of weeks of wage loss benefits depending upon the body part that you are claiming has lost its use. This could result in your receipt of wage loss benefits, depending upon the nature of the injury, in addition to what you receive for disability purposes.

What if I'm exposed to certain types of chemicals in the work place?

There are certain kinds of injuries under the Occupational Provision of the Workers' Compensation Act which can lead to an actual presumption that you have a work injury, and provide the same basic benefits as a regular workers' compensation claim. However, your disability or injury must have occurred within 300 weeks of your last exposure of whatever the hazard was from which you developed your disability or unfortunately if it is a death claim, the death. If your disability occurs outside the 300 week period while you may not have an occupational disease claim you will however be able to sue your employer or the source of the exposure for negligence assuming that there was negligence.

What if the treatment of my work injury causes additional injuries, such as if I fall off a treadmill in physical therapy or if I develop an infection while in the hospital?

As long as you incurred the additional injury in the formal treatment of your work injury, it can be considered part of your work injury and should be covered by the workers' compensation carrier by having your medical bills paid and/or lost wage benefits paid.

What if I'm on Social Security Disability as a result of my work injury? How does that affect my right to receive continued benefits under the Workers' Compensation Act?

The answer to this question is complicated but you will continue to receive your workers' compensation benefits and your Social Security Disability benefits, but your Social Security Disability benefits will be reduced to an extent by your receipt of your wage loss benefits under the Workers' Compensation Act. To thoroughly answer this question you should seek the advice of an experienced workers' compensation attorney.

What are some of the cases you've won?

  • $250,000.00 award for client injured in an automobile accident - cervical disc injury with no surgery.

  • 42-year-old delivery truck driver lumbar disc injury one operation - $175,000.00.

  • 25-year-old laborer - partial loss of vision - $275,000.00.

  • 35-year-old office manager - torn medial meniscus - $80,000.00.

  • 50-year old policeman - partial rotator cuff tear - $89,500.00.

  • 72 year-old male slip and fall - cervical disc and torn rotator cuff - $180,000.00.

  • 50-year-old male - medical only - Reflex Sympathetic Dystrophy - $245,000.00.

  • Multiple cases involving facial/head/neck scars ranging from 1-4 inches - $19,000.00 to $60,000.00.

  • 43-year-old healthcare worker - post-traumatic stress syndrome witnessing traumatic event - $125,000.00.

  • Uninsured motorist claim - aggravation or pre-existing knee arthritis and cervical arthritis - $125,000.00.

  • 45-year-old carpenter - fractured wrist/forearm - $180,000.00.

  • Truck Driver - Post-concussion syndrome - $198,500.00

  • Sands Casino worker - cervical disc injury - $241,000.00

  • Office Manager - post-concussion syndrome - minimal lost wages - $85,000.00

  • Baker worker - local grocery chain store - torn rotator cuff - $118,902.00

  • Administrative Assistant/Salesman - slip and fall - injury to upper extremity, elbow and shoulder - no surgery - $110,000.00