How We Can Help
When you, a loved one, or someone you know has suffered an injury at work (including death on the job), there may be compensation available for those work place injuries. The problem is the employer’s insurance company may undervalue the claim or even deny the claim for benefits all together. Alternatively, the employer may grant benefits at the outset, but could later seek to terminate those benefits arguing the individual has recovered from his or her work place injuries when in reality he or she has not recovered.
Buzgon Davis Law Offices is experienced in all aspects of the claim process, including the initial claim for compensation and when an employer is seeking to terminate or suspend compensation benefits that an individual is already receiving. As is illustrated in the discussion below, the Worker’s Compensation arena is a complex area of law and should only be analyzed on a case-by-case basis. Meeting with one of our experienced attorneys will allow us to give you the best advice and strategic decisions regarding your case. If you or someone you know is considering trying to obtaining Worker’s Compensation benefits, either federally or through Pennsylvania, he or she should contact our office immediately.
To learn more and discuss your specific case with a skilled Workers’ Compensation attorney, contact our office at 717-274-1421.
What You Want to Know
Do I Qualify?
When focusing on Pennsylvania’s Workers’ Compensation eligibility, many individuals are covered by Pennsylvania’s Workers’ Compensation Act. However, certain employees are not covered by the Act and/or are covered by a federal plan instead, thus, making them ineligible to receive Pennsylvania benefits. The follow classifications of individuals are NOT eligible for Pennsylvania Worker’s Compensation Benefits:
- All Federal Employees;*
- Railroad Workers, Freight Handlers, and Engineers;
- Longshore Workers and Other Habor Workers;
- Volunteers of any kind;
- Independent Contractors;
- Self-employed individuals; and
- Domestic Workers, Housekeepers or maintenance workers for a private household
- covered by a federal plan/federal law
Starting the Process from Scratch
When an individual is injured on the job, the first thing an employee should do is give notice to the employer of his or her injury on the job. With some rare exceptions, Pennsylvania law requires that the employer be notified of the injury within 120 days of the injury. Failure to notify the employer can result in the inability to proceed with your claim. The safe approach is to notify your employer in writing of your work place injuries immediately after they occur.
After notice is given, an individual has three (3) years from the date of the injury to file a claim for compensation. Once an individual files his or her claim for compensation, the claim process has begun. If the employer denies the claim, the matter will proceed to an Administrative Law Judge (ALJ).
Once before the ALJ, he or she will set a schedule for the resolution of the claim. The schedule will include times to take the injured employee’s and employer’s testimony as well as set deadlines for taking depositions of various doctors. The employee’s doctor(s) that have knowledge of the employee’s injuries would likely testify at a deposition. Additionally, the employer, or its insurer, will hire doctors to testify at a deposition as to their opinions on the employee’s condition.
It is important to note that when dealing with a new claim for compensation for a workplace injury, the burden is on the employee to establish the following: there was an employment relationship during which an injury arose in the course of employment and the injury is related to the employment. A common litigated point in a workers’ compensation claim surround the “is related to the employment” language. The “related to the employment” aspect becomes an arguable point when an individual suffers an injury on the job, but has preexisting conditions related to that injury.
After the employee and employer’s testimony and doctor’s depositions, the ALJ will set a schedule for filing briefs from both the employee and employer. The briefs are a legal document setting forth the factual and legal arguments for why/why not the employee is entitled to benefits. After the briefs are submitted, the ALJ will make a decision on the case. If benefits are denied, an employee has the right to appeal the case.
Other Important Aspects
While the explanation above gives the general overview for a new claim from start to finish under Pennsylvania Law, there are other important things that come up in a Worker’s Compensation setting.
For example, an individual could be receiving workers’ compensation benefits and an employer could seek to terminate and/or suspend those benefits. In that scenario, the burden is no longer on the employee to prove his or her case, but is on the Employer. That said, the employee will still need to produce evidence that his or her injuries are ongoing.
Additionally, there are examinations and evaluations known as Independent Medical Examinations (IME) and Independent Rating Evaluations (IRE). An IME is typically an avenue available for the employer or its insurance company to have the employee be evaluated by a doctor of its own choosing every six months in order to determine the employee’s capabilities and whether he or she is fully recovered. The result of an IME will typically result in the employer seeking a modification, suspension, or termination of the employee’s compensation benefits.
Meanwhile, an IRE is another avenue available for the employer. The IRE is a special type of medical examination that an employer can get after an individual has received 104 weeks of compensation benefits. The IRE is a medical examination intended to calculate the injured employee’s level of whole body impairment resulting from the work place injury, which can impact the individual’s eligibility to collect benefits. The Bureau of Workers’ Compensation assigns the doctor to perform the IRE. Generally, if your whole body impairment is less than 50% disabled, you will only be able to collect temporary total disability benefits for set period of time. If you are more than 50% disabled, generally, you will likely be able to collect benefits for life.
On a final note, it is important to mention that not all cases are fully litigated. It is common for the employer and employee to settle the case based on agreed upon terms and compensation. This is known as a Compromise and Release Agreement (CNR). A CNR will generally result in the resolution of the claim and will typically prevent an employee from seeking any further compensation in the future for the work place injury that they suffered. A CNR should be considered with the utmost caution because once executed, the ramifications can be significant.
*The information is for informational purposes only and is NOT to be construed as legal advice and does not create an attorney/client relationship. If you have any questions specific to your case, you should consult an attorney as each individual’s case and the law applicable thereto varies on a case-by-case basis.