Workers' Compensation FAQ

How do I know if I qualify for workers' compensation?


Covered injuries include any type of injury, illness or condition that occurs at work or because of your work activities, an aggravation or re-injury of a pre-existing injury or condition, or conditions or injuries that develop gradually, such as low back conditions, repetitive motion injuries or carpal tunnel syndrome. Worker's comp also covers illnesses that are contracted in the workplace, or conditions that develop as a result of exposure to chemicals or toxins.

Who is eligible to collect workers' compensation benefits?


Employers with one or more employees are required to carry workers' compensation insurance. The requirements to receive workers' compensation benefits are established by law and administered by the Pennsylvania Department of Labor, Division of Industrial Affairs and Office of Workers' Compensation. Workers considered to be independent contractors, rather than employees, are not covered. Farm workers are also exempt from the workers' compensation statute.


If I'm injured at work, what are the first steps I should take in order to collect workers' compensation?


Report your injury to your employer immediately. Request that the employer complete a Report of Occupational Injury or Disease and submit it to the Office of Workers' Compensation. Seek medical attention as soon as possible. Tell your doctor you were hurt at work, explain your symptoms, and ask him or her to provide you with work restrictions, if appropriate. Provide those work restrictions to your employer. Follow your doctor's recommendations for treatment.


What benefits are available to me through Pennsylvania workers' compensation?


All necessary medical treatment and hospitalization are provided by the employer or the employer's insurance carrier. The employee has the right to choose the treating physician.

Temporary total disability - If there is lost time that extends beyond three days due to the injury, temporary total disability benefits become payable starting with the fourth day lost. If the disability extends to seven days, the full disability period becomes compensable and no waiting period applies. The benefit amount is 66 2/3 percent of gross weekly wages received at the time of the injury, up to a maximum established annually by the secretary of labor.

Temporary partial benefits - If an employee returns to work part time or at a lower rate than his or her pre-injury wage, the employee may be entitled to two-thirds of the difference between the pre-injury wage and his or her current wage. Partial disability may be received up to 300 weeks.

Disfigurement benefits
- An employee may file a petition for disfigurement for permanent and unsightly scarring to the head, neck, or face related to a work accident. Disfigurement is paid out in a number of weeks depending upon the severity of the scar.

Death benefits
- When a job-related accident or illness results in a worker's death, benefits are payable to the dependents of the worker as defined by law. The weekly benefit payments are based upon the number of dependents, but the maximum total benefit payable to all of the worker's dependents cannot exceed 80 percent of the maximum rate established by the secretary of labor. A child who is deemed to be a dependent remains so until the age of 18, or until age 25 if the child is a full-time student. If a child is physically or mentally disabled, he or she may be eligible for further benefits. The employer or its insurance carrier is responsible to pay up to $3,500 in funeral expenses for a job-related death.

How much are the payments for lost wages?


Wage-loss benefits are equal to approximately two-thirds of your average weekly wage, up to a weekly maximum. WC wage-loss benefits can be offset for 50 percent of Social Security benefits, the employer-paid portion of a retirement pension, severance pay, unemployment compensation or other earnings the employee receives. The law does not allow for a cost-of-living increase.

There are several different ways to calculate the average weekly wage under the Act. The minimum compensation rate is the lower of 90 percent of the workers' average weekly wage or 50 percent of the statewide average weekly wage.


When are wage-loss payments made?


You must be disabled more than seven calendar days (including weekends) before WC payments for disability are payable. Benefits for time lost from work are payable on the eighth day after injury. Once you have been off work 14 days, you receive retroactive payment for the first seven days.

If you report the injury promptly, miss more than seven days of work and your claim is accepted by the insurance carrier, you should receive your first compensation check within 21 days of your absence from work. After that, you will receive a check on a regular basis.

Payments of temporary compensation may be made by your employer or the insurance carrier for up to 90 days, even if your claim is not accepted by your employer or its insurance carrier. If your employer or the company's insurance carrier advises you that it will not continue your temporary compensation checks past 90 days, or if they deny your claim, you have the right to file a claim petition with the Office of Adjudication for a hearing if you believe you are entitled to benefits.


Can I sue my employer if I am injured on the job?


Sometimes when people are injured on the job the first reaction they have is to bring a law suit against their employer. Generally, you are barred from suing your employer for a work injury. This is because when employers provide workers' compensation insurance for the benefit of their employees, they are typically protected from defending personal injury claims brought by those employees. This workers' compensation system was established as a trade-off in which injured employees give up their right to sue employers in court in exchange for the right to receive workers' compensation benefits, regardless of who was at fault for their injuries. This is known as a no-fault system. However, there are some important exceptions. Read on to learn more about these exceptions.

Is your employer or the insurance carrier trying to suspend your workers compensation benefits?


In Pennsylvania, the Workers Compensation Act allows employers and insurance carriers to try to suspend benefits if they think that your injury is no longer affecting your ability to earn your average weekly wage. If you are still treating for your workers compensation injury and you are not earning the average weekly wage you earned before your injury, the workers' compensation attorneys at McCormick & Vilushis can help you keep your benefits going while you continue treating.

Are you treating for a workers compensation injury and the medical bills are not being paid?


If you have been injured at work and the medical bills related to that injury are not being paid, your workers compensation rights are being violated. The workers' compensation attorneys at McCormick & Vilushis can intervene on your behalf to force the workers compensation insurance company to pay your medical bills for your work injury.

If I'm injured at work, what are the first steps I should take in order to collect workers' compensation?


Report your injury to your employer immediately. Request that the employer complete a Report of Occupational Injury or Disease and submit it to the Office of Workers' Compensation. Seek medical attention as soon as possible. Tell your doctor you were hurt at work, explain your symptoms, and ask him or her to provide you with work restrictions, if appropriate. Provide those work restrictions to your employer. Follow your doctor's recommendations for treatment.

What benefits are available to me through Pennsylvania workers' compensation?


All necessary medical treatment and hospitalization are provided by the employer or the employer's insurance carrier. The employee has the right to choose the treating physician.

Temporary total disability - If there is lost time that extends beyond three days due to the injury, temporary total disability benefits become payable starting with the fourth day lost. If the disability extends to seven days, the full disability period becomes compensable and no waiting period applies. The benefit amount is 66 2/3 percent of gross weekly wages received at the time of the injury, up to a maximum established annually by the secretary of labor.

Temporary partial benefits - If an employee returns to work part time or at a lower rate than his or her pre-injury wage, the employee may be entitled to two-thirds of the difference between the pre-injury wage and his or her current wage. Partial disability may be received up to 300 weeks.

Disfigurement benefits
- An employee may file a petition for disfigurement for permanent and unsightly scarring to the head, neck, or face related to a work accident. Disfigurement is paid out in a number of weeks depending upon the severity of the scar.

Death benefits
- When a job-related accident or illness results in a worker's death, benefits are payable to the dependents of the worker as defined by law. The weekly benefit payments are based upon the number of dependents, but the maximum total benefit payable to all of the worker's dependents cannot exceed 80 percent of the maximum rate established by the secretary of labor. A child who is deemed to be a dependent remains so until the age of 18, or until age 25 if the child is a full-time student. If a child is physically or mentally disabled, he or she may be eligible for further benefits. The employer or its insurance carrier is responsible to pay up to $3,500 in funeral expenses for a job-related death.

How much are the payments for lost wages?


Wage-loss benefits are equal to approximately two-thirds of your average weekly wage, up to a weekly maximum. WC wage-loss benefits can be offset for 50 percent of Social Security benefits, the employer-paid portion of a retirement pension, severance pay, unemployment compensation or other earnings the employee receives. The law does not allow for a cost-of-living increase.

There are several different ways to calculate the average weekly wage under the Act. The minimum compensation rate is the lower of 90 percent of the workers' average weekly wage or 50 percent of the statewide average weekly wage.

When are wage-loss payments made?


You must be disabled more than seven calendar days (including weekends) before WC payments for disability are payable. Benefits for time lost from work are payable on the eighth day after injury. Once you have been off work 14 days, you receive retroactive payment for the first seven days.

If you report the injury promptly, miss more than seven days of work and your claim is accepted by the insurance carrier, you should receive your first compensation check within 21 days of your absence from work. After that, you will receive a check on a regular basis.

Payments of temporary compensation may be made by your employer or the insurance carrier for up to 90 days, even if your claim is not accepted by your employer or its insurance carrier. If your employer or the company's insurance carrier advises you that it will not continue your temporary compensation checks past 90 days, or if they deny your claim, you have the right to file a claim petition with the Office of Adjudication for a hearing if you believe you are entitled to benefits.


Can I sue my employer if I am injured on the job?


Sometimes when people are injured on the job the first reaction they have is to bring a law suit against their employer. Generally, you are barred from suing your employer for a work injury. This is because when employers provide workers' compensation insurance for the benefit of their employees, they are typically protected from defending personal injury claims brought by those employees. This workers' compensation system was established as a trade-off in which injured employees give up their right to sue employers in court in exchange for the right to receive workers' compensation benefits, regardless of who was at fault for their injuries. This is known as a no-fault system. However, there are some important exceptions. Read on to learn more about these exceptions.

Is your employer or the insurance carrier trying to suspend your workers compensation benefits?


In Pennsylvania, the Workers Compensation Act allows employers and insurance carriers to try to suspend benefits if they think that your injury is no longer affecting your ability to earn your average weekly wage. If you are still treating for your workers compensation injury and you are not earning the average weekly wage you earned before your injury, the workers' compensation attorneys at McCormick & Vilushis can help you keep your benefits going while you continue treating.

Are you treating for a workers compensation injury and the medical bills are not being paid?


If you have been injured at work and the medical bills related to that injury are not being paid, your workers compensation rights are being violated. The workers' compensation attorneys at McCormick & Vilushis can intervene on your behalf to force the workers compensation insurance company to pay your medical bills for your work injury.

If I'm injured at work, what are the first steps I should take in order to collect workers' compensation?


Report your injury to your employer immediately. Request that the employer complete a Report of Occupational Injury or Disease and submit it to the Office of Workers' Compensation. Seek medical attention as soon as possible. Tell your doctor you were hurt at work, explain your symptoms, and ask him or her to provide you with work restrictions, if appropriate. Provide those work restrictions to your employer. Follow your doctor's recommendations for treatment.

What benefits are available to me through Pennsylvania workers' compensation?


All necessary medical treatment and hospitalization are provided by the employer or the employer's insurance carrier. The employee has the right to choose the treating physician.

Temporary total disability - If there is lost time that extends beyond three days due to the injury, temporary total disability benefits become payable starting with the fourth day lost. If the disability extends to seven days, the full disability period becomes compensable and no waiting period applies. The benefit amount is 66 2/3 percent of gross weekly wages received at the time of the injury, up to a maximum established annually by the secretary of labor.

Temporary partial benefits - If an employee returns to work part time or at a lower rate than his or her pre-injury wage, the employee may be entitled to two-thirds of the difference between the pre-injury wage and his or her current wage. Partial disability may be received up to 300 weeks.

Disfigurement benefits - An employee may file a petition for disfigurement for permanent and unsightly scarring to the head, neck, or face related to a work accident. Disfigurement is paid out in a number of weeks depending upon the severity of the scar.

Death benefits - When a job-related accident or illness results in a worker's death, benefits are payable to the dependents of the worker as defined by law. The weekly benefit payments are based upon the number of dependents, but the maximum total benefit payable to all of the worker's dependents cannot exceed 80 percent of the maximum rate established by the secretary of labor. A child who is deemed to be a dependent remains so until the age of 18, or until age 25 if the child is a full-time student. If a child is physically or mentally disabled, he or she may be eligible for further benefits. The employer or its insurance carrier is responsible to pay up to $3,500 in funeral expenses for a job-related death.

How much are the payments for lost wages?


Wage-loss benefits are equal to approximately two-thirds of your average weekly wage, up to a weekly maximum. WC wage-loss benefits can be offset for 50 percent of Social Security benefits, the employer-paid portion of a retirement pension, severance pay, unemployment compensation or other earnings the employee receives. The law does not allow for a cost-of-living increase.

There are several different ways to calculate the average weekly wage under the Act. The minimum compensation rate is the lower of 90 percent of the workers' average weekly wage or 50 percent of the statewide average weekly wage.

When are wage-loss payments made?


You must be disabled more than seven calendar days (including weekends) before WC payments for disability are payable. Benefits for time lost from work are payable on the eighth day after injury. Once you have been off work 14 days, you receive retroactive payment for the first seven days.

If you report the injury promptly, miss more than seven days of work and your claim is accepted by the insurance carrier, you should receive your first compensation check within 21 days of your absence from work. After that, you will receive a check on a regular basis.

Payments of temporary compensation may be made by your employer or the insurance carrier for up to 90 days, even if your claim is not accepted by your employer or its insurance carrier. If your employer or the company's insurance carrier advises you that it will not continue your temporary compensation checks past 90 days, or if they deny your claim, you have the right to file a claim petition with the Office of Adjudication for a hearing if you believe you are entitled to benefits.

Can I sue my employer if I am injured on the job?


Sometimes when people are injured on the job the first reaction they have is to bring a law suit against their employer. Generally, you are barred from suing your employer for a work injury. This is because when employers provide workers' compensation insurance for the benefit of their employees, they are typically protected from defending personal injury claims brought by those employees. This workers' compensation system was established as a trade-off in which injured employees give up their right to sue employers in court in exchange for the right to receive workers' compensation benefits, regardless of who was at fault for their injuries. This is known as a no-fault system. However, there are some important exceptions. Read on to learn more about these exceptions.

Is your employer or the insurance carrier trying to suspend your workers compensation benefits?


In Pennsylvania, the Workers Compensation Act allows employers and insurance carriers to try to suspend benefits if they think that your injury is no longer affecting your ability to earn your average weekly wage. If you are still treating for your workers compensation injury and you are not earning the average weekly wage you earned before your injury, the workers' compensation attorneys at McCormick & Vilushis can help you keep your benefits going while you continue treating.

Are you treating for a workers compensation injury and the medical bills are not being paid?


If you have been injured at work and the medical bills related to that injury are not being paid, your workers compensation rights are being violated. The workers' compensation attorneys at McCormick & Vilushis can intervene on your behalf to force the workers compensation insurance company to pay your medical bills for your work injury.

Are you receiving workers compensation benefits but you are unsure if you are getting paid enough?


If you are not working or working a modified job and receiving benefits, and you are unsure if the amount of benefits is the right amount, contact the workers' compensation attorneys at McCormick & Vilushis to see if you are entitled to more money.

Has the insurance company denied you a surgery or medical procedure that will make you better?


Many times, in an effort to save money, an insurance company will directly contact your doctor to stop treatment or a medical procedure that your doctor feels will help you. By law, the insurance company must pay all reasonable and necessary medical bills related to your accepted work injury. The insurance company's failure to pay those bills or deny you treatment is not allowed. Contact the workers' compensation attorneys at McCormick & Vilushis so we can get involved to force the insurance company to pay your bills and stay out of your medical treatment.

Has the insurance company hired a nurse case manager to "help" you?


Many times insurance companies hire nurse case managers to "assist" you with your medical treatment. Although the person they hire may be very nice, their sole purpose is to limit what the insurance company pays on your claim. You need someone who does not have a financial interest in your medical treatment looking out for you. Also, we have found that workers compensation nurse case managers interfere with medical treatment. We have had cases where the workers compensation nurse case manager has cancelled appointments or had the doctor change work restrictions. Our involvement eliminates the nurse case manager from interfering with your workers compensation case. Contact the workers' compensation attorneys at McCormick & Vilushis to step in on your behalf and remove anyone who tries to interfere with your treatment.

Has your employer scheduled you with another doctor, of their choosing, for a "second opinion"?


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 examination 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. Contact the worker's compensation attorneys at McCormick & Vilushis to get advice on how you should handle your employer's request for a "second opinion."

What are "Specific Loss Benefits"?


You may be entitled to specific loss or scarring benefits if you have had a body part amputated, lost use of a body part, a loss of vision or hearing, or sustained scarring to your head, neck, or face. The Workers' Compensation Act assigns particular values for loss of the body part, and local Judges have the ability to evaluate facial and neck scarring. The workers' compensation lawyers at McCormick & Vilushis can help you determine the value of your loss or scar and get you the benefits to which you are entitled.

Was your work injury caused by your employer's faulty equipment or machine?


If you were injured by a piece of equipment or a machine at work you may be entitled to compensation beyond what you are provided by workers' compensation. The workers' compensation lawyers at McCormick & Vilushis can determine if your injury may allow you to pursue personal injury actions against the manufacturer of the piece of equipment you were injured on or against the company or third-party that was responsible for your injuries.

Was your work injury caused by your employer's faulty equipment or machine?


Death
Brain injuries
Spinal cord injuries
Herniated and bulging discs
Broken bones
Strains and sprains
Rotator cuff tears
Hearing loss
Vision loss
Loss of a body part or limb
Repetitive use injuries
Burns and scarring
And many more

Can my employer fire me for filing a workers' compensation claim?


No. Pennsylvania law prohibits an employer from firing an employee in retaliation for filing a workers' compensation claim. Unfortunately, that does not always stop an employer or a supervisor from harassing you, trying to force you to quit, or fabricating a reason to fire you. Obtain legal representation if you are having problems at work after you've filed a workers' comp claim.

Do I really need a workers' compensation lawyer?


You are not required to hire a workers' compensation lawyer to file a claim. However, if your initial claim is denied, or if you decide not to accept the insurance company's offer because it will not cover your medical costs and lost income, you will enter into negotiations with the insurance company. Insurance providers have experienced, highly compensated lawyers who do this every day. Given the complexity of workers' compensation procedure and law, it is wise to put an experienced workers' compensation lawyer on your side. In most instances, we add value to a workers' compensation claim by putting more money in our clients' pockets even after our fees are paid. Our fees are set by Pennsylvania law. If we do not obtain a recovery for you, you will not pay any attorney fees.

Should the injured worker consult an attorney prior to settling a workers' compensation claim?


The answer is absolutely YES. If an injured worker is unrepresented and the employer makes a settlement offer, the amount of the offer will probably be unfair. The workers' compensation attorneys at McCormick & Vilushis offer free consultations to new clients. If the settlement offer is fair, we will let you know. In minor claims with no permanent residual effects, it might make sense to accept the offer. However, in claims involving serious injuries, lost time from work, and permanent impairment, the injured worker should definitely retain legal counsel. At a minimum, the injured worker should take advantage of a free consultation with the attorneys at McCormick & Vilushis before signing a settlement agreement.

When Can You Choose Your Own Pennsylvania Workers' Compensation Doctor


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.

What should I do if I've been injured on the job?


Get medical care as soon as possible.
Notify your employer promptly.
Do not speak with the insurance company, provide them with a recorded statement, or sign any insurance company documents.
Keep track of your expenses and collect documents that prove your annual earnings.
Contact McCormick and Vilushis, LLC for a free consultation.

I caused or contributed to my own injury. Am I entitled to benefits?


Yes. Workers' compensation is a no-fault insurance program. You are entitled to benefits for any injury you suffered while on the job.

A third party (not my employer) caused my injury. Can I get benefits?

Yes, you can. In addition to workers' compensation benefits, you may be entitled to compensation from the party that caused your injury. These "third party claims" can include losses for pain and emotional suffering as well as financial losses, so the total compensation can be far higher than that for just a workers' compensation claim

My employer told me I waited too long to inform them of my injury. Is there anything I can do?

An injured employee has 120 days to report the injury to an employer. But the clock starts ticking when you become aware of your injury, so you should report it as soon as possible. This point is important. You may not become aware of an illness or chronic ailment such as a repetitive stress injury until some time after the condition began.

Is it possible to obtain both workers' compensation benefits and Social Security Disability (SSD) benefits?


Yes. But these dual claims can be complicated and the interplay between Social Security and workers' compensation can cause problems. If your workers' comp claim is not handled properly, it can reduce your SSD benefits.

Is my employer responsible for paying my medical expenses?


Yes. The Pennsylvania Workers' Compensation Act states that the employer shall pay for all reasonable and necessary medical treatment that is causally related to the work injury. Medicine, supplies, hospital treatment and services, orthopedic appliances and prostheses are all treatments that are covered for as long as they are needed.

What is the statute of limitations for filing a claim for workers' compensation benefits?


An injured worker has three years from the date of their injury, or date they were last paid temporary total disability benefits, to file a claim petition for workers' compensation benefits. Claims not made within this time period are forever barred. Don't take a chance with your workers' compensation claim - call the experienced workers' compensation attorneys at McCormick and Vilushis today.

Can my employer force me to work outside my work restrictions?


No. If you have been hurt at work and given work restrictions by the workers' compensation doctor, your employer has two choices: (i) they can either make sure that they accommodate your work restrictions or (ii) they can tell you that they do not have any work available given your restrictions and you will then be entitled to temporary total disability ("TTD") benefits. But what do you do when your boss insists that you come to work and do more than the workers comp doctor said you can perform?

As always, be polite and respectful to your employer. Chances are good that they simply did not fully understand the work restrictions imposed by your doctor. Make sure that when you receive a copy of any work restrictions the doctor has given you, you retain a copy and deliver the other to your employer. If your employer has any questions about your job restrictions, they can always call the doctor and ask for clarification.

Am I entitled to workers' comp benefits if my work injury aggravated an old injury?


The number one reason for denied workers' compensation claims is "pre-existing injury." Many workers' compensation insurance adjusters will try to convince injured workers that they do not have a compensable claim for this reason and hope that they do not speak to an experienced workers' compensation attorney. However, workers with pre-existing medical conditions are protected by the Pennsylvania Workers' Compensation Act. The act specifically states that aggravations of pre-existing injuries are compensable work injuries. In Pennsylvavnia, if you have an old injury, or some other form of pre-existing condition, which has not prevented you from performing your job duties, then any job accident which aggravates your old injury (or pre-existing condition) is a valid workers' compensation claim and the workers comp insurance carrier is responsible for your worsened condition.

If your claim has been denied on the basis of a "pre-existing" injury, contact the experienced workers' compensation attorneys at McCormick and Vilushis to discuss your claim.

What do I do if my boss refuses to file injury report?


Employers will sometimes refuse to file an injury report. They might think that the injured worker was not actually injured or they might be concerned that their workers' compensation insurance rates might go up. By law, if a worker claims to have suffered a work injury, then the employer (or their insurance carrier) is supposed to file a First Report of Injury with the Pennsylvania Department of Labor. If your employer simply refuses to do this, contact the workers' compensation insurance carrier directly to report your injury. They will then contact your employer and an injury report should be filed in a timely manner thereafter.

What can I do if I was fired after suffering a job injury?


Unfortunately, it is not unusual for our attorneys to receive a phone call from a worker who, after suffering a job injury, was fired. A lot of the times, the termination (or layoff) was for legitimate reasons. However, many times there is a practice at a particular place of business where anyone who pursues workers' compensation benefits soon finds themselves without a job. In this situation, you do have legal recourse available. In Pennsylvania, your employer cannot fire you solely because you have reported and sought workers' compensation benefits related to a job accident.

What do I do if the recommended medical treatment was denied?


In Pennsylvania, the law is clear: the employer (through their workers' compensation carrier actually) must pay for any and all reasonable and necessary medical treatment related to a work injury. If your medical treatment is not being paid, you must contact an experienced workers' compensation attorney immediately. The reason most often given is that the treatment is not related to the accepted work injury. If that is the case, you must check the paperwork originally filed in your claim and identify the description of your injury contained in that paperwork. Often times, the insurance carrier will have narrowly defined the nature of your injury to provide themselves an out for paying for medical treatment. If you suffered a work injury that was not contained in the original paperwork, it may be necessary to file a petition to enlarge the description of the injury so that your medical treatment for all work injuries will be covered.

Other times, the insurance carrier will deny medical treatment claiming that the treatment is expensive and not reasonable or necessary. There are very specific procedures under the Workers' Compensation Act for challenging the reasonableness and necessity of treatment. However, the insurance carrier will often dispense with following these procedures and just rely on a report from their IME doctor to deny reasonable treatment. If so, they may be subject to penalties for denying treatment unilaterally without the court's permission. If your doctor recommends a course of treatment, but the insurance company denies the treatment, you don't have to accept their decision. Contact an experienced workers' compensation attorney at McCormick and Vilushis today to discuss your denied treatment.

Do I have to see the company doctor?


While you are free to see whomever you wish to see, you should realize that your personal health insurance will not pay for treatment related to a work injury. This means that any treatment you receive by seeing who you want to see - instead of who comp tells you to see-will have to be paid for out of your pocket. Most of us simply cannot afford much medical care on a cash basis - which means that for most practicable purposes, yes, you do have to see the doctor workers' compensation tells you to see. Having stated this, if workers' compensation denies liability or otherwise refuses to provide you with the reasonably necessary medical treatment needed, then you may go to whomever you wish and if later your injuries are shown to be related to a job injury, then workers comp will be responsible for ensuring your medical bills are paid and the doctor you picked will be your treating doctor.

As for who the doctor works for, rest assured that the majority of physicians who handle workers' compensation cases are reputable and their primary concern is helping you heal so you can return to work; however, just as with all professions - there are some doctors who have a reputation for putting the desires of the insurance carrier over the needs of the injured worker.

What is an impairment rating?


After suffering a work injury and receiving medical treatment, you will eventually come to the point where your treating physician states that you are as good as you are going to get; this is known as your date of reaching "maximum medical improvement." At this juncture, the physician will give an opinion as to whether you have suffered a permanent injury; if you have, then an impairment rating will be calculated.

What exactly is the impairment rating and what does it mean? Impairment ratings are generally calculated in accordance with procedures listed in the A.M.A. Guides to the Evaluation of Permanent Impairment. Specific impairment ratings are provided according to the type of injury you have suffered and what permanent restrictions you now have to the affected body part (arm, hand, leg, feet, eye) and/or to the body as a whole. While the A.M.A. Guides specifically state that their ratings are not purposed to say what an injured worker can do post-accident, in practice these ratings are viewed by most courts as evidence of your permanent physical impairment, but the court is not bound by these ratings.

If you have suffered a permanent injury to a non-scheduled body part (neck, back, shoulder or hip), or if your injury is such that it effects to proper functioning of the body as a whole and you are no longer able to perform your job duties or earn the same type of money, then the impairment rating really is not as important as your physical limitations, as your permanent restrictions are what will be relied upon in determining what compensation you are entitled to receive

Can workers' compensation cut off my check?


If your workers' compensation claim has been accepted, then the insurance carrier cannot unilaterally cut off your checks. The employer must seek approval from a workers' compensation judge by filing a petition.

If your check has been stopped and you are wondering what your next step should be, contact an experienced Pennsylvania workers' compensation Lawyer at McCormick and Vilushis.

Am I entitled to compensation for pain and suffering?


Unfortunately, no. The vast majority of employees injured at work are not entitled to any compensation for pain and suffering. Workers who have experienced job injuries are entitled to only those benefits set forth in Pennsylvania's Workers' Compensation Act and pain and suffering is not one such benefit. However, if your work injury was caused by a third-party who is not your employer or a fellow employee, then you might be entitled to pain and suffering. For example, if you are injured in a car accident in the course and scope of your employment and the accident was caused by the other driver's negligence, you can make a claim for pain and suffering damages against the at-fault driver. Workers' compensation claims are not like other personal injury type claims, that is why you need to speak with an attorney who has experience handling Pennsylvania Workers' compensation claims, not at attorney who may handle one every now and then.

Am I entitled to a settlement?


At the outset, when we are just meeting with a potential client, we go ahead and discuss settlement. At that point, it is impossible to discuss any figures or how long it may take to reach a potential settlement-there are just too many variables to deal with for any credible attorney to be able to give you any figures at the outset of your case.

Why then do we discuss the possibility of settlement at the outset if we can't provide any figures or time frame? Because we want our clients to know from the start that they are not entitled to a lump sum settlement; no one is. A settlement is an agreement, a meeting of the minds, between two parties-both of whom agree to a certain set of terms. Since you cannot control what the other side is willing to do, you can't claim to be entitled to a settlement, and any attorney worth their salt will tell you the same thing. This is not to say that most cases don't settle, because the fact of the matter is that most cases do settle.

One of the main reasons cases settle is because in a settlement, you can demand a lump sum payment. If you try your case, the court does not have the power to force the defendant to make you a lump sum payment; all the court can do it determine and rule on the percentage of disability you have suffered as the result of your job injury. At this point, the defendant will generally choose to pay you in weekly checks. Most clients would rather their cases settle. However, as explained, there is no recourse to demand a settlement because workers' compensation judges lack the authority to make an insurance carrier settle.

Do I have to take the job offered me following my job injury?


No, you do not have to accept any position. Being hurt at work does not remove your ability to choose what you want to do for a living, but failure to attempt to return to a position your employer believes you can perform given your restrictions - or to a position they have created for you - may result in the employer filing a petition to suspend your wage loss benefits. The law allows for your employer to attempt to find a position for you. It is not uncommon for an employer to offer an injured worker a meaningless job sitting in an office all day not doing much of anything. The worker may feel like they are being harassed by such a job, but it is usually better to make 100% of your pay as opposed to the 2/3rds you receive with TTD benefits. If the amount you make in another position is less than your average weekly wage made prior to your job injury, then you would be entitled to temporary partial disability benefits for 2/3rds of the difference.

If you try the offered position, but are unable to do it given your restrictions, then inform your physician of the same and you may then be entitled to continuing wage loss benefits until you can return to work.

Is the company nurse allowed to be present during my doctor visit?


No, they are not. You have the right to ask them (politely) to wait outside while you are evaluated and discussing your injury with the doctor. The law allows the insurance company to have a nurse speak with the doctor about your treatment, but this can be done before or after you visit is over.

Do I have to have surgery if I don't want it?


If you have suffered a compensable job injury in Pennsylvania, you have to see the company doctor. You are also obliged to cooperate with the treatment recommended by the treating physician, be it by attending physical therapy, properly taking certain medication or other reasonable forms of medical treatment. But what if the doctor says you need surgery and you don't want surgery? Do you have to go under the knife just because you were hurt at work?

Generally, no. Surgery can be a serious thing, and not something to run into. If a back surgery has been recommended, but you are doubtful about the results-you don't have to have surgery. If the surgery could lead to worse problems, then the decision whether to move forward with surgery belongs to you. You cannot be forced to have surgery as long as your reasons are reasonable.

However, certain surgical procedures are deemed sufficiently low risk (like a knee surgery or surgery to correct carpel tunnel syndrome) that refusing to have them to correct your injury would not be deemed reasonable. In those situations, refusing to undergo surgery could lead to a suspension of your workers' compensation benefits.

Do I need a lawyer?


You are not required to have a lawyer. Pennsylvania's workers' compensation laws have very specific rules, and if you do not know what to do, or what time period you have in which to act, you could be waiving valuable rights.

Not everyone who calls our office ends up hiring us to represent them. In certain situations we are able to answer the injured workers' questions and give some free advice. In other cases, the worker realizes that they need help; the choice is yours, but the wisest course of action is to at least call a knowledgeable workers' compensation lawyer with the questions you have.

How much money am I entitled to?


This is one question we receive which we are not able to readily answer because every case is unique. We were all created uniquely, and how an injury affect us all is also unique.

If you have suffered a serious job injury and the insurance company is pushing you to settle, it is worth the time for you to at least call an experienced Pennsylvania workers' compensation attorney and let them take a look at your case. Additionally, the language contained in any settlement petition is extremely important, as certain terms and phrases could waive your right to future vocational benefits and/or the right to pursue a wrongful termination claim if you are wrongfully terminated after seeking worker compensation benefits.

How do I get medical treatment?


Once you have informed your employer that you have suffered a job injury and desire medical treatment, your employer has an obligation to inform the Pennsylvania Department of Labor of the fact one of their employees has suffered a job injury and they are to file a First Report of Injury with the Commonwealth and file a claim with their workers comp insurance provider. Then your employer and their workers' compensation insurance carrier have the legal obligation to pay for any and all reasonable and necessary medical treatment needed to treat your job injury.

In the last few years the workers' compensation insurance carriers in Pennsylvania have been trying to avoid their legal responsibility to pay for an injured worker's medical treatment. In today's climate, Pennsylvania workers have to fight just to have a MRI performed. We have had to file petitions for clients several times where the doctor the workers' compensation insurance carrier told our client to see ordered a MRI, but the insurance carrier refused to comply with the doctor's request. In those cases it was necessary to file a petition to ensure that the worker receives the treatment the law states they are entitled to receive so they can recover and get back to work as soon as possible.

What if the workers' compensation carrier disagrees with my treating doctor's medical opinion?


If the workers' compensation insurance carrier does not like what the authorized treating physician recommended in terms of medical treatment, then they have the right to use the utilization review process and hire another physician to review the findings of the authorized physician and opine if they agree with the doctor's findings. Utilization review (UR) typically works like this. Your treating physician informs you that surgery is needed. At this time the workers' comp insurance asks the Dept. of Labor to appoint another physician to review your medical records and state whether the suggested treatment is reasonable and necessary given your diagnosis. If the doctor agrees with your treating doctor, then the carrier will continue to pay for the treatment. If they do not, you may need to file a petition to review the UR doctor's decision.

Do I have to see the IME doctor?


If you have suffered a serious injury and are receiving costly treatment from your treating physician, chances are that at some point you will be contacted by workers comp and told that you have to see another doctor (called an independent medical examination or IME). It is not because the doctor caring for you has done anything wrong, but because comp doesn't like paying the medical bills associated with your treatment. So, do you have to see this new IME physician?

Generally, yes. The law in Pennsylvania is clear the workers' compensation insurance carrier is allowed to request an IME with a doctor of their choice. If you are receiving benefits and the insurance company requests that you undergo an IME, you should contact the Pennsylvania workers' compensation attorneys at McCormick and Vilushis immediately

What is the 7-day waiting period?


According to Pennsylvania law, if a worker suffers a job injury and is taken off work (or given restrictions which their employer cannot/will not accommodate), then the injured worker will be entitled to temporary total disability (TTD) benefits, BUT these benefits do not begin until the 4th day the worker has been out of work.

Why? I don't know. Going 3 days without pay is difficult in today's economic climate, but it is the law. After the 3 day waiting period, your right to TTD benefits begin, and if you miss 21 days of work, then you are entitled to be reimbursed for the initial 3 days.

What if there were no witnesses to my job injury?


While many job injuries happen in the middle of the warehouse with plenty of witnesses present, many do not. If you suffer a job injury, but there were no witnesses to the event, your employer cannot refuse to file a workers' compensation claim on this basis alone.

Do I have to take a drug screen after a job injury?


If you want to receive the Pennsylvania workers' compensation benefits that you are entitled to receive following a job injury, an injured worker must submit to a drug or alcohol screen post-injury. Failure to do so might give your employer a legitimate reason to fire you which may result in you not receiving any monetary compensation for the job injury you suffered.

A positive drug or alcohol post injury screen can have an adverse effect on your claim for workers' compensation benefits. If you suffered a job injury because you were under the effects of an illegal drug, or because you were abusing a legally prescribed drug or alcohol, then you may not be entitled to workers' compensation benefits if your employee handbook provides notice that use of such substances will result in termination.

However, just because you may have tested positive for drugs does not mean that you are automatically disqualified from receiving workers' compensation benefits in Pennsylvania. Failing a drug screen is not what would prevent you from receiving benefits; suffering a job injury because you were under the influence of said drugs is what stops you from receiving benefits. In some cases, the employer must prove that the injury was caused by the use of illegal drugs. In many cases, such as those involving marijuana which stays in the body a long time after inhalation or ingestion, it is practically impossible to prove that the employee was actively high at the time of the work accident. If the employer cannot prove that the presence of any illegal substance caused the job injury, then the injured worker is still entitled to workers' compensation benefits.

What happens if my doctor releases me to light duty work but my employer refuses to offer light work?


Often a treating physician will release an employee to limited kinds of work before the injured worker is fully recovered. If the employer does not provide work within the doctor's restrictions, the worker is still considered temporarily disabled from their usual and customary occupation and disability payments will continue.

If the worker returns to modified work, but at less hours, or less pay than prior to the work injury, the worker may be entitled to temporary partial indemnity on a wage loss basis in addition to the worker's earnings during this period.

If the partially disabled employee refuses an offer of modified work, the refusal may be the basis for terminating payments of temporary disability indemnity.

If the doctor releases the injured worker to modified work on a permanent basis, then the employer must either provide work within the restrictions, or provide vocational rehabilitation benefits to assist the injured worker in finding other work in the labor market.

What if my doctor says I can go back to work, but I don't think I can?


If your employer makes you a legitimate offer of employment, and you choose not to take the offer, your temporary total disability benefits may be suspended.

What will happen to my workers' compensation benefits if I return to work?


If you are receiving temporary total disability (TTD) benefits, your weekly benefit check may be suspended while you are working, or reduced, depending on what actual wages you earn. If you return to work and later your doctor takes you back off work, your checks may be reinstated. Medical benefits will continue, as long as the treatment is reasonable and necessary and causally related to the work injury.

Can I still get medical treatment for my work-related injury after I return to work?


Yes. You can also ask to be paid for your travel costs to and from treatment. You can be repaid for the cost of medications and some other items prescribed by your doctor as well.

I have gone back to work, but sometimes lose time due to my work-related injury. Can I get paid for the days I miss?

Yes, you can receive workers' compensation benefits. If you are sometimes absent from work because of your work-related injury, this is called "Intermittent Lost Time." You must tell the Workers' Compensation Board and your insurer. Please keep careful records of your lost time and your pay stubs.

When I go back to work, can I still claim workers' compensation for the time when I was hurt and could not work?


Yes. You have up to two years after your workplace injury to file a workers' compensation claim. This is true even if you have already returned to work.

Does my employer have to keep my job open for me while I am out due to my workplace injury?


The Workers' Compensation Law does not require your employer to keep your job open for you. But, most employers do take injured workers back. Keep in contact with your employer about your job status. The federal Family and Medical Leave Act (FMLA) requires some employers to provide up to 12 weeks of unpaid leave during a twelve-month period to an employee who cannot work because of a serious health condition. Contact the U.S. Department of Labor or your employer for more information

What happens if I return to work and find I cannot do the work?


If you go back to work but are unable to continue working due to your prior workplace injury, you may be able to reopen your case and collect benefits again. You may want to ask your employer for a short-term job that you can do.

Can a new employer refuse to give me a job because I have a compensation case?


Employers are not allowed to ask you if you have had a workers' compensation claim. They cannot deny you a job for filing a past claim, either. The Workers' Compensation Board cannot share your workers' compensation case with another employer.