Frequently Asked Questions About Cumberland County Workers’ Compensation and Social Security Disability
If you’ve been injured and now need to file a claim, you have many questions. Get the answers you need to guide your case in collection of responses from our Cumberland County workers’ compensation and Social Security disability attorneys.
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Am I entitled to payment for my scarring and disfigurement?
Yes. Scarring and disfigurement of the head, neck, or face, if serious, permanent, and unsightly, and not usually incident to the employment, is compensatied for a period of time not to exceed 275 weeks of benefits. This award can be negotiated between the parties. If the parties cannot agree upon the award amount, the Workers' Compensation Judge (WCJ) has the discretion to award benefits based upon a personal observation of a Claimant's facial and neck scars. If the WCJ concludes that the scars are insufficient to produce an unslightly appearance, the WCJ may refuse to award an award.
It is important to realize that scarring may also be associated with treatment of the work injury. Therefore, a Claimant with herniated discs in their neck, resulting in a cervical discectomy or fusion, may be entitled to a scarring award as a result of the surgery and the resulting scar. A good description, on the record, of the length, width and appearance of any scar is the best way to maximize this award from a WCJ. If a Claimant disagrees with the award mader by a WCJ, an appeal may be filed with the Workers' Compensation Appeal Board.
What is carpal tunnel syndrome? How is it caused? What are the treatments?
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a painful disorder of the hand and wrist that is caused when pressure is placed on the median nerve in the carpal tunnel of your hand. Essentially, your median nerve becomes "entrapped" resulting in symptoms in your hands. The median nerve controls the feeling in your thumb, index finger, middle finger and ring finger. It does not control your pinkie finger. Carpal tunnel syndrome is an extremely common repetitive motion injury suffered by Pennsylvania Workers.
In our workers' compensation practice we see many different types of workers diagnosed with carpal tunnel syndrome. Common examples of workers that are prone to suffering from carpal tunnel syndrome include:
- Assembly line worker
- Auto mechanics
- Factory worker
- People using computers throughout the work day
What are symptoms of carpal tunnel syndrome?
Because of the nature of the injury, symptoms will often begin over time. Doing things like picking up the phone, or a gallon of milk can trigger the pain in your hands. Buttoning a shirt, or tying a tie can become difficult and the pain will usually cause you to shake your hands trying to shake the discomfort away. Common symptoms include:
- Hand weakness
- Numbness and pain in your hands and fingers
- "Pins and Needles" feeling in hands and fingers
- Difficulty picking objects up
- Tingling in all fingers (except pinkie) that radiates up your arm
If you are suffering from these symptoms and believe that your condition is work related, you should provide immediate notice to your employer and ask for a list of panel physicians to seek treatment. Only a medical professional can properly diagnose your problem and tell you if you are indeed suffering from carpal tunnel syndrome.
How is carpal tunnel syndrome treated?
The proposed treatment an injured worker will receive after being properly diagnosed with carpal tunnel will vary depending on the severity of the carpal tunnel syndrome they are suffering from. Common treatment includes:
- Physical or Occupational therapy
- Wearing braces or splints to immobilize your hands and wrists
- Use of anti-inflammatory drugs (such as aspirin or ibuprofen)
- Resting of your hands and arms
- Steroid or cortisone injections
Very often your doctor will begin your course of treatment with conservative treatment, and surgery will usually become an option after all conservative treatment options fail to provide relief.
How long after my compromise and release hearing will I get my settlement check?
I you waived the appeal period, you will usually get your check a couple of weeks after the decision approving the Compromise & Realse is issued by the judge. If you did not waive the appeal period, the Defendant/Insurance Company has 30 days after the decision to issue your check.
If you do not receive your check by then, you may file a Penalty Petition seeking a "penalty" of up to 50% of the compensation that is owed and payable to the Claimant.
I have an upcoming workers compensation settlement, Can I collect unemployment after settlement?
Usually, as part of a workers’ compensation settlement, the employer will want a resignation as part of the deal. Your attorney will have to bargain for favorable language if you wish to seek UC benefits.
You should discuss the case Lee v. Unemployment Compensation Board of Review with your attorney. In this case, the injured worker gave both a resignation and a release as part of her workers’ compensation settlement. Following the approval of the settlement, the Claimant filed for unemployment compensation benefits.
Benefits were initially granted but The Unemployment Compensation Board of Review reversed, finding the injured worker not eligible for unemployment compensation benefits. Upon further appeal, this was affirmed by the Commonwealth Court of Pennsylvania. If your resignation is "voluntary" you may not be eligible for UC benefits.
I have a mandatory mediation hearing in 4 weeks are they looking to settle my case? What should I expect?
The fact that there is a mandatory mediation, and not a voluntary mediation, scheduled would indicate that there must be some type of petition pending. I am assuming that this is a petition filed by the Insurance Company,and consequently, your benefits may be being placed in jeopardy. If you have not done so, you should discuss this with an attorney immediately. Mediation can be a very useful procedure in getting cases resolved, but it certainly sounds like there are some issues with your case that need to be discussed with someone BEFORE you try and resolve your claim. Do yourself a favor and use AVVO to find someone to discuss this matter with (if you do not already have an attorney).
Both mandatory mediation and voluntary mediation can be very effective ways to resolve your claim, or narrow the issues you are arguing over with the Insurance Company. You should always discuss the pros and cons of attempting to resolve your case via mediation, and also have an experienced workers' compensation attorney represent your interests at the mediation, because the Insurance Company certainly will have representation.
When are Penalties awarded to an injured worker? How much can the Judge award?
When an Employer or Insurance Company violates the provisions of the Pennsylvania Workers' Compensation Act, an injured worker may file a Penalty Petition seeking a "penalty" of up to 50% of the compensation that is owed and payable to the Claimant. The award of penalties is solely within the discretion of the Workers' Compensation Judge. Not every violation will result in a significant penalty being awarded, but the ability to file for penalties does provide a Claimant with recourse in the event of violations of the Act.
Examples of violations of the Act that have resulted in penalties being awarded:
- When an Insurance Company fails to make payment within 30 days of when the obligation to pay wage loss benefits, or a settlement arises;
- When an Insurance Company unilaterally stops paying benefits;
- When the Insurance Company fails to properly investigate a claim;
- When an Insurance Company or Employer fails to pay compensation when owed and payable to an injured worker;
- When the Insurance Company or Employer fails to notify the injured worker, within 21 days, that the claim is being denied;
- When an Employer stops paying medical expenses and fails to file an appropriate petition.
The above list is only a small sample of the possible scenarios that may violate the Act and lead to the imposition of penalties against a defendant in a workers' compensation case.
If you or a loved one believe that a violation of the Pennsylvania Workers' Compensation Act has occurred with your case, or you need a Penalty Petition filed – contact Norfleet and Lafferty to speak with our Pennsylvania workers’ compensation lawyers today. Our Central Pennsylvania workers compensation attorneys in Harrisburg, York and Lemoyne will answer all of your questions and lead you through the complex workers’ compensation process. Call (717) 737-7574 or fill out our case evaluation form.
What is a Review Petition? When do I need to file one?
The Review Petition can be filed by an injured worker to correct a material mistake contained in the Agreement for Compensation or the Notice of Compensation Payable (NCP). For example, the injured worker would want to file a Petition To Review when:
The date of injury is listed incorrectly;
There is a mistake in the description of the injury; or the injury is not listed properly;
There is a mistake that was made in calculating your average weekly wage, or compensation rate.
An injured worker may also file a Petition to Review to add or change the Agreement for Compensation or NCP. Very often, the Employer or Insurance Company will list an injury as a "sprain/strain" injury in order to comply with the time requirements of acknowledging a reported work injury. Only after the necessary diagnostic tests, such as an MRI or CT Scan is the actual injury properly known. In this example, if the Employer or Insurance Company refused to expand the definition of the injury voluntarily, the injured worker would need to file a Petition To Review in order to prove the injury was more than a "strain/sprain."
An Employee must file the Petition for Review within three years of the date of the most recent payment of compensation, and the burden of proof for an Employee-filed Petition to Review will be on the injured worker.
The Employer may also file a Petition to Review for the above reasons as well as to review medical treatment or billing.
If you or a loved one believe that a your injury may be listed improperly on the Notice of Compensation Payable, or you need a Petition to Review filed – contact Norfleet and Lafferty to speak with our Pennsylvania workers’ compensation lawyers today. Our Central Pennsylvania workers compensation attorneys in Harrisburg, York and Lemoyne will answer all of your questions and lead you through the complex workers’ compensation process. Call (717) 737-7574 or fill out our case evaluation form.
How does "Substantial Gainful Activity" affect my application for Social Security Disability benefits?
"Can I apply for Social Security disability benefits while I am working?" This is one of the most frequently asked questions I receive. Because the application process can be lenghty, I encourage new clients to file as soon as possible. In some cases, you may be able to file an application for benefits while you are working - but when?
To answer this question, let's start by looking at what the Social Security Administration refers to as "Substantial Gainful Activity." To be eligible for Social Security Disability benefits, you must be found to be unable to work at Substantial Gainful Activity ("SGA") level. In fact, this is the first question that the Social Security Administration will look at when you file your application for benefits - even before your medical evidence is reviewed. "Substantial Gainful Activity" describes your level of work activity and your earnings. "Substantial" means that you are working in a job that requires you to perform significant physical or mental activities. "Gainful" means that you are being paid for the work that you are doing or that it is work that you would normally be paid for doing.
Now that we have looked at what "Substantial Gainful Activity" means - how can it impact your application for benefits? When you file your application for benefits, the Social Security Administration asks you if you are working and how much you are earning. You cannot earn more than a specific dollar amount each month ("SGA") and be eligible for benefits. For 2014, you cannot earn more than $1,070.00 per month ("SGA level") or $1,800.00 if you are blind. If you are not blind and you are earning more than $1,070.00 per month, you are earning above SGA level and the Social Security Administration will find that you are not disabled. If you are submitting an application for benefits, your application will be denied for non-medical reasons and your medical evidence will not be reviewed. If you are already receiving benefits, the SGA requirement still applies to you - you can earn up to $1,070.00 per month (if you are not blind) and you will not lose your benefits.
My son injured his hand and lost three fingers while working with machinery at work. Is he entitled to money for losing his fingers?
Yes. Under the Pennsylvania Workers' Compensation Act, injured workers are entited to a specific loss award for both the loss of an appendage -- amputation of the appendage -- or the loss of use of the body part "for all practical intents and purposes." The amount of the benefit payable for the specific loss is calculated the same was as an injured workers' weekly total disability payment is calculated. Body parts have their own unique value which is represented by the payment of a number off weeks of compensation. For example, each finger, as well as the thumb, has its own award amount. Each body part also provides for a "healing period" and, provided that the injured worker doesn not return to work prior to the number of weeks provided for the "healing period," the worker will receive the assigned number of "healing" weeks of benefits in addition to the specific loss award.
If you or a loved one have suffered a specific loss, or other type of work injury – contact Norfleet and Lafferty to speak with our Pennsylvania workers’ compensation lawyers today. Our Central Pennsylvania workers compensation attorneys in Harrisburg, York and Lemoyne will answer all of your questions and lead you through the complex workers’ compensation process. Call (717) 737-7574 or fill out our case evaluation form.
What is a Statement of Wages?
The Statement of Wages (LIBC-494c) is the bureau form used by the employer to calculate an injured workers Average Weekly Wage (AWW) and corresponding Workers' Compensation Rate. These calculations determine how much of a weekly or bi-weekly wage loss benefit you will be entitled to receive. If you have been employed for the past year, the employer will be obligated to take the wages from the highest three of the last four quarters to determine your AWW. If you have not been an employee for the past year; if you have worked less than 13 weeks; or if you are a seasonal employee, the form also allows for the calculation of an AWW but uses different formulas. Depending on your type of employment lodging and tips and gratuities may also factor into the calculation of your AWW. You should receive your Statement of Wages when you receive your Notice of Compensation Payable, Temporary Notice of Compensation Payable, or Agreement for Compensation.
I was hurt at work and received a Temporary Notice of Compensation Payable, what rights do I have?
After you provide proper notice of your injury, the employer, within 21 days of that notice, may issue several documents including a Temporary Notice of Compensation Payable. The Notice of Temporary Compensation Payable (LIBC-501) is filed to extend the investigation period to 90 days before they are forced to accept or deny full liability for the injury. In other words, this allows the employer, or its insurance company, to begin paying your medical bills and wage loss benefits while reserving the right to deny your claim within 90 days while they continue to "investigate" your claim. If they take no action to deny your claim within 90 days, your Temporary Notice of Compensation Payable will convert to a Notice of Compensation Payable by operation of law and attach the most rights possible to your claim. If the conversion takes place, you will be notified by the Bureau of Workers' Compensation and, thereafter, your benefits may not be stopped or changed until there is a return to work without a wage loss, and Order from a Workers Compensation Judge, or a negotiated settlement between the parties. The Temporary Notice of Compensation Payable is filed with the Bureau in conjunction with the Statement of Wages.
Who is responsible for the future medical expenses related to my workers' compensation claim if I settle my case through a Compromise and release Agreement?
Unless you and your attorney negotiate for the future payment of medical expenses, the workers compensation insurer will stop paying for medical expenses incurred after the date of the hearing to approve your settlement. If that is the case, then you will be responsible for any and all medical expenses following the hearing to approve your settlement, or Compromise and Release Agreement. You can, however, negotiate to have the workers compensation insurer remain responsible for the payment of future medical expenses indefinitely, or for a certain "closed period" of time following the settlement, but this must be negotiated and explicitly included in the terms of the Compromise and Release Agreement that needs to be approved by the Workers Compensation Judge.
Can I sue my employer if I get hurt because of their negligence?
Probably not. Under the "Exclusivity Provision" of the Pennsylvania Workers' Compensation Act, an injured worker is precluded from suing their employer, or a co-employee, for negligence. You can file a Claim Petition (if your injury is not accepted by the employer's workers' compensation insurance company) and seek indemnity, or wage loss, benefits; medical benefits; and if applicable, specific loss benefits and a scarring or disfigurement award. Unfortunately, you cannot collect for pain and suffering under the Workers' Compensation Act. If you are injured because of the negligence of a third party (not your employer or a co-worker), you may have a claim against them and be able to pursue a claim for pain and suffering. For example, if you are involved in a motor vehicle accident, and it is the fault of the other driver, you may have both a workers' compensation claim and a negligence claim against the driver. This would allow you to collect all of the available benefits under the Workers' Comp Act as well as pain and suffering and other damages as well. An injured worker may also have claims such as a products liability, medical malpractice claim, or a slip and fall claim, so it is important to discuss your specific case with an experienced attorney as son as possible.
What is an Independent Medical Examination?
An Independent Medical Examination (IME), which many claimant lawyers also refer to as a Defense Medical Examination (DME), is a medical examination paid for by the employer or insurance company, with a doctor of their choice, used in many instances to attempt to terminate, modify or suspend your wage loss benefits. It can also be utilized to try and terminate your medical benefits. Very often, the adjuster will tell unrepresented claimants that they are "setting up a second opinion" for the claimant to be examined; however, these exams are not for treatment purposes at all. In fact, the doctor will tell you that no doctor/patient relationship is being created. This is because this examination is just for his paid for "opinion" regarding your medical condition, ability to return to work, or need for ongoing treatment. If you receive a notice that you are to attend an IME, you should contact your attorney immediately; if you do not have counsel, now is the time to retain someone. The IME results can have a significant impact on your benefits, so being informed about the process and prepared for the exam is vital.
The insurance company can asked for an IME every 6 months, and very often you will attend more than one during your workers' compensation claim. If you are unable to drive to the exam, you can request that transportation be provided, and if you are able to drive there, you are entitled to be reimbursed for travel expenses.
Can my employer force me to go to one of their doctors?
Yes. For the first 90 days following your injury, you are obligated to treat with a "Panel Physician." These medical providers are to be listed somewhere at your place of work, and you are required to select from the provided list until 90 days elapse. If you are provided with a list of doctors, and you refuse to seek treatment from the medical providers designated as panel providers, your employer will not be required to pay for your medical treatment. Very often the list is made up of urgent care facilities such as Worknet, Concentra, or WorkFirst, but you may see that your doctor is also on the panel list. After the 90 days has elapsed, you may seek treatment from the medical provider of your choice, and the employer will have to pay for all reasonable, necessary and related treamtment, regardless of the provider.
Does my employer have to pay my medical expenses if I am hurt while working in Pennsylvania?
Your employer's workers' compensation insurance company is responsible to pay for all reasonable, necessary and related medical expenses related to your work injury. These medical expense may include ambulance charges, hospital stays, doctor appointments, X-rays, MRIs, crutches, wheelchairs, physical therapy appointments, chiropractic visits and prescriptions. The insurance company will be obligated to pay the scheduled amount for services rendered and the medical providers cannot bill you for any unpaid balance that may result from the workers' compensation approved charge. Even if you have private medical insurance, or public assistance insurance, you should insist that all work related bills be properly billed to the workers' compensation insurer.
How long do I have to report my injury to my employer?
Under the Pennsylvania Workers' Compensation Act, you have 120 days to report your work injury to your employer. We strongly recommend that you report any work injury to your boss or direct supervisor immediately (even if you think it is not a serious injury) to avoid any dispute regarding proper notice. Keep in mind that providing proper notice, while required under the Act, will not toll the Statute of Limitation, which is 3 years.
How long do I have to file a claim if I am hurt at work?
The Statute of Limitations for filing a workers' compensation claim in the Commonwealth of Pennsylvania is 3 years from the date of the accident or 3 years from the date you have knowledge of your injury. Providing notice to your employer is not sufficient to toll the statute and failing to properly file your claim within the required time limit may cause you to lose your right and ability to do so.
I was hurt at work. How much will workers compensation pay me?
If you are injured on the job and are unable to work you will be entitled to indemnity, or wage loss, benefits of approximately two-thirds of what you were earning. The precise amount will be determined by taking the highest three of the last four quarters of your earnings to calculate your average weekly wage. If you make below a certain amount (for example $517.77 in 2014), you will be entitled to 90 per cent of your average weekly wage. Below is a chart of the Pennsylvania Workers' Compensation Rate Schedule for the years 2009-2014. To see how much your workers' compensation benefits would be, look to see where your average weekly wage falls in the year you were injured, and you can determine your workers compensation rate.
Workers' Compensation Rate Schedules
2012 - 2013 - 2014Maximum: $888.00
2009 - 2010- 2011Maximum: $836.00
Source:Pennsylvania Department of Labor and Industry