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| 1. | What types of injuries does workers' compensation cover? An employee is entitled to workers' compensation benefits if he or she suffers an injury which arises from and is related to his employment. The term injury is broadly defined to include any injury to an employee, regardless of his previous physical condition, including injuries resulting from exposure to harmful chemicals or substances. |
| 2. | Do I have to prove that I was injured in an "accident" at work? No. Although many injuries are caused by accidents at work, the law does not require employees to prove that they were injured in a particular accident. The injury does not have to be pinpointed to a specific event or a particular incident so long as there is proof that the injury arose from and is related to your employment. For example, cumulative trauma injuries resulting from repetitive movements at work such as repetitive back movements or repetitive use of the hands, may be shown to be work-related. |
| 3. | Am I entitled to workers' compensation if I have a pre-existing condition? Under the Workers' Compensation Act, an employee who suffers an aggravation of a pre-existing condition is eligible to receive workers' compensation benefits. |
| 4. | What do I have to prove to receive workers' compensation benefits? To obtain workers' compensation benefits, you must prove that you were employed at the time of the injury, that you were working or in the course and scope of your employment at the time of the injury and that your injury is related to your employment. You are not required to prove that the injury was caused by someone's negligent conduct. |
| 5. | How much will I receive in workers' compensation benefits? There are essentially two components of workers' compensation benefits: wage loss and medical. The employee's wage loss benefits are based upon the employee's average weekly wage. In general, an employee's benefit rate is two-thirds of his average weekly wage up to a statewide maximum rate that changes on an annual basis. Wage loss benefits are not paid for the first seven days that an employee is off work unless the employee misses a total of 14 days. Employers are also required to pay for reasonable and necessary medical expenses related to the work injury. |
| 6. | Do I have to treat with the employer's "panel" doctors? Where the employer has a posted list of six designated healthcare providers, injured employees are required to treat with one of the designated providers for the first 90 days. Employees may not be forced to treat with a particular provider on the panel and is free to treat with other health care providers after 90 days have expired. |
| 7. | What is a Utilization Review Request? The utilization review procedure allows an employer to challenge the reasonableness and necessity of a particular treatment. The injured employee's treating physician or chiropractor must provide the reviewing doctor with copies of treatment records and usually will discuss the injured worker's treatment over the telephone. The employee has the right to appeal an adverse utilization review decision to a Workers' Compensation Judge. |
| 8. | Do I have to return to work if the doctor has not released me? Employers frequently ask injured workers to return to work based upon an opinion from a physician who performed an IME ("Independent Medical Evaluation"), even though the employee's treating physician has not released him or her to return to work. The Workers' Compensation Act generally requires injured workers to follow-through on job offers for positions that they are capable of performing. Once cleared to return to work by a physician or chiropractor, the employee runs the risk of losing his or her benefits if he does not return to work. If you disagree with a recommendation to return to work, you should consult a lawyer assoon as possible to discuss the specifics of your case. |
| 9. | What is an Impairment Rating? If you were injured after June 1, 1996, your employer has the right to request that you undergo an impairment rating to be performed by a qualified physician after you have received two years of total disability benefits. If you are determined to have a whole body impairment of 50% or higher, then total disability is presumed to continue. If you are under the 50% threshold, then you will be considered partially disabled and the employer may request a hearing for the purpose of determining your earning power. The impairment rating is based upon the degree of impairment as determined under the American Medical Association's "Guides to the Evaluation of Permanent Impairment." |
| 10. | How much time do I have to make a workers' compensation claim? There are two limitations periods to keep in mind in workers' compensation. First, you must provide the employer with notice that you were injured at work within 120 days of the date of the injury or the date that the employee knew, or should have known, of the existence of the injury and its relationship to his employment. Notice should be given to a supervisor or other member of management and should clearly state that the injury is work-related. Second, any claim for workers' compensation benefits must be filed within three years of the date of the injury. |
| 11. | When should I file a claim for workers' compensation benefits? Technically, an employer is required to accept or deny a claim for workers' compensation benefits within twenty-one days that notice was given. If your claim is denied or you simply do not get a response from your employer or its insurance carrier within twenty-one days after you report the injury, you should seek legal advice about pursuing your claim. |
| 12. | How long does it take to get benefits? The amount of time that it takes to obtain benefits can vary greatly from one person to another. If your employer denies your claim for benefits, it can take several months to litigate a disputed claim before a Workers' Compensation Judge. |
| 13. | What is a termination or suspension petition? An employer has the right to try to terminate or stop your workers' compensation benefits if it obtains a medical opinion that you have fully recovered from your work injury. Similarly, an employer may seek to suspend or reduce your benefits if it has evidence that work is available to you within your physical restrictions. We recommend that you seek legal advice as you received a termination or suspension petition. |
| 15. | What are the fees for representation? Lawyers generally charge a twenty percent contingent fee on any benefits that are recovered, and all fees must be approved by a Workers' Compensation Judge. When negotiating a fee agreement with a lawyer, you should also inquire as to whether you are responsible for the costs of presenting the case (i.e., fees for hearing transcripts, deposition fees for doctors, etc.) or whether the law firm will agree to advance the costs of litigation. |
If you have any additional questions about workers' compensation, please contact Greg Kunkel at 800-467-5272 or email him at gkunkel@kunkelfink.com.
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Kunkel & Fink, LLP Toll-free Phone: 800-467-5272 | |||||
| Pittsburgh Office |
| Uniontown | |||
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