The law provides several types of workers’ compensation benefits:
Wage-loss benefits are available if it is determined that you are totally disabled and unable to work or partially disabled and receiving wages less than your pre-injury earnings.
Total disability benefits are payable for as long as you are unable to work. There are no specific time limits imposed by law to collect these benefits. However, after you have collected total disability benefits for two years (104 weeks), you may be asked to undergo an Impairment Rating Evaluation (IRE) by the workers’ compensation insurance carrier.
If, as a result of the examination, you are found to have less than a 50% whole body impairment rating, the amount of time you can collect total disability benefits is limited to a maximum of 500 weeks, and you will be considered “partially disabled.” Your benefit rate, i.e. the amount that you collect per week, however, will remain the same. The workers’ compensation insurance carrier can still attempt to reduce your partial disability benefit further through vocational rehabilitation during the 500 weeks of partial disability.
Any benefits less than total is partial. Partial disability benefits are usually received in a situation in which the injured worker has returned to work at wages that are less than the pre-injury wages.
Partial disability benefits are payable up to 500 weeks (9.6 years) when your partial disability status is determined from an IRE or if a judge finds that you are capable of performing light-duty work at wages less than the pre-injury wages. This means that you have the ability to earn some wages, but you have not completely recovered from your work injury.
If you are back to work but the new job pays less than the pre-injury job, you are entitled to be paid two-thirds of the difference between average weekly wage of your old job and your new job up to the maximum rate for the year of your injury.
If you’ve been injured at work or diagnosed with a work-related illness, you are entitled to receive medical treatment that is “reasonable and necessary” to treat your work injury. These medical costs are the responsibility of your employer and the employer’s workers’ compensation insurance carrier. Once a claim is accepted, you should never have to make a co-payment or pay any other fee for medical care associated with a work-related injury or illness.
Even if you have lost no time from work, your employer should still be responsible for health care costs for a work-related injury or illness.
Even though it is the duty of the workers’ compensation insurance carrier to pay for medical treatment related to a work injury, these carriers frequently try to get out of paying by challenging the relatedness of the treatment to the work injury. A workers’ compensation insurance carrier may narrowly describe an injured worker’s injury to avoid paying for treatments down the road. It is very important that an injured worker be aware of what injuries have been accepted by the insurance carrier and what injuries have not been accepted, even though the injuries all occurred in the same accident.
If the injury results in death, surviving dependents may be entitled to benefits.
If you have lost the permanent use of all or part of your thumb, finger, hand, arm, leg, foot, toe, sight, hearing or have a serious and permanent disfigurement on your head, face or neck, you may be entitled to a specific loss award.
To speak with an experienced Pennsylvania workers’ compensation attorney about your workers’ compensation claim, contact McCormick & Vilushis LLC today! There are no consultation fees and we charge no attorney’s fee unless we win your case.
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