Temporary Disability Attorney in Philadelphia, Pennsylvania
Workers’ compensation is an insurance system available in all 50 states that pays for employees’ medical expenses and lost wages if they are injured on the job or fall ill due to chemicals or allergens. It is a no-fault system designed to prevent lawsuits by employees against their employers.
Each state establishes rules on how the system should operate regarding when claims need to be made, how soon the benefits should commence, whether employees need to see company-approved physicians, how to appeal decisions, and more.
Employers generally contract with insurance providers to manage their workers’ compensation program. Insurers, of course, are for-profit institutions, so they are out to protect the bottom line. They thus are on the constant lookout for fraudulent or inflated claims and for benefit recipients who try to “extend” their benefits beyond the point of necessity.
Insurers can order an independent medical examination (IME) if they suspect a benefit recipient is not being honest – in other words, their condition no longer warrants payment for wage loss and medical expenses. That being said, for the honest employee who is injured or falls ill on the job, workers’ compensation should provide benefits for as long as needed.
If you or a loved one has been injured or fallen ill on the job due to workplace conditions and need to file a claim – or appeal one that has been denied or canceled – in or around Philadelphia, Pennsylvania, contact H. Rosen Law, P.C. for trusted legal help.
We understand the Commonwealth’s workers’ compensation statute and regulations and can help you obtain the compensation you deserve. We also proudly serve clients throughout Southeastern Pennsylvania, including Harrisburg and Scranton.
Overview: Workers’ Compensation in Pennsylvania
The Commonwealth of Pennsylvania enacted its Workers’ Compensation Law in 1915. Under the act, the Department of Labor and Industry and the Bureau of Workers’ Compensation oversee the administration of the law and the appeals process.
Almost all employers are required to offer workers’ compensation coverage except for a few exceptions in agriculture, working with the railroad, or longshore industries that have separate coverage. Federal employees also have their own system.
Coverage for employees begins the day that they commence their jobs. Workers’ compensation, as noted earlier, covers injuries suffered at work, or in work-related situations, and also illnesses that derive from workplace conditions such as allergens or toxic chemical usage. Benefits include payment for medical expenses and for lost wages if an employee cannot return to duty.
Common Causes of Workers’ Compensation Injuries and Illnesses
Injuries that occur on the job can include slips and falls, resulting in back and neck injuries. Depending on the type of work, an employee might also be struck by a moving object or by a vehicle.
Also, repetitive stress injuries are fairly common. These types of injuries result from doing work that is repetitive, in nature. Probably the most cited such injury is carpal tunnel injury, which often results from sitting at a desk all day and entering data into a computer, but other repetitive jobs can also lead to injury. Even working a cash register or stocking shelves can result in repetitive stress injuries, as can using a jackhammer or other piece of machinery all day on the job.
Illness claims must spring from conditions at work that cause the illness. For instance, using or being exposed to toxic chemicals or allergens can often result in illness. Asbestos exposure is probably the most common of all work-induced illnesses.
Temporary Disability Benefits in Pennsylvania
The workers’ compensation system divides work-related disability into two broad categories: Total Disability and Partial Disability. This is determined by calculating, based on medical evidence, what is called the impairment rating of the injured or ill employee.
If the impairment rating rises to 50 percent or more, then the employee will be considered totally disabled, but to achieve a rating that high, the individual must be profoundly disabled. Less than a 50 percent impairment rating is considered partially disabled.
Benefits can be either temporary or permanent. Temporary benefits can last for up to 500 weeks if the disabling condition persists. Permanent benefits can theoretically last for a lifetime, but rarely do. After 104 weeks of total disability benefits, the insurer will usually order an independent medical examination (IME) to determine the extent of the disability.
Medical expenses are covered, and employees are exempt from having to honor any copays. The insurer should pay all expenses according to a schedule they establish. The employer, however, is allowed to require employees to choose from a list of at least six approved physicians or medical groups. As for lost-wage benefits, they are paid two-thirds of the worker’s average weekly wage at the time of injury or illness.
The Application Process
If you are injured or fall ill on the job, you should report it to your employer immediately, but under the Workers’ Compensation Act, Section 311, notice of an injury be given within 21 days after it occurs, or at the latest, within 120 days of the injury.
Under the law, the workers’ compensation insurer has 21 days after receiving notice of an injury of illness to provide benefits. In other words, the sooner you report your injury or illness and start seeking medical evaluation and treatment, the sooner your benefits can start.
Disputes and Appeals
As noted earlier, workers’ compensation insurers are constantly monitoring claims and benefits being awarded. In addition to an ordered IME, if the insurer is really suspicious, your activities may even be monitored. At the very least, they can follow you on social media to see if you’re doing activities that suggest you’re not as disabled or unable to work as you claim. They can even cancel benefits that you’re already receiving using social media or surveillance evidence.
If your claim is denied or your benefits later canceled, you can appeal the decision under the Worker’s Compensation Act, but you must do so within three years. Your appeal may end up before an administrative law judge (ALJ) or the Workers’ Compensation Appeals Board. The insurer’s attorneys will be on the case, so you should have an attorney representing you as well.
If you have a claim for temporary disability in or around Philadelphia, or worse, your claim has been denied or your benefits suspended or canceled, contact us immediately at H. Rosen Law, P.C. We will help you assemble the medical and other evidence needed to press your claim or appeal forward. Don’t go it alone. Reach out immediately.