Quick Guide to the Worker's Compensation Act
 
Download PA's Workers' Compensation Law with
Practical Tips
 

WHAT IS CONSIDERED AN INJURY?

* REPETITIVE MOTION INJURIES (EXAMPLE: CARPAL TUNNEL)
* AGGRAVATION OF PRE-EXISTING CONDITIONS
* SPECIFIC LOSS (LOSS OF HEARING OR USE OF A LIMB OR DIGIT)
* DISFIGUREMENT (SCARRING ON THE HEAD OR NECK)
* OCCUPATIONAL DISEASE (LUNG CANCER, MESOTHELIOMA, OCCUPATIONAL ASTHMA, CANCER, ETC.)


REPORTING THE INJURY:

* AN INJURY MUST BE REPORTED WITHIN 120 DAYS OF THE DATE OF INJURY. IF REPORTED, ONE HAS 3 YEARS
TO FILE A CLAIM.
* MUST REPORT THE INJURY TO A SUPERVISOR OR SOMEONE IN AUTHORITY
* MUST STATE THAT THE INJURY IS WORK-RELATED
* BEST FORM OF NOTICE IS AN ACCIDENT REPORT


ACCEPTING AN INJURY AS WORK RELATED:


* EMPLOYER MUST DECIDE WITHIN 21 DAYS WHETHER THE INJURY WILL BE ACCEPTED OR DENIED
* NOTICE OF COMPENSATION PAYABLE ISSUED FOR ACCEPTED INJURY
* NOTICE OF TEMPORARY COMPENSATION PAYABLE WHICH IS ONLY EFFECTIVE FOR 90 DAYS
* MEDICAL ONLY ACCEPTANCE BUT MERE PAYMENT OF MEDICAL BILLS IS NOT AN ACCEPTANCE
* IF DENIED THAN A CLAIM MUST BE FILED BEFORE A WORKERS’ COMPENSATION JUDGE


TREATING FOR THE INJURY:


* EMPLOYER SHOULD HAVE A LIST OF SIX DESIGNATED PHYSICIANS OR TREATMENT GROUPS (I.E. PANEL DOCTOR)
* MUST TREAT WITH A PANEL DOCTOR FOR 90 DAYS
* A COMPANY DOCTOR IS NOT A PANEL DOCTOR
* AFTER 90 DAYS ONE CAN TREAT WITH A DOCTOR OF THEIR CHOICE BUT THEY MUST NOTIFY THE INSURANCE
CARRIER WITHIN 5 DAYS OF TREATING WITH A NEW DOCTOR.
* THERE IS NO REQUIREMENT THAT ONE HAS TO COOPERATE WITH A REHAB NURSE


WORKERS’ COMPENSATION BENEFITS:

* TO BE ELIGIBLE FOR WEEKLY BENEFITS MUST BE OFF FOR AT LEAST 7 DAYS AND WILL NOT RECEIVE BENEFITS
UNTIL AFTER THE 14TH DAY.
* GENERALLY, THE BENEFIT AMOUNT IS 2/3 OF THEIR WAGES
* BENEFITS ARE BASED UPON ONE’S AVERAGE WEEKLY WAGE WHICH IS THE AVERAGE OF ONE’S
WAGES OVER A ONE YEAR PERIOD PRIOR TO THE INJURY
* THE BENEFIT AMOUNT CANNOT EXCEED THE MAXIMUM ALLOWED WHICH IN 2011 IS $858.00


RELEASE TO RETURN TO WORK:

* WHEN RELEASED TO RETURN TO WORK THERE IS AN ABSOLUTE OBLIGATION TO RETURN IF WORK IS PROVIDED
* AN EMPLOYER, HOWEVER, DOES NOT HAVE AN OBLIGATION TO RETURN SOMEONE TO WORK WITH RESTRICTIONS
* IF THERE ARE NO RESTRICTIONS AND NO WORK IS PROVIDED WORKERS’ COMPENSATION BENEFITS CONTINUE
* IF RETURNED TO WORK TO A POSITION EARNING LESS THAN PRE-INJURY EARNINGS THERE IS AN ENTITLEMENT TO PARTIAL BENEFITS
* IF THERE IS NO WORK AVAILABLE WITHIN A WORKERS RESTRICTIONS VOCATIONAL REHABILITATION MAY BE INITIATED


RETURNING TO WORK:

* BENEFITS CAN BE SUSPENDED SO THAT THEY CAN BE REINSTATED IF ONE AGAIN BECOMES DISABLED DUE
TO THE SAME INJURY
* BENEFITS CAN BE TERMINATED IF ONE FULLY RECOVERS FROM THE INJURY
* BENEFITS CAN BE RESOLVED THROUGH A LUMP SUM SETTLEMENT
* NEVER SIGN ANYTHING WITHOUT CONSULTING A LAWYER


COMPANY DOCTOR AND REHAB NURSE:

* COMPANY PHYSICIANS AND/OR REHAB NURSES ARE NOT TREATING PHYSICIANS
* COMPANY PHYSICIAN AND/OR REHAB NURSE CANNOT MANAGE THE CARE OF THE WORKER NOR PLACE RESTRICTIONS UPON THAT WORKER
* THE NURSE, NO MATTER HOW FRIENDLY, DOES NOT HAVE THEIR BEST INTEREST IN MIND
* A NURSE SHOULD NEVER BE PERMITTED TO PARTICIPATE IN DOCTOR’S EXAMS
* THE NURSE OR MCS HAS NO RIGHT TO CHANGE, MODIFY OR MANAGE PHYSICIAN APPOINTMENTS


MEDICAL REVIEW:

* EMPLOYER IS RESPONSIBLE FOR ALL MEDICAL EXPENSES RELATED TO A WORK INJURY
* EMPLOYER HAS THE RIGHT TO CHALLENGE WHETHER MEDICAL TREATMENTS ARE REASONABLE, NECESSARY & RELATED
* THIS CHALLENGE IS ACCOMPLISHED THROUGH THE UTILIZATION REVIEW PROCEDURE
* BY WAY OF THIS PROCEDURE, THROUGH AN INDEPENDENT THIRD PARTY, MEDICAL CARE IS REVIEWED
* WHILE THE REVIEW IS PENDING EMPLOYER DOES NOT HAVE TO PAY THE CHALLENGED MEDICAL CARE
* HOWEVER, EMPLOYER HAS NO RIGHT TO SIMPLY STOP PAYMENT BEFORE FILING THE REVIEW
* CAN ONLY BE SENT TO TWO INDEPENDENT MEDICAL EXAMS IN A 12 MONTH PERIOD


WORKERS COMPENSATION, FMLA & ADA:

* A WORK-RELATED INJURY DOES NOT QUALIFY AS TIME OFF UNDER THE FAMILY MEDICAL LEAVE ACT
* A WORK INJURY IS NOT A SERIOUS HEALTH CONDITION AS DEFINED BY THE FAMILY MEDICAL LEAVE ACT
* A WORK RELATED INJURY MAY BE SO SEVERE THAT THE SAME QUALIFIES AS A QUALIFIED CONDITION UNDER ADA.
* IF AN INJURED WORKER IS NOT PROVIDED A REASONABLE ACCOMMODATION OR IS DISCHARGED DUE TO AN INJURY, THERE MAY BE AN ADA VIOLATION


OTHER BENEFITS:

* IF AN EMPLOYER DENIES WORKERS COMPENSATION BENEFITS APPLY FOR SHORT-TERM AND/OR SICKNESS AND ACCIDENT BENEFITS
* UNEMPLOYMENT COMPENSATION BENEFITS MAY BE APPROPRIATE WHERE A WORKER IS PROHIBITED FROM RETURNING TO WORK
* SOCIAL SECURITY BENEFITS ARE APPROPRIATE IF FOREVER BARRED FROM RETURNING TO WORK
ALL OF THESE BENEFITS CAN BE RECEIVED IN CONJUNCTION WITH WORKERS’ COMPENSATION BENEFITS ALTHOUGH THERE MAY BE EITHER AN OFFSET OR REPAYMENT OBLIGATION

Click here to download Quick_Facts for workers comp

 

PITTSBURGH OFFICE: 967 Liberty Avenue, Floor 2, Pittsburgh, PA 15222
PHONE: (412) 412-566-1245 - FAX: (412) 566-1085

HARRISBURG OFFICE: 114 Walnut Street,. Suite 1, Harrisburg, PA 17101
PHONE: (717) 412-4518

Darren@dkplaw1.com
Copyright 2011 Darren K. Parr Law Firm