Workers' Compensation

Thursday, October 8, 2015

Pennsylvania Indicts Workers’ Compensation Fraudster

What happens if someone tries to cheat or lie on their worker’s compensation claim?

When claimants take advantage of the workers’ compensation system, it becomes more difficult for valid claimants to benefit from a system set up to help those who are truly injured and in need of financial assistance.

Under Pennsylvania law, workers’ compensation fraud is a crime. In addition, this sort of misconduct is also punishable under federal fraud laws – as is the case in a recent indictment entered against a Chambersburg-area man accused of bilking funds from the Federal Employees Compensation Act (FECA) program, which assists federal workers injured on the job.

According to media reports, the defendant was charged with five separate counts of workers’ compensation fraud. The counts in total amounted to over $143,000 in payouts over the years, which is money that could have been used by claimants with legitimate workplace injury claims.

Allegedly, the defendant applied for benefits in 2011 after suffering an injury while working with the Army Corps of Engineers. He continued to apply for, and receive, benefits for several years thereafter based on his assertion he was too injured to return to his job. However, as an investigation ultimately revealed, the claimant was working the entire time for a catering company known as “CM Pig Out,” and collecting benefits on top of his regular wages.

The case was investigated by the U.S. Department of Labor’s Office of Inspector General’s Office of Labor Racketeering and Fraud Investigations, which is responsible for mitigating this type of issue.

Under Pennsylvania law, anyone with suspicions of workers’ compensation fraud is encouraged to report the information directly to the Office of Attorney General. Workers’ compensation fraud can occur on the part of the claimant or employer, with cases against the latter often involving misclassification of employees to avoid having to make payouts.

If you are experiencing difficulty with your workers’ compensation claim and would like to speak to a reputable attorney, please do not hesitate to contact Louis P. Lombardi, II & Associates today: 610.239.7600 or 888.818.4343.

Sunday, September 27, 2015

How to Appeal an Unfair Ruling Concerning Workers’ Compensation Benefits

I received a rejection of my claim for workers’ compensation benefits. What can I do?

Navigating the workers’ compensation process in Pennsylvania can be difficult, particularly for those who are enduring the after-effects of a severe workplace injury. If a claim is initially denied, the applicant has the option of launching an immediate appeal with the PA Workers’ Compensation Appeal Board. This quasi-judicial administrative group is responsible for reviewing the decisions made by workers’ compensation referees – and can only overturn their decisions in limited circumstances.

If you receive a negative decision from the workers’ compensation referee, it is imperative to launch your appeal as quickly as possible. Under the current rules and regulations, appellants have just 20 days from the circulation date listed on the judge’s order to send in the  paperwork necessary for an appeal. The time limit begins on the date stamped on the judge’s order, and the appeal is deemed “submitted” based on the postmark date on the envelope. If the postmark is more than 20 days from the judge’s order, the appeal will be considered waived.

To launch an appeal, an appellant must state the particular grounds of appeal, that is, precisely what is being questioned about the judge's decision. The statement must address both factual and legal reasons for the original decision to be considered in error; "general allegations are insufficient.”

In addition to the actual appeal, additional documentation is required to ensure that the paperwork is complete. The appealing party, for instance, is required to ensure that all parties listed on the circulation sheet of the judge’s order are provided with notice of the appeal. In addition, the appealing party must arrange for mailing of the original appeal plus two copies to the Board.

If you are dealing with a rejection of workers' compensation benefits, don’t delay. For skilled assistance with an appeal, contact one of our knowledgeable attorneys at Louis P. Lombardi, II & Associates. Serving clients throughout the Philadelphia metropolitan area, we can be reached at 610.239.7600 or 888.818.4343.

Friday, September 4, 2015

Court Orders Payment of Death Benefits; Widow Alleges Company Literally ‘Worked him to Death’

What are the options for a surviving spouse who has been denied death benefits from the PA Workers’ Compensation Board?

In one recent Bucks County workers’ compensation case, a widow proved that a denial by the Workers’ Compensation Board does not necessarily mean the end of the fight for survivors’ benefits – especially considering the fact she had a small child to care for following her husband’s death.

Earlier this month, the appealing party took her case to the PA Commonwealth Court after the WCB denied her claim for survivorship benefits on behalf of herself and her young daughter. According to the petition for relief, the survivor’s 48-year old husband died of a sudden heart attack after working a 14-hour shift at the Lower Bucks County Joint Municipal Authority.

After its review, the WCB denied her claim, concluding that there was insufficient evidence to link the long shift to the sudden, fatal heart attack. However, the Commonwealth Court came to the opposite conclusion, siding with the widow who contended her husband was literally worked to death.

In the court’s opinion, it referenced “[t]he overwhelming circumstantial evidence...[which] shows that exertion from (Dietz's) regular work activities over the course of a 14-hour workday caused his heart attack…” Moreover, the court highlighted the fact that the decedent was often required to work these lengthy shifts, and worked with a jackhammer for the Municipal Authority for over 20 consecutive years.

The court reviewed medical testimony that pointed to the decedent’s history of smoking as the root cause of his fatal heart attack. However, it gave greater weight to other medical testimony concluding that the final 14-hour work day was the fatal catalyst.

In Pennsylvania, surviving spouses and minor children may receive up to 60 percent of the decedent’s salary, plus $3,000. for burial expenses. In general, the surviving spouse must prove that the decedent’s employment caused his or her death, either due to illness or injury.

If you are considering a workers’ compensation action, please do not hesitate to contact the Law Office of Louis P. Lombardi, III, serving the Philadelphia metropolitan area, as well as Montgomery and Bucks Counties. We can be reached at 610-239-7600 or 888.818.4343.

Monday, August 24, 2015

Mitigating the Unthinkable: Workers’ Compensation Laws Following Jobsite Assault

I work in a retail store that was recently robbed. If I had sustained an injury, could I collect workers’ compensation benefits?

Certain industries are, unfortunately, more prone than others to break-ins, burglaries, and armed robberies. Some of the most high-risk jobs include those at stand-alone establishments known to store large amounts of cash, including check-cashing stores, gas stations, banks, and convenience markets. When the unthinkable occurs, and an employee is seriously injured during a workplace assault, can he or she collect workers’ compensation benefits? Thankfully, in a reversal of the Pennsylvania Workers’ Compensation Board’s answer in the negative, the Pennsylvania Commonwealth Court unanimously held that a workplace assault victim is unequivocally entitled to workers’ compensation support while recovering from an egregious attack.

In the aforementioned case, the victim was forced at gunpoint to unlock the safe at her place of employment – a check-cashing store – and was hog-tied before the assailant fled with copious amounts of cash. Unbelievably, upon applying for workers’ compensation based on physical injury and mental distress, the Workers' Compensation Board not only found that her physical injuries were not severe enough, but that her robbery experience was not an “abnormal” workplace incident that would qualify for compensation.

On appeal, the Commonwealth Court decided in a 7-0 decision that, while check-cashing establishments are prone to robbery, the precise details of the victim’s experience are not considered within the scope of a “normal” robbery, even given the fact that the establishment trained employees as to how to best handle break-ins and burglaries. Here, the court pointed out that the employee was ambushed immediately upon leaving her car by the assailant, who was hiding in the dumpster. Keeping a gun to her head the entire time, he guided her throughout the store and made her empty the safes – all the while threatening to kill her family if she did not comply. In the words of the court, “[a]lthough it is generally expected that a check-cashing business might be the target of theft, it is unusual for an employee to be hog-tied and have her husband threatened with death in the event of a robbery…”

If you are facing a difficulties regarding a workers’ compensation claim, please do not hesitate to contact one of our highly skilled attorneys at Louis P. Lombardi II & Associates, serving clients in Philadelphia, Montgomery and Bucks County. We can be reached locally at 610.239.7600 or toll free at 888.818.4343.

Tuesday, August 4, 2015

Employer Blocked From Disclaiming Worker as Employee; Worker Entitled to Compensation Benefits

What are my options if my employer is claiming I am an independent contractor? Can I still receive workers’ compensation benefits? 

One of the most pivotal issues in a workers’ compensation case is the classification of the injured worker as either an independent contractor or employee. If classified as the former, it may be more difficult to obtain workers’ compensation benefits, especially within the construction industry. However, other employees are generally presumed covered by an employer’s workers’ compensation plan provided certain criteria are met. 

Take, for instance, a recent case involving a painter and an employer who had placed an advertisement in the local newspaper seeking painting services on an upcoming construction project. In that case, the painter arrived at the jobsite with his own truck, tools, and supplies – which is an important factor in considering a worker’s status (i.e., does he supply his own equipment?). 

Shortly thereafter, the employer stated that the painter would need to sign a document prior to beginning the job, and would be paid at a rate of $100.00 per day. However, the document establishing the relationship as contractual (as opposed to employment) was never actually signed.  Thereafter, the painter sustained severe injuries on the third day of work when he fell from a roof. 

The painter made a claim for workers’ compensation benefits, to which the employer objected on the grounds that the painter was misclassified as an employee. The employer also asserted that there is no legal requirement that an independent contractor agreement must be signed prior to a contractor beginning work. The court disagreed. 

As a starting point, the court reviewed the language of the applicable workers’ compensation regulation which states “[A]n individual who performs services in the construction industry for remuneration is an independent contractor only if . . . [the individual] has a written contract to perform such services.” Taking the language at face value, the court held that at no point in the short-lived, three-day work relationship did an agreement exist between the employer and the painter. And, even if the painter eventually signed the agreement (which he has denied), this does not alter the employment relationship as it existed in the first three days prior to the injury. 

If you were recently injured on the job and would like to discuss your rights and obligations under the law, please do not hesitate to contact the Pennsylvania workers compensation attorneys at Louis P. Lombardi, II and Associates.  We serve the areas of Montgomery and Bucks County.  Call us at  (610) 239-7600. 

Thursday, July 23, 2015

Off-duty Worker Prevails in Obtaining Workers’ Compensation Following Unsuccessful Rescue Attempt of Fellow Laborer

Can I collect workers’ compensation benefits if I am injured at work, but not technically “on the clock?” 

As the name suggests, workers’ compensation benefits are reserved for those who are injured while engaged in an employment-related activity. The concept draws a clear line between work-related injuries versus those that occur during personal pursuits – the latter of which are not covered. But how does the law treat that thin grey area in which a worker – who is not technically “on the clock” – is injured on the jobsite? As the following story details, these cases are decided based on a thorough analysis over whether the victim was acting within the “scope of employment” at the time of the injury, and not whether he was actually being compensated at the precise moment of the accident. 

Off-the-clock worker prevails following rescue attempt

In July, 2010, an Allegheny County sewage plant worker rushed to the aid of a fellow employee after the employee fatally fell into a concrete pit on the jobsite. Not realizing the futility of his efforts, the plant worker descended into the pit – along with several other workers – to try and rescue the employee, to no avail. On the way out of the pit, the worker was overcome by methane gas, and fell from the ladder injuring his left leg, knee, foot, ribs, back, head and lungs.

In the days following this fateful fall, the injured worker filed for workers’ compensation benefits, which were initially granted by the Workers’ Compensation Board. The employer and its insurance provider immediately appealed the decision to the Commonwealth Court, asserting that a rescue attempt is not an employment duty, and should therefore not be compensated under the terms of the workers’ compensation policy. More specifically, the employer alleged that the victim was not even assigned to work anywhere near the pit, and had stepped outside the scope of his employment just by being in the area. More succinctly, the employer asserted that “his compulsion to act as a Good Samaritan was not employment-related….”

Fortunately, the Court held in favor of the victim and ultimately decided that “[a]ttempts to render aid to another do not, in and of themselves, constitute an abandonment of employment.” In a victory for Pennsylvania’s workers, this holding stands for the notion that the “scope of employment” standard is heavily fact-driven and must be applied subjectively to each situation, regardless of whether the worker was on-the-clock at the time of the injury. 

If you are having difficulty with a workers’ compensation issue, please do not hesitate to contact the Montgomery and Bucks County, Pennsylvania attorneys at Louis P. Lombardi, III & Associates by calling (610)239-7600 to discuss your case today. 

Friday, July 10, 2015

Pennsylvania Appellate Court Considers Complex Case Involving Workers’ Compensation & Unemployment Benefits

Can I accept unemployment benefits while out-of-work on disability? 

In a recent case decided by the Commonwealth Court of Pennsylvania, a work injury victim had her unemployment benefits reinstated despite claims by her employer that she could have returned to work and committed alleged “willful misconduct” by refusing to accept a promotion after the injury. The following case presents a complex procedural issue that – while perhaps unusual for the appellate court to unravel – represents a fact pattern that workers’ compensation clients could easily experience in the aftermath of an injury. 

Details of Paolucci v. Unemployment Compensation Board of Review

In 2010, Ms. Paolucci was employed at WalMart and endured a concussion while on the job. After properly and timely submitting her claim to her employer’s workers’ compensation carrier, she received compensation benefits. After some time, the carrier required the employee to undergo an Independent Medical Evaluation, which concluded that she was fit to return to work. Her personal treating physicians, however, disagreed with this finding and Ms. Paolucci did not return to her position – despite being offered an alternative position within the company. 

Shortly thereafter, Ms. Paolucci filed for unemployment compensation in addition to her workers’ compensation benefits. She was awarded unemployment benefits, and the employer immediately appealed the decision. On appeal, the employer cited that she should not be eligible for benefits as she left her job due to “willful misconduct” and is therefore precluded. Specifically, the employer asserted that the worker could have returned to work (based on the IME results), and held the following: 

The claimant never made the employer aware that she could return to work. Further, the claimant did not respond to the employer’s offer of work. Finally, the claimant’s attorney told the employer to no longer contact the claimant.

On a second appeal, the Commonwealth Court of Pennsylvania reversed the decision, and found the results of the IME to be irrelevant given the fact the treating physician asserted that Ms. Paolucci could not return to work. Further, the court found no evidence that the “employee violated a policy, work rule or reasonable expectation of employer.”

If you are facing a difficult workers’ compensation issue, do not hesitate to contact Louis P. Lombardi & Associates today at (610)239-7600.  We serve the areas of  Montgomery and Bucks County, Pennsylvania.

Wednesday, June 17, 2015

Recent Pennsylvania Supreme Court Ruling Limits Subrogation of Workers’ Compensation Claims Against Negligent Third-Party

What happens if I am injured at work, but my injury was caused by the negligence of another worker? 

Workers’ compensation coverage offers a sense of security to workers across Pennsylvania. However, these claims can quickly become marred by procedural complexities and conflict with the insurance company – as in a recent Pennsylvania Supreme Court case involving an injured worker whose accident was caused by the negligent acts of a co-worker or third party entity. Prior to this case, Pennsylvania laws were somewhat unclear as to the rights and obligations of a workers’ compensation insurer when the payee was actually injured by someone else. However, the holding in Liberty Mutual Insurance Co. v. Domtar Paper Co. et al. shed some interesting legal light on the issue – much to the dismay of both insurers and employers, who came out primarily on the losing end. 

Facts & Procedure of Domtar

The Domtar case began in 2009 when an employee for a trucking company known as Schneider National fell in a parking lot leased by paper company Domtar Corporation. The employee filed a workers’ compensation claim with Schneider National, and was paid over $30,000 for his injuries. In turn, Schneider National, through its insurer Liberty Mutual Insurance Company, alleged that Domtar was negligent in its maintenance of the parking lot, resulting in injury to the employee. However, the employee did not individually pursue a claim against Domtar and refused all attempts both by Liberty Mutual and Schneider National to file a negligence lawsuit against the paper company. 

As a result, Liberty Mutual filed a claim against Domtar itself, alleging negligence resulting in injury to the employee. In response, Domtar asserted that the insurer had no right to file an independent claim for damages on behalf of the injured employee who did not pursue his own right to file an action. The trial court agreed with Domtar, and the case was appealed to Superior Court, which also agreed. 

As a last resort, Liberty Mutual filed an appeal with the Pennsylvania Supreme Court, which affirmed the lower courts’ rulings for several different reasons: 

• Both Liberty Mutual and Schneider National failed to get the employee’s cooperation in the matter. In other words, it is technically not their fight. 
• Liberty Mutual did not properly “perfect” the subrogation (reimbursement) claim, nor did it follow proper procedural frameworks to pursue its assertions. 

As a result of Domtar, Pennsylvania precedent stands (somewhat) clearly for the notion that an insurer may not pursue reimbursement of a compensation claim without the involvement of the actual injured party – and it better follow proper procedures when it does. 

If you are having a difficult time with your workers’ compensation claim or appeal, please contact the Montgomery and Bucks County workers compensation attorneys at Louis P. Lombardi II & Associates by calling (610)239-7600. 

Friday, June 12, 2015

Driver Injures Four Construction Workers in Pennsylvania Turnpike Crash

Can you receive workers compensation or a personal injury settlement for the work related death of a loved one?

A motorist injured four construction workers in an early morning crash on the Pennsylvania Turnpike near the Bensalem Interchange.  The driver was killed during the crash.  One worker was taken by ambulance to a nearby hospital and another worker was airlifted to another Philadelphia hospital and rushed into surgery shortly after arriving.  The two remaining construction workers had minor injuries and were taken to a local hospital in Bristol for observation.  Authorities are investigating the incident.      

The construction workers, all male, were working for contractors hired by the Pennsylvania Turnpike to work on a link between the Turnpike and I-95.  This crash comes on the heels of another incident in Bedford County.  In that incident, a state trooper attempted to pull over a car.  The car sped off and swerved into a lane under construction hitting a construction worker.  Thankfully, none of the workers died in this accident. 

Being employed as a construction worker on a main road or highway is a dangerous job.  Many construction workers and others are killed while working on Pennsylvania roads every year.      

As a result of the recent events, the Turnpike Chairman, Sean Logan, requested extra troopers in construction zones to enforce speeding and distracted drivers.  The extra enforcement is part of Operation Orange Squeeze.  A trooper sits inside of a construction vehicle while another trooper waits in a patrol car to pull over the speeding car.  Drivers traveling 11 mph or more in a construction zone face a $200 fine and a 15-day driver’s license suspension.  Last year alone there were 150 crashes in construction zones.  

Unfortunately, no matter how many extra precautions are taken to keep workers safe, work-related deaths will still occur on these roads.  If a member of your family was killed in a work-related accident, the attorneys at Louis P. Lombardi II & Associates may be able to help you with your workers compensation or personal injury claim.  Our Montgomery and Bucks County attorneys can be reached by calling (888) 818-4343.

Wednesday, May 27, 2015

Seasonal Employees Injured on the Job Deserve Full Benefits

Does workers' compensation apply to me at my summer job?

During the summer months, many employers in Montgomery and Bucks Counties hire temporary, seasonal employees. Though these employees are only at their posts for a limited amount of time, in Pennsylvania, the workers’ compensation laws that apply to full-time employees usually also apply to them.

If you were injured while working a seasonal job, there are a few things you should be aware of to ensure that you get all of the workers’ compensation benefits you deserve.
• Even if it seems like the accident that caused your injury was your fault, you are likely still eligible for compensation. All too often, seasonal employees are not properly trained or given adequate protections.
• All wages should be taken into account when calculating workers’ compensation benefits. So, if you work multiple jobs and are injured at one of them, the benefits you receive should reflect the amount of income you are losing in total, not just the money you would have earned while working at the job where the injury occurred.
• Even if you are able to keep working at the job where you were injured, you can probably collect wages lost because you are unable to work other jobs you may have. For example, if you break your leg while working at your office job, you could get workers’ compensation benefits if the broken leg prevented you from working at your other job as a golf caddy, even if you can still work at the office.
• If the injury is a very serious one that will prevent you from working for a year or more, you may be eligible for additional disability benefits from Social Security.
• Some employers will try to tell you that you are or were an independent contractor and are therefore ineligible for benefits. Our experience suggests that this is rarely the case when it comes to seasonal employees. It is very likely you should have been classified as an employee and are due benefits.
• Though it is possible to represent yourself in a workers’ compensation case, hiring an experienced attorney can help level the playing field and ensure that you are getting all the benefits you deserve.

The attorneys at Louis P. Lombardi II & Associates, P.C., have the experience and knowledge to successfully guide your workers' compensation claim. We serve the Philadelphia metropolitan area with convenient locations in the city of Philadelphia, Plymouth Meeting, Montgomery County and Chalfont, Bucks County. Contact us today at (610)239-7600 or (888)818-4343 to arrange a consultation.

Monday, May 18, 2015

How to Handle a Work-Related Injury That Was Caused By A Third Party

If My Work Related Injury Is Caused by a Third Party Do I Also Have a Personal Injury Claim?

People who suffer work related injuries that were caused, at least in part, by someone other than your employer may have a viable personal injury claim as well.

Some examples include:

• While driving a company owned vehicle in the course of your duties you were injured in an accident caused by the negligence of another driver.

• You slipped and hurt yourself when you stepped onto a slippery surface at a customer’s facility. 

• You were injured as you worked on the assembly line by a machine tool that was defectively designed or manufactured or defectively repaired by an outside contractor. 

If you exercise your right to file this lawsuit, your employer (or its insurer) has a right to collect a percentage (based on a formula) of what you collect from this third party in order to be paid back what it paid to you. This is known as subrogation.

Your employer or its insurance carrier cannot directly sue the third party to be reimbursed what it paid out, the injured worker needs to be part of the litigation, according to a state Supreme Court decision, Liberty Mutual Insurance Co. v. Domtar Paper Co.

In this case, George Lawrence worked for the trucking company Schneider National, Inc., at a facility leased by Domtar when he slipped and fell in the parking lot, injuring himself, resulting in a payment of $33,929.23 in workers' compensation benefits. Liberty Mutual sued Domtar and the owners of the facility claiming they were responsible for the injury. Lawrence never filed his own suit, assigned his legal rights to Liberty Mutual nor did he join their lawsuit.

The lower court ruled Liberty Mutual did not have a right to sue on its own a third party alleged to have caused the work related injury and dismissed the case. On appeal the Supreme Court disagreed with Liberty Mutual’s interpretation of state statute and prior court decisions and agreed with the trial court.

If you find yourself suffering from a work related injury caused by another party, the workers compensation and personal injury attorneys at Louis P. Lombardi II & Associates, P.C., can help you navigate through the complex legal system. The firm helps those in the Philadelphia area with offices in Philadelphia, Plymouth Meeting, Montgomery County and Chalfont, Bucks County. Call (610)239-7600 or (888)818-4343 today to schedule a consultation. 

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