My workers’ compensation claim has been accepted. What are my next steps?
Once your workers’ compensation claim has been accepted, the goal of your employer and their workers’ compensation insurance carrier is to get you off of workers’ compensation as soon as possible. If you and your employer do not agree concerning your right to continued receipt of compensation benefits, your employer or its insurance company may file a petition requesting that a judge terminate, suspend, or modify your benefits.
MEDICAL TREATMENT: Choice of Health Care Provider
If your claim has been accepted by your employer and they have posted in your workplace a list of six or more physicians or health care providers, you are required to visit a provider on the list for initial treatment. You are to continue treatment with that provider or another on the list for a period of 90 days following the first visit. You may see any provider on the list; your employer may not require or direct you to any specific provider on the list. If during the 90-day period you visit a provider(s) not on the list, your employer or your employer’s insurance carrier may refuse to pay for such treatment.
After the 90 days, and in situations where your employer has no posted list or an improper list, you may seek treatment with any physician or other health care provider you select. You must notify your employer of the provider you have selected. During treatment, the employer or the employer’s insurance carrier is entitled to receive monthly reports from your physician or provider.
If a listed provider prescribes invasive surgery, you are entitled to a second opinion that will be paid for by your employer/insurer. Treatment recommended as a result of the second opinion must be provided by a listed provider for 90 days.
Once you begin receiving workers’ comp benefits, the employer/insurer has the right to ask you to see a doctor of their choice for examination. If you refuse, the employer is entitled to request an order from a workers’ compensation judge requiring you to attend an examination. Failure to then attend may result in a suspension of your benefits.
Many times, when your injury is not recovering the way your employer thinks it should recover, they schedule you for a second opinion with another doctor of their choosing. The law is clear that within the first 90 days of your injury, if your employer accepts your injury, you must treat with the doctors on the panel list. After 90 days, you are free to treat with any doctor of your choosing who will accept Pennsylvania Workers Compensation benefits. The law also allows your employer or its insurance company to have you submit to two medical examinations per year. These examinations are usually called an “IME” (independent medical examination), however, there is usually nothing independent about it. There is nothing in the law that requires you to seek a “second opinion” with a doctor chosen by your employer. You can seek a second opinion on your own, but do not let the insurance company or your employer make that choice for you.
If you are receiving benefits and the insurance company requests that you undergo an IME (“independent medical examination”} you should contact an attorney. If you have already had an IME and you receive a Petition to Terminate, Suspend or Modify your compensation benefits, you will need an attorney. Call the experienced workers’ compensation attorneys at McCormick & Vilushis at (814) 455-5362.
JOB OFFERS: LIGHT DUTY
If your doctor has released you to return to work at less than full duty, your employer may choose to offer you a less-demanding job until you recover fully. For example, many employers offer light duty work to injured workers until they recover enough to go back to their time of injury job. If your doctor releases you to return to work light duty, you will usually have to accept the light duty position. If you decline the job offer, the employer may then petition a WC judge to either reduce or stop your wage-loss benefits based upon that job.
If you do return to modified duty work, your employer does not have to pay you your pre-injury salary. However, they do have to compensate you for 2/3rds of the difference between your pre-injury wages and your post-injury wages.
On many occasions, a disagreement arises between the claimant and the employer as to what kind of work the injured worker is capable of doing. If your employer offers you a job outside the work restrictions imposed by your doctor, they can’t force you return to work early. If your doctor has given you restrictions to follow for your recovery, you don’t have to accept a job that exceeds those restrictions. You do, however, have to accept a modified-duty position that falls within your restrictions or risk forfeiting your wage loss benefits.
Similarly, if you have undergone an IME and the IME doctor feels you are capable of performing work at a much higher level than your treating doctor, your employer might offer you a job within the restrictions set by the IME doctor. The IME doctor does not get to automatically override your treating doctor. You can continue to remain off work per your doctor’s instructions. The employer will have to file a petition to suspend your benefits to stop your wage-loss benefits.
If your employer is pressuring you to return to work early, you need to speak with an experienced Pennsylvania workers’ compensation attorney. Contact McCormick and Vilushis today for a free consultation.