Workers Compensation Lawyer FAQ

Serving all of Pennsylvania

What is Workers’ Compensation?

Workers compensation is a state-mandated insurance program that provides compensation to employees who suffer work related injuries. An injured employee receives benefits regardless of who was at fault. If an employer provides workers' compensation coverage, then workers' compensation is the sole remedy and you cannot sue your employer. However, if the employer fails to provide workers' compensation coverage, then it is the injured worker's option to either sue the employer in tort or under the Pennsylvania Workers' Compensation Act. The advice of an attorney should be sought in making the decision on which option would better benefit the injured worker.

If a person or party other than the employer is responsible for a worker's injury, the injured worker may be able to bring a personal injury action against such third party. Additional damages including pain and suffering and loss of consortium are available in third party cases.

What do I do if I was injured on the job?

If you are hurt on the job, it is recommended that you immediately report your work injury to your superior or an agent of the employer. The superior or agent of the employer must then give notice to the employer within 120 days of the injury, or no compensation will be allowed under the Pennsylvania workers compensation law. It is imperative to give notice of every work injury, no matter how minor. The notice should be detailed and include a description of the work injury along with the time and place the injury occurred.

What injuries are covered under Workers’ Compensation?

Employees are entitled to receive benefits if they suffer an injury that arises out of and in the course and scope of their employment with the employer. The injury must occur while the employee is carrying out or performing their normal, assigned work related duties for the benefit of the employer.

Must I treat with the company doctor?
Under the Pennsylvania workers' compensation laws, if the employer has a list of approved physicians, the injured worker is required to treat with a doctor on the list for the first 90 days of treatment. The injured worker may treat with a doctor outside of the list; however, he/she will be responsible for payment of the bills.

If the employer does not have a particular specialty covered on the list, the injured worker may go off the list to a doctor within that specialty. The employer may not direct the injured worker to treat with a physician who is not on the list.

How will I know if my injury was accepted?
Once an injury is reported, the insurance carrier should either accept or deny the claim through one of the following documents:

Notice of Compensation Payable (NCP): This document provides the injured worker the greatest protection and provides for payment of both lost wage and medical benefits. Once an NCP is issued, the insurance carrier may not stop payment of lost wage or medical benefits without a Judge's order. At the time an NCP is issued, the injured worker should also receive a Statement of Wages (SOW). The SOW outlines the calculation of the injured worker's Average Weekly Wage (AWW) and compensation rate.

Temporary Notice of Compensation Payable (TNCP): This document provides for payment of lost wage and medical benefits. However, the TNCP may be revoked within 90 days and a denial issued.

Medical Only Notice of Compensation Payable: This is a new form created by the Pennsylvania Workers Compensation Bureau to allow insurance carriers to accept liability for a work injury and pay medical bills without agreeing to pay lost wage benefits.

Notice of Denial: The insurance carrier denies acceptance of the work injury. No lost wage or medical benefits will be paid. The injured worker must file a claim petition with the Pennsylvania Workers' Compensation Bureau and litigate the case in front of a Workers' Compensation Judge.

When will I begin receiving lost wage benefits?
If disability extends for seven (7) days or less, no lost wage benefits are due under the Pennsylvania workers' compensation laws. If disability extends from eight (8) to thirteen (13) days, benefits are paid just for the specific period of time. Benefit payments revert back to the first day if disability extends fourteen (14) days or more. The first payment of benefits must be paid within twenty-one (21) days of the employer's notice or knowledge of your disability.

What will an attorney charge to represent me?

In a workers compensation case, Michael J. O'Connor & Associates charges a contingency fee, which means that no attorney's fees will be due unless the attorney secures a settlement or award. In addition, a workers' compensation Judge must approve a deduction of attorney's fees. Accordingly, there is no fee to monitor a case that is not yet in litigation.

The benefits of retaining a workers compensation lawyer in the pre-litigation stage of a case include:

The insurance carrier and/or rehabilitation nurse may not have direct contact with a person represented by counsel. The attorney acts as a go-between and ensures that the injured worker does not make any mistakes that will result in litigation.
Your attorney will review all legal documents and give the injured worker advice before you sign a document that could have a long lasting negative impact on your workers' compensation benefits.
Your attorney will review the SOW to ensure the injured worker is being paid at the correct rate.
Your attorney may negotiate a lump sum settlement for the injured worker.

How much money will I receive while on Workers' Compensation?
That is dependent upon the answers to the following questions:

• Are you on total disability or partial disability?
• How long have you been employed by your employer?
• Were you working for more than one employer at the time you were injured?
• How much have you regularly earned from your employer, and is that a set amount per week/month/year? Or are you paid on a different basis?

The answers to these questions will help to determine how to compute your average weekly wage (AWW). Once your AWW is determined, partial and total disability benefits may be calculated. There is a maximum rate of compensation recognized by the Pennsylvania Department of Labor and Industry, which may result in the amount you are eligible to receive being capped. In Pennsylvania, the statewide AWW is the basis for determining the maximum compensation rate for which you are eligible. This AWW is determined yearly by the Department of Labor and Industry.

Will my Workers' Compensation checks be paid on the same schedule as my paycheck?
In Pennsylvania, compensation must be paid in the same periodic installment as the injured worker's wages were paid before the injury. An insurance carrier may be assessed penalties for failure to pay in a regular and timely manner.

What is a Lump Sum Settlement?
A lump sum settlement is a one-time payment made by the employer to the injured worker in exchange for the injured worker giving up his/her continued rights to workers compensation benefits. This payment results from an executed agreement typically referred to as a “compromise and release agreement." The agreement may include settlement of lost wage benefits and/or medical benefits.

Once a settlement is approved by Workers Compensation Judge, the agreement is final. An injured worker may not seek to reopen his/her case for additional benefits, even if his/her condition becomes significantly worse in the future.

I received a petition to modify, suspend, and/or terminate my benefits. What should I do?
At this point, you should seek the advice of an attorney. This is an effort on your employer's part to have your compensation benefits reduced or terminated. Your case will now go into litigation before a Workers' Compensation Judge (WCJ). The WCJ will hear medical and testimony evidence and then render a decision with regard to the pending petitions.

A modification petition alleges the injured worker may work at a loss of earnings. If granted, this petition would result in the injured worker's disability status changing from total to partial. The injured worker would then be entitled to 2/3 of the difference between his/her AWW and the alleged earning capacity. Partial disability is capped at 500 weeks. Medical benefits continue
indefinitely.
A suspension petition alleges the injured worker may return to work at no loss of earnings. If granted, this petition stops an injured worker's lost wage benefits; however, medical benefits continue indefinitely.

A termination petition alleges the injured worker has completely recovered from the work injury. If granted, this petition stops an injured worker's lost wage and medical benefits.

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The workers compensation lawyer team at Michael J. O'Connor & Associates is ready to begin tackling your legal problem today. Email or Call our toll free number at 1.800.518.4LAW for a free initial consultation and review of your case.

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