Frequently Asked Questions about Pennsylvania Workers’ Compensation Law

By Wolf, Baldwin & Associates, P.C.

How Does Returning To Work Affect My Workers' Compensation Disability Benefits?

If you are receiving benefits from workers' compensation for a disability, the effect of going back to work will depend on the type of benefit involved and the laws in your state. Although the details of each state's workers' compensation plans vary, there are characteristics that most plans share in common.

Is Your Disability Temporary Or Permanent?

There are two major categories of disability benefits: temporary and permanent. Temporary benefits are given when an employee needs to be away from work for a short period of time for medical attention or recovery. These benefits are intended to be temporary and expire when the employee returns to work.

Permanent disability benefits are given when the employee will never fully recover from their injury and therefore, their future earning potential is affected. The amount of the benefit reflects future lost wages (the difference between what the person would have earned and what they are able to earn with the disability). In cases where the employee is unable to do any work as a result of their injury, the individual would receive total disability benefits (these can be temporary or permanent depending on how long the disability prevents the person from working). This amount is generally calculated considering what the employee was able to earn before his or her injury.

Temporary Disability Benefits Will End

When a person returns to work, temporary disability benefits are terminated, since there is no need to compensate the person for lost wages since they are now able to work. In some states, the mere fact that the person returns to their former position would be enough to end the disability benefits, but other states require a letter from the doctor saying that an employee is able to return to full duty.

Total disability benefits are given when an employee is considered unable to do any work. Therefore, if the employee returns to work or finds a new job they will be unable to collect benefits. In general, if the person resumes working their benefits will terminate. Different states use different standards to determine when benefits will end. Some states will ask whether the person is capable of finding sustained gainful employment while other states will require that the person actually has an opportunity to perform a gainful and suitable occupation. The question is not just whether or not the person is capable of performing at a job but whether the person actually has a present opportunity for employment, such as a job offer.

Permanent Disability Benefits Will Likely Continue

Individuals who receive permanent disability benefits generally receive an amount that is based on their previous earnings and compensates them for future lost wages. The idea is that the employee may be able to find another job but they may not be able to earn the same wage. If an employee is receiving benefits and ends up finding a job that pays the same wage or more, their disability benefits will generally not terminate. In general, fluctuations in the amount that the employee earns will not cause his or her benefits to be reduced or discontinued. This includes reductions in salary as well. If the employee earns less than expected then the amount of disability benefits is not increased. The amount of the benefit is calculated considering the effect of the disability on employment so if the disabling condition doesn't change then the amount of the benefits generally shouldn't either.

Consult An Attorney About Changes To Your Employment Status

The effect of returning to work, whether in your former position or to a new job, will vary from state to state. An employee who is being paid workers compensation for future lost earnings or who is totally disabled should use caution before making major changes in their employment status. These changes could affect their benefits. These individuals should also consider that they may have a duty to report changes in their employment to the company through which they obtained workers' compensation or to the insurer who is paying the benefits. An employee who fails to do this may find that they are responsible for reimbursing workers' compensation for any excessive payments made. The financial stakes in these cases can be high so a worker in this situation may want to consult an attorney before going back to work. An attorney may also be able to inform the employee of other options available to them such as applying for social security disability benefits.

How Do I Know If I Have A Workers' Comp Claim?

Most injuries which happen at work, regardless of who is at fault, will be covered under workers' compensation. Even injuries which happen away from the office or jobsite can be covered if you are furthering the business of your employer at the time of the injury. Injuries do not have to be associated with a specific incident, but can be the result of repetitive motion or cumulative trauma.

How Long Do I Have To Report My Injury?

It is a good idea to report any injury, no matter how small you think it is, right away to a supervisor. Saying something to your coworker is not the same as notice to your employer. If you delay giving notice of a work injury, you run the risk that when you do give notice later your employer will not believe you. The sooner you give notice, the sooner you can receive wage loss and medical benefits. Under the workers' compensation law, you will lose the right to make a claim if you do not give notice within 120 days of when you knew or should have known about the work injury.

Can I See My Own Doctor? What Is The "90 Day Rule"?

Many employers and their insurance companies will tell you that you must treat only with a "panel physician" within the first 90 days of a work injury. This is only true in certain limited circumstances, because the employer must comply with many elements of the workers' comp law in order to force an injured employee to choose a panel doctor. In truth, you can see any doctor you choose in the first 90 days, but if your employer complies with all aspects of the panel doctor law it will have no obligation to pay that doctor. After the 90 days is up, you can treat with whoever you want, and even get second opinions.

Will It Hurt My Employer If I Try To Get Workers' Comp?

Your employer has already paid the insurance company and bought the insurance which covers you. Presumably, your employer wants you to use the insurance which it already paid for. The workers' comp system is designed to make sure that injured workers get the treatment they need quickly and get back to work as soon as they can, and this benefits employers. If you delay your treatment by deciding not to file a claim, your employer may have to wait a lot longer to get a valued employee back.

Will I Lose My Job If I Make A Claim?

Most non-union Pennsylvania workers are "at-will employees," which means they can be fired at any time for any reason or no reason, as long as they are not being discriminated against. An employer can be subject to a wrongful termination lawsuit if it fires you for pursuing a workers' compensation claim. This does not mean that your employer must keep your job open for you forever, and it does not have to provide light duty for you. However, if you are fired after a work injury or not brought back to work if you are released to work modified duty, you may be entitled to wage loss benefits under workers' compensation.

To What Benefits Am I Entitled?

Workers' compensation in Pennsylvania provides for a wage loss benefit (typically 2/3 of your preinjury average weekly wage), and medical treatment which is reasonable, necessary, and causally related to the work injury. The calculation of the preinjury average weekly wage can be very complicated, and should always be double-checked by an experienced workers' compensation lawyer. Overtime and bonuses should be included in the calculations. Even if you are receiving wage loss benefits, you may be receiving the wrong amount. If you cannot earn your preinjury wages because of the work injury, you may be entitled to total or partial disability benefits.

Should I Settle My Claim?

Settlements of workers' comp claims are common in Pennsylvania. They are achieved by a Compromise and Release, where usually the insurance company pays the injured worker a lump sum of money in exchange for the worker giving up all of his or her rights under the law. The negotiation of these settlements is best left to experienced workers' compensation attorneys who can draw on years of experience to determine the worth of a claim and get the most value for the case. Not all cases should be settled, and not all cases must be settled for a full release of both wage loss and medical benefits. Each person's case is unique and should be evaluated individually.

Do I Need To See A Lawyer? What Will I Have To Pay?

You are not required to hire an attorney to go through the workers' compensation system, but most people who try to handle cases on their own realize quickly that they are in over their heads. Workers' compensation insurance companies will always be represented by lawyers, most of whom only practice workers' compensation law. Their mission is to reduce or eliminate your benefits. You will be wise to have a free consultation with an experienced workers' compensation lawyer who only represents injured workers. It costs you nothing to have your case evaluated, and having a lawyer involved in your claim from the beginning will maximize your ability to receive all of the benefits to which you are entitled. The lawyers of Wolf, Baldwin & Associates offer free consultations in workers' comp cases, and charge a contingent fee which must be approved by a workers' comp judge.

About Wolf, Baldwin & Associates, P.C.

The law firm of Wolf, Baldwin & Associates, P.C. has been serving the Tri-County community for almost 40 years. With multiple attorneys and offices in Pottstown, Reading, and West Chester, we can assist you with workers' compensation claims. We welcome the opportunity to serve you.