Permanent Partial Disability Attorney in Philadelphia, Pennsylvania

Like every state except Texas, Pennsylvania law requires employers to carry workers’ compensation insurance or self-insure. Workers’ compensation is a no-fault system that pays for medical expenses and lost wages if an employee is injured on the job or falls ill because of workplace conditions, such as the presence of toxic chemicals or asbestos. 

Being no-fault, neither employer nor employee can sue one another in almost every instance. All workplace injuries and illnesses that occur during the course and scope of one’s employment are covered, except for self-inflicted injuries or injuries resulting from intoxication or violation of the law. 

When injuries prevent an employee from working altogether, then it is classified as total disability. If the employee can return to work but only in a reduced capacity, it may be classified as a partial disability. In either circumstance, you will be entitled to benefits, though partial disability benefits are limited to 500 weeks’ duration, either consecutively or not. 

If you have been injured on the job in or around Philadelphia, Pennsylvania, and your injuries have resulted in total disability, your employer and/or insurer can request what is called an impairment rating evaluation (IRE) after 104 weeks. This could result in your classification being changed and your benefits reduced or even stopped altogether.  

When dealing with all workers’ compensation claims and subsequent issues, rely on H. Rosen Law, P.C. Our legal team will help you from the beginning to assemble the most complete package of medical evidence and then represent you if any appeals are necessary or hearings are held. We proudly represent workers not only in Philadelphia but also throughout Southeastern Pennsylvania, including Harrisburg and Scranton.

Determining Disability Under Pennsylvania’s Workers’ Compensation System 

The simple answer to the difference between total and partial disability, as alluded to above, is that total disability means you can no longer work in any capacity, while partial disability means you can work but perhaps in a different and less challenging or more accommodating environment.  

In cases of total disability, you will have your medical expenses covered and your lost wages paid up to two-thirds of your weekly earnings when the injury occurred, with a cap of $1,273 in 2023 (the cap is adjusted yearly). In cases of partial disability, your medical expenses will still be covered, but you will be paid only two-thirds of the difference between your pre-injury wage and your current wage when you return to work. And, as mentioned earlier, partial disability payments are capped at 500 weeks. 

How is disability determined? Initially, the physician treating the employee will make a determination as to whether that person can perform his or her job-related duties. Of course, the insurer or self-insured employer may challenge the determination. Then what happens? 

According to the Department of Labor and Industry (DLI), which oversees workers’ compensation in the Commonwealth, “Payments of temporary compensation may be made by your employer or the insurance carrier for up to 90 days, even if your claim is not accepted by your employer or its insurance carrier.” If your claim is ultimately denied, you can petition the Office of Adjudication for a hearing. For this, you should definitely seek the services of a Philadelphia workers’ compensation attorney. 

What Happens to Disability Benefits After 104 Weeks? 

Assuming that your claim is honored and you have been out on disability for two years, which the law defines as 104 weeks, you will then likely be asked to undergo what is called an impairment rating evaluation (IRE) to determine the extent of your impairment; in other words, to determine whether you’re totally or partially disabled, or perhaps no longer even impaired. 

The IRE system was changed after the Pennsylvania Supreme Court in 2017 struck down the impairment standards in the Workers’ Compensation Act as unconstitutional. The next year, House Bill 1840 became law, which established the current IRE system. Under this act, the employer or insurer can, after 104 weeks of disability benefits, order an employee to undergo an IRE by an independent physician. 

The IRE relies on the AMA Guides to the Evaluation of Permanent Impairment to evaluate the extent of an employee’s impairment or disability. If the employee is found to be 35 percent or less impaired, then the worker’s status can be adjusted to partial disability. Medical benefits will continue, but the worker must return to work to receive wage benefits at two-thirds the difference between their former wage and their new wage. 

If the insurer or self-insured employer requests the IRE within 60 days after the 104 weeks have lapsed, any change in status is automatic. After 60 days, they must file a Petition for Modification. They also have the right to request two IREs within 12 months.  

You have the right to challenge any IRE result, and you may even be able to challenge the need for an IRE, but in either case, you are going to need the help of an experienced workers’ compensation attorney to help you navigate the system. 

Workers’ compensation insurers and self-insured employers are going to use every means at their disposal to limit their costs in terms of medical and lost-wage benefits. You need to present as complete a package of medical evidence as possible at the beginning, and you will no doubt still be asked for further data, such as further test results, as your claim is evaluated. If your claim is for permanent disability, you will no doubt eventually be subjected to an IRE as well.