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Workers' Compensation FAQ

Enforcing Your Work Injury Rights Since 1991

Workers Compensation Injury Attorney Louis P. Lombardi II has represented injured employees since 1991. His valuable claimants' legal experience and prior experience in insurance defense have served his clients well. For the past 16 years, he has served as chairman of the Workers' Compensation Committee of the Montgomery Bar Association. Mr. Lombardi has won many large settlements for claimants who have a permanent disability, and large awards for injured individuals to help retrain them for the work force. He handles all categories of claims:

How Do I Get My Pennsylvania Workers' Compensation Benefits?

If you are an employee who suffers an injury at work, the law is supposed to be simple: You are entitled to Workers' Compensation benefits.

Unfortunately, some employers and insurance carriers are often far more anxious to put obstacles in your path than they are to comply with their legal obligations under the Pennsylvania Workers' Compensation Act. They may even try to mislead you about your rights as an injured worker, often adding insult to injury.

The most important thing you need to do to secure your right to benefits is to report your work injury as soon as possible to your employer. Tell them you were injured at work, what parts of your body are affected, and that you plan to obtain appropriate medical care from a competent physician or medical provider.

Insist that the employer report the injury to its workers' compensation insurance carrier. The carrier then has twenty-one days to accept, deny or otherwise formally respond to your claim, although disability benefits in many cases may be started sooner, and access to medical treatment should be immediate. If the insurance carrier has not provided a formal response to your claim within twenty-one days of the report of injury, such as by issuing a Notice of Compensation Payable or Notice of Compensation Denial, this suggests that the employer or the insurance carrier is violating the law. You need to contact a competent workers' compensation attorney immediately, to protect your rights. Further, if your claim is denied, you need to discuss this with an attorney to determine what steps may be taken to get you all of the benefits you are entitled under the Workers' Compensation Act. In fact, even if your claim is accepted as payable, but with an improperly limited description of your work injury, or for purposes of medical only, then you should contact an attorney to discuss your legal rights.

What Benefits Are Available?

In general, an employee injured on the job in Pennsylvania is entitled to payment of medical bills for reasonable and necessary treatment relating to his or her work injury, and to weekly or biweekly payments of compensation benefits to replace wages lost due to partial or total disability. The amount of the wage loss benefit generally depends on how much you were earning in the year prior to your injury, including overtime and bonuses. For new hires, the benefit rate is based upon how much you were expected to earn. Lost earnings from a second job, if any, must also be properly considered and included.

The Workers' Compensation Act provides detailed formulas to allow the proper calculation of wage loss benefits for all employees in all circumstances. Despite this, employers and insurance carriers often fail to correctly calculate the benefit rate, usually by underpaying the injured worker. A skilled attorney will often be able to tell you immediately if you are being short-changed or if your employer or its insurance carrier is failing to comply with the Act in calculating your compensation rate.

The most common calculation is two-thirds of any wage loss caused by the work injury, subject to certain statutory maximums and minimums. Workers with very limited pre-injury earnings are entitled to a rate of fully ninety percent of their pre-injury earnings. If you have any questions regarding whether your workers' compensation benefit rate has been correctly and fairly calculated, we strongly encourage you to contact one of our attorneys.

Do I Have To Treat With The Company Doctor?

This is often a somewhat complex legal question, since the answer is rarely a simple yes or no, at least within the first ninety days of treatment. If you have significant concerns about a medical referral by your employer or its workers' compensation carrier we encourage you to contact one of our attorneys to discuss your options.

The Act does give employers and insurers a substantial amount of control over your access to medical care for the first ninety days of treatment for a work injury, in some circumstances. However, it is common for employers or insurance carriers to claim rights to control your care far in excess of what is actually provided by the Workers' Compensation Act. At the same time, these sources cannot be relied on to provide you with accurate information about what rights you retain with regard to your medical care.

If your employer simply names a company doctor or practice and tells you that is where you must go for treatment of a work injury, they are not acting in compliance with the Workers' Compensation Act. In fact, the employer's ability to control your access to medical treatment, even within the first ninety days, is always subject to limits, and in many cases may not even apply. If your employer fails to adhere to the law, you will have options relating to medical treatment choices which may dramatically affect the outcome of your claim.

Injured workers are often made to believe that their only option is to continue treating with a company doctor who may be entirely unsympathetic, overly influenced by the employer, or simply in the wrong practice area to address the patient's needs. Such doctors may attempt to keep a disabled worker on the job, release the injured worker to full duty too soon, or deny the patient appropriate diagnostic testing.

The insurer, the employer, and even the company doctors are generally well-versed in the ways of the workers' compensation system. Any or all of them may seek to benefit their own positions at your expense. For this reason, it is important for you to really know your rights, including your right to seek a second opinion - even within the first ninety days of treatment, your right to file a petition to get medical treatment approved, your right to file a petition to correct or expand the description of your injury, your right to file a petition to protest the denial of medical billing or treatment due to a Utilization Review, your right to refuse "independent" examinations if scheduled unreasonably by the employer, and your right to treat with doctors or providers entirely of your own choosing once ninety days have passed from the date of first treatment. In fact, you have the right to treat with a doctor of your own choosing even within the first ninety days, subject to certain limitations. The experienced attorneys in our office can help you learn more about your rights in this regard.

How Do I Find A Doctor Who Can Help Me?

Unfortunately, we continue to hear of instances where doctors or other medical providers decline to get involved in the treatment of work injuries. This is particularly common where the description of injury is improperly limited, where the claim may be subject to dispute, or within the first ninety days of treatment. This is an even more serious problem for injured workers who have no other health insurance, or whose health insurance through the employer is subject to cancellation during a period of disability.

It is also common for many doctors to insist on treating only the limited injury as defined by the employer, even if other serious injuries are involved.

If you are being told by the employer or its insurer that your only option is to treat with a company doctor, who may not listen to your concerns or who sends you back to work before you are ready, your injury could be made substantially worse at the same time your rights under the Act are severely prejudiced. The same is true where you cannot get proper treatment for your legitimate injuries because the employer's description of the work injury is unfairly limited or simply wrong. At times, your access to treatment or medications may be blocked by an insurance adjuster's refusal to "pre-authorize payment" sometimes even by making false or misleading claims about the status of your file, or for no reason whatsoever.

These tactics can hurt not only your right to medical benefits, but also your right to wage-replacement benefits. This is because in workers' compensation, your entitlement to wage loss benefits almost always depends upon your disability status (except for cases of "specific loss", for example, loss of a limb or digit) and your disability status is defined by the doctors who treat or examine you. If your access to treatment is cut-off, your right to wage loss benefits may soon follow.

An injured worker must find his way around these obstacles when seeking a physician, or his rights will be lost. In workers' compensation matters, it is important to find medical experts who will not only provide you with competent and sympathetic treatment, but who may also be relied upon to document your claim in accordance with the standards of the Act and with the understanding that workers' compensation claims often give rise to litigation. In fact, even where the employer and insurer have acknowledged your claim and are paying benefits, they may elect to pursue litigation at virtually any time, beginning with a request to a Judge to stop or reduce your benefits.

The attorneys of Lombardi and Associates can help you to identify medical providers responsive to your needs and the needs of the Act, and competent to treat you with compassion, dignity and respect. We have decades of experience dealing with physicians and specialists in virtually all medical fields and convenient to your locality. We can help in your search for a competent medical advocate, should you need it. We can also assure you we will work with any physician, anywhere, who you feel provides reasonable and necessary care for your work injuries. We will confer with your medical expert to any extent needed to help him or her be a strong advocate for your claim. Whoever you choose to treat with, we will coordinate with them to maximize your access to necessary care and to establish and protect your full rights.

How Do I Know If My Employer And Its Insurance Carrier Are Complying With The Workers' Compensation Law?

Stated simply, you almost certainly will not know whether your employer or its workers' compensation insurance carrier are fully complying with the Pennsylvania Workers' Compensation Act and related regulations unless you speak with a competent workers' compensation attorney. It is, unfortunately, very common for both employers and insurers to play fast and loose with the law and to cut every corner they can with regard to honoring the legal rights of employees claiming work injuries.

Typical abuses by insurance companies include failing to timely issue a formal acceptance or denial of your claim, understating your wages and compensation rate, using an artificially limited description of your injury, failing to comply with time deadlines for paying compensation benefits and using inappropriate bureau forms to acknowledge or document your injury such that your important rights regarding the injury may be prejudiced immediately or in the future.

Typical abuses by employers include failing to report your claim to insurance carriers, understating your wages, improperly steering injured workers to a specific company doctor over whom they have influence or control, forcing or pressuring injured workers back to work before they are ready and failing to fully honor light duty restrictions set by a doctor. Some employers will even pressure employees to accept lay-offs with unemployment benefits or other disability payments instead of workers' compensation benefits for a work-related injury. This will profoundly compromise the injured workers' rights.

Of course, abuses such as these are just the tip of the iceberg. Many previously very highly valued employees suddenly find themselves treated with contempt by their employer simply because they have the misfortune to suffer a work injury. 

&Make no mistake, even in the exceptional cases where an employer shows true compassion for the injured worker and a desire to respect his rights, the Pennsylvania Workers' Compensation system is adversarial by design. Even employers who want to do the right thing are often compelled to follow the directives of insurance carriers seeking to minimize the costs of every claim. This may include attempts to downplay the seriousness of the injury, pressuring doctors for early releases or even claiming "full recovery" without regard to the worker's continuing symptoms and limitations.

These abuses can be confronted or even turned to your advantage when you have competent and aggressive legal counsel.

The Workers' Compensation Insurance Carrier Is Trying To Stop My Compensation Benefits! What Do I Do?

If you have an acknowledged claim and you are receiving workers' compensation benefits, the workers? compensation insurance carrier may be very aggressive in seeking ways to cut off your benefits. In some cases, they may simply send you a "Notice Stopping Temporary Compensation" and attempt to deny any disability relating to the work injury, even if you have already missed time, you are still disabled from your prior job or you are working with limited duties or limited hours. You need to fight this.

In many other cases, the employer and insurer will send you to an "independent" medical examination with a doctor they have carefully selected. When this doctor claims you are capable of returning to work, whether in your old job or in some form of light duty, you will receive a "Notice of Ability to Return to Work". This puts you on notice that the insurance carrier has decided that you are ready to work and warns of legal consequences of not returning to work. This notice is often followed by a specific job offer from your employer, for return to light duty or full duty work. Alternatively, you may receive a letter from an insurance "vocational expert" whose role will be to identify jobs generally available in the market place. You might then be directed to apply for specific job openings, or the vocational expert might simply list available jobs in a "labor market survey". Either way, the purpose is to give the employer evidence to cut off your compensation.

In these situations, the insurance carrier cannot legally simply stop paying your benefits. They must file a petition before a Judge. This would be a petition to Modify, Suspend, or Terminate benefits. These petitions will include a request for "supersedeas". This means that the employer and insurer are asking the Judge to immediately stop your benefits, based on their evidence. The very first thing a Judge will do in your case will be to accept and review this supersedeas evidence. If the request for supersedeas is granted, your benefits will stop. It is therefore essential that you have an attorney representing you before this happens.

In fact, at every step taken by the insurance carrier toward its goal of cutting off your benefits, there are steps you can and should be taking to protect your own rights. You should be in contact with our firm as early as possible for advice and guidance. We strongly encourage you to contact an attorney in our office before you appear for any "independent" medical examination scheduled by the insurance carrier. Even if you decide at that point that you do not yet need formal representation, we will be happy to speak with you. We could then be in a position to monitor your claim before your benefits are put in jeopardy in litigation with a Workers' Compensation Judge.

Can I Settle My Workers' Compensation Claim For A Lump Sum?

Yes. Lump sum settlements of workers' compensation claims are common. In fact, lump sum settlements are often available even if your claim has been denied or is being contested before a Workers' Compensation Judge. Contact our offices to discuss how to best position your claim for a negotiated lump sum settlement of the highest possible value.

What Is My Workers' Compensation Case Worth?

Determining the proper settlement value of a workers' compensation claim is not dependant upon any single formula, and there are many factors which affect when and how much an insurance carrier or self-insured employer will pay in settlement of a given claim. Literally, the potential factors are too multiple to list. Just some of the factors affecting an insurance carrier's assessment of potential settlement value would be as follows:

* Are you on compensation, or merely pursuing a claim for same?

* If on compensation, for how long have you been receiving same?

* What ongoing treatment are you receiving?

* What are your diagnoses in relation to the work injury, according to your treating physicians?

* Is there strong support for long-term disability in your treating doctors' records?

* Are there objective diagnostic studies which support, or refute, your work-related diagnoses?

* What description of injury has been acknowledged, if any, by the employer/insurer?

* What is your past medical history?

* Have you admitted and discussed your past medical history consistently with all doctors?

* Do your medical records suggest any credibility issues?

* Are there elements in your records which might make the Judge regard you unfavorably?

* Have you attempted to return to work at any time?

* If so, what was the result?

* Is the employer able to present fact witnesses to dispute the circumstances of your injury, return to work efforts or availability of light duty work?

* If so, how credible is the employer's evidence?

* Is the employer asserting you have been fired for cause?

* How big is the difference between what the insurance medical expert says you can do and what your own doctor would allow you to attempt?

* Is there a pending offer for return to work, for full duty or light duty?

* Have you testified before the Judge?

* If so, how clearly were you able to make your case? How well did you stand up to cross examination? How consistent was your testimony with the other available evidence?

* Who is the presiding Workers' Compensation Judge?

* Who are your attorneys and how hard and effectively can the insurance carrier expect them to fight on your behalf, if they decide to offer you only a typical "low-ball" settlement?

Of course, the biggest single factor affecting the value of your workers' compensation claim will be the strength of the medical evidence supporting your injuries or disability from employment. The Workers' Compensation Judge is generally not willing or able to sift through the volumes of medical notes, records and diagnostic reports documenting your care. Instead, the Judge relies upon the attorneys to create a formal record, including trial depositions of the appropriate medical expert witnesses. In preparing and completing these depositions, your attorney needs to ask just the right questions to maximize the points in your favor, while minimizing any problem areas, or finding ways to convert them into positives for your case. In dealing with your doctor, your attorney needs to prepare the doctor for all questioning and create a persuasive record which highlights the favorable elements that help your case, while deflecting problem questions on cross examination. In dealing with the insurance carrier's medical witness, your attorney needs to hammer him with the elements in your favor and expose any weaknesses or untruths he may be espousing for the insurance carrier who hired him.

A truly gifted workers' compensation attorney will carefully review every element of the available medical evidence with an awareness of what points can be used for you and what points must be deflected or converted to your benefit, and will orchestrate the medical witness testimony in such a way that the formal record, reviewed by the Judge, favors your position not only adequately, but dramatically. This is how workers' compensation cases are won. It is also how the attorneys ofLombardi and Associates make clear to insurance carriers the extent of their exposure, driving home the point that the settlement of your claim must be for its full proper value.

The above considerations are far from a complete list of the factors affecting the potential settlement value of your claim. However, all of these factors can be influenced by the competence, experience and aggressiveness of the workers' compensation attorneys you choose to represent you. The attorneys who represent the insurance carriers and employers know this very well, as do the insurance company adjusters, who often control the purse strings. The attorneys of Lombardi and Associates have demonstrated to them, day after day and case after case, the significant influence that strong, competent and unrelenting legal advocacy has on their exposure for a claim. This has given us a reputation, acknowledged even by Workers' Compensation Judges, as attorneys who obtain maximum value for the cases we settle.

By design, our firm is selective in the cases we take, so that we maintain a case volume sufficient to allow us to be intimately, aggressively and actively engaged in every case, and to litigate circles around our adversaries. If you have been injured at work, please call one of our attorneys to discuss how we will distinguish ourselves as vigorous advocates of your legal rights, whether in negotiating a lump sum settlement in your best interest, in protecting or advancing your rights through litigation, or simply monitoring your claim to ensure that your rights are not abused by others.

What Can I do to Help My Attorney Advance My Claim?

 

1. Do not sign anything relating to your workers' compensation claim without first consulting with an experienced and competent workers' compensation attorney. We encourage you to contact our office,Louis P. Lombardi II and Associates, P.C., by phone at 610-239-7600 or by email at the links provided in these pages.

2. Do not discuss your workers' compensation claim any more than is strictly necessary. When in doubt, contact your attorney first, and ensure that all appropriate inquiries concerning your case, including telephone calls and letters, are referred to your attorney.

3. Prepare a handwritten diary, on a continuing basis, reciting all the events and problems you have as a result of your injury.

4. Keep a record of any medical bills or drug expenses which relate or could be related to your injury and provide these to your attorney periodically as accumulated.

5. Follow up appropriately with medical treatment and notify your attorney promptly if there is any change in your health or injury or if you have any new accidents or injuries. Also, notify your attorney promptly if you are sent to a new doctor or specialist.

6. Notify your attorney promptly in the event of a change of name, address, or telephone number.

7. If there is any change in your employment status, call your attorney.

8. Be aware that the insurance company may hire investigators to follow you and film you in order to see how injured you are and if you are working in any capacity. Contact your attorney if you, your neighbor or anyone has been contacted. But remember, do not talk to anyone directly.

I Would Like To Speak To An Experienced Lawyer Now

If you have any questions, please call us for a free confidential consultation, or contact us to schedule a free initial consultation at your convenience.  All workers' compensation cases are accepted on a Contingent Fee basis. Know your rights and make sure that you are receiving everything that you rightfully deserve. 

OTHER RESOURCES

For official information and frequently asked questions about workers' compensation in Pennsylvania, we recommend you view the links available through the Department of Labor and Industry website.

 


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1000 Germantown Pike, Suite J6 , Plymouth Meeting, PA 19462
| Phone: 610-239-7600 | 888-818-4343
215 South Broad Street, Suite 702, Philadelphia, PA 19107
| Phone: 215-922-6300 | 888-818-4343
21 N. Main Street, Chalfont, PA 18914
| Phone: 215-997-8282

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