What is Workers' Compensation?
Workers' Compensation is insurance paid for by employers to cover on-the-job injuries. State law requires employer to have such insurance or make other arrangements to pay for on-the-job injuries. Workers' suffering from work related injuries or diseases are entitled to wage-loss and medical expense benefits arising as a result of the injury or disease.
For what injuries or diseases may I receive benefits?
If your injury or disease arises in the course of your employment or if your preexisting condition, disease or infection is aggravated, reactivated, or accelerated by a work injury, you are entitled to benefits.
If I have a pre-existing condition which is aggravated by a work injury, am I entitled to receive benefits?
Yes. The aggravation, reactivation, or acceleration of an underlying or preexisting condition entitles you to benefits. For example, if you have degenerative disc disease and a work injury worsens the disease, you may receive benefits. Do not assume that you may not receive benefits merely because you have a preexisting condition.
May I receive benefits if I suffer an injury from repetitive job activities?
Yes. It is generally accepted that repetitive motion injuries such as carpal tunnel syndrome, thoracic outlet syndrome, and other conditions are either caused, aggravated, or accelerated by repetitive job activities, and thus are compensable work injuries.
Am I entitled to receive benefits if I return to work after suffering a work injury and my condition reoccurs?
Yes.
Are certain diseases presumed to be work related?
You may receive benefits for diseases caused, aggravated, or accelerated by work activities. Additionally, there is a presumption that certain diseases are work related. These include:
- Tuberculosis and hepatitis for nurses, blood processors, and related professions that which involve exposure to these diseases.
- Diseases of the heart and lungs for firefighters who have four or more years of service.
- Pneumoconiosis and silicosis for any occupation that involves direct contact with or exposure to coal dust.
- Specific types of chemical poisoning (such as lead, mercury, phosphorus, and arsenic) for occupations involving direct contact or exposure to those chemicals, or to their preparations or compounds.
The Act also has a catchall provision that entitles you to a presumption that your condition is work related if you can demonstrate the following:
- you have been exposed to the disease by reason of your employment;
- the disease is causally related to your industry or occupation; and
- the occurrence of the disease is substantially greater in that industry or occupation than it is in the general population.
What should I do if I suspect that my injury, illness, or disease was caused in whole or in part, by my job?
If you suspect that you are suffering from a work related injury or disease, you should notify your employer and discuss this with your treating physician. You should explain why you think that the job is causing the physical problems and ask your physician for an opinion. If the physician believes that the condition is work related, you should inform your employer immediately.
Must I be injured on my employer's premises to be entitled to benefits?
As long as you are engaged in activities that further the business interests of your employer, you are entitled to benefits. For example, if you suffer an injury while running an errand for your employer or while you are participating in a company-sponsored athletic event, you are entitled to benefits. On the other hand, injuries occurring while commuting to or from work ordinarily are not covered by the Act. There are many circumstances where such an injury may be covered, however, and thus you should notify your employer of the injury.
Must I notify my employer of my injury?
Unless notice of the injury is given to your employer within twenty-one days, you are not entitled to receive compensation until notice is given. If notice is not given within 120 days, you will forfeit the right to receive any benefits at all.
There are circumstances in which the notice period does not begin to run until you know or should know that your disability was caused by a work injury or disease. If your employer or its insurance company tells you that you are not entitled to receive benefits because you gave late notice, you should consult an attorney.
What kind of notice is sufficient under the law?
You have the obligation to notify your employer of your condition and its relationship to your employment. This notice may be oral, but written notice is preferred. Notice should be given to a supervisor, foreman, or other agent of the employer.
Must my employer prepare an injury report?
Employers are obligated to keep records of all on-the-job injuries. If an injury results in the loss of a day, shift, or turn, your employer must complete Form LIBC-344, Employer's Report of Occupational Injury or Disease. This report must be completed even if the employer disputes its responsibility for your injury. You are entitled to receive a copy of the report.
May I obtain from my employer medical records and other documents that may be relevant to my claim?
OSHA Medical Access regulations give Workers' the right to obtain copies of their medical records held by the company. Furthermore, either the injured worker or his union may obtain air sampling information and other data from the employer. Employees may also be entitled to receive copies of material safety data sheets, which set forth, among other things, the ingredients, physical characteristics, and hazards associated with chemicals in the workplace. The regulations are set forth in Section 1910.20 of Volume 29 of the Code of Federal Regulations.
How long does an employer have to investigate a claim and make a decision on whether it will be accepted?
An employer has twenty-one (21) days from the date you give notice to investigate a claim and decide whether to accept responsibility for it. Often it takes longer than twenty-one days. The most common reason is the written medical records are either not forwarded to the insurance company, or the records fail to state whether the condition is work related. If your injury is causing you to miss time from work, you should make sure that your treating physician verifies, in writing, that your condition is work related and that you are disabled from your pre-injury employment as a result of the injury. You should also make sure that the medical records are forwarded to the insurance company.
Whom should I contact if I suffer a disabling work injury?
After receiving notice of a work injury, your employer will ordinarily refer you to an insurance company that handles claims for the employer. The name, address, and telephone number of the Workers' compensation insurance company is supposed to be posted on the employer's premises. Once the employer notifies the insurance company of the claim, the insurance company will assign a claims representative or adjuster to handle your claim. The claim will be assigned a number, and all future correspondence to the insurance company should include the claim number.
Should I use my sick time while my claim is being reviewed?
Because it takes several weeks to process the claim, it is generally reasonable to use accumulated sick time. Your employer, however, may have a policy that prohibits you from using your sick time. Alternatively, you may be required to repay your sick time if your claim is accepted.
Should I use my health and accident insurance if my claim is denied?
Some employers provide health and accident insurance, which is available in the event that you suffer a non-work related injury or disease. You may be entitled to use this coverage while your claim is being processed. Insurance Department regulations require health and accident insurers to pay benefits when a Workers' compensation claim is denied. These benefits are usually substantially less than what is allowed under the Workers' Compensation Act. They are also limited in duration and are taxable. If your employer insists that you use such benefits in lieu of Workers' compensation benefits, you should notify your union, if you have one, seek the advice of an attorney, or both.
What wage-loss benefits are available to me in the event that I miss time from work as a result of a work injury?
If you are disabled for seven days or more, including weekends, you are entitled to receive wage-loss benefits. If your disability lasts for more than fourteen days, you are entitled to receive compensation for the first seven days of disability. To qualify for benefits, the lost workdays need not be consecutive. Furthermore, if you are working in a light duty position as a result of your injury, you are considered disabled and you are entitled to partial disability benefits if your disability exceeds seven days.
May my employer pay me wage-loss benefits without accepting responsibility for my claim?
If your employer issues a notice of compensation payable in connection with your work injury, it formally accepts responsibility for your claim and must continue paying wage-loss benefits unless certain conditions are met. An employer may, however, pay wage-loss benefits to you for up to ninety days without formally accepting responsibility for the claim. To do so, the employer must file a notice of temporary compensation payable. The employer has the right to stop making payment of wage-loss benefits at any time following the issuance of a notice of temporary compensation payable. If benefits are paid for a period longer than ninety days, the employer automatically accepts responsibility for your claim.
How are my wage-loss benefits calculated?
Your benefits are calculated by analyzing the four thirteen week periods preceding the date of your injury. The calculation is based on wages and other compensation from all forms of employment. Accordingly, if you have a second job, those wages are included in calculating your benefits. The average weekly wage is calculated by averaging your wages during the three highest thirteen-week periods. If you are a seasonal employee or have worked less than thirty-nine weeks, a different calculation method may be used.
You are entitled to receive approximately two-thirds of your pre-injury average weekly wage up to a statewide maximum that increases every year. Low-wage employees may be entitled to receive more than two-thirds. Workers' Compensation benefits are not taxable.
Unfortunately, your wage-loss benefits are fixed at the date of injury and will not increase to reflect inflation or wage increases you otherwise would have received had you not been injured.
Are there any offsets or credits that the employer or the insurance company can take which will reduce my benefits?
Yes. If you were injured on or after June 24, 1996, the insurance company will deduct an amount equal to fifty percent of any social security old age benefits you receive. This off-set does not apply to social security benefits received prior to the date of the work injury, and does not apply to social security disability benefits.
If you receive pension benefits from a plan that was funded by the employer for whom you were working at the time of the injury, the insurance company can take a dollar-for-dollar deduction against your benefits to the extent that the employer funded the plan.
Employers and their insurance companies may take credit for severance payments funded by your employer.
Furthermore, benefits will be reduced for each dollar that you receive in unemployment compensation benefits during your period of work related disability.
If you are receiving benefits and you are contemplating retiring or applying for social security benefits, you should consult an attorney first.
Are there special benefits available if I suffer an amputation or loss of the use of a body part?
The Workers' Compensation Act contains a schedule of “specific losses” that set forth the benefits you receive if you have suffered a permanent loss or loss of use of certain limbs or functions of the body including vision and hearing. The law fixes a specific number of weeks for each specific loss. You are entitled to receive these benefits for the period set forth in the Act regardless of whether you are out of work. You may also be entitled to benefits for a healing period to the extent that you miss time from work while recovering, but you may not receive benefits for a longer period than is specified in the Act.
Are special benefits available if my job causes hearing loss?
Yes. The number of weeks you are entitled to receive benefits for occupationally-induced hearing loss depends upon the amount of hearing loss attributable to the your work.
May I receive benefits if I suffer a disfigurement?
You may receive up to two hundred and seventy-five weeks of benefits for a permanent disfigurement of the face, neck, or head. The award is supposed to be proportionate to the extent of the disfigurement.
May my family collect benefits in the event that I die from a work injury?
If you were to die as a result of a work related illness or injury within three-hundred weeks of the date you suffered the injury or contracted the disease, your widow or widower is entitled to receive benefits that vary depending on the number of your dependent children. Widows or widowers who remarry are entitled to receive a lump sum “dowry” equal to two years of compensation payments, after which all compensation ceases. If your children are full-time students at an accredited school, they are entitled to receive benefits until they reach the age of twenty-three years, as long as they remain enrolled.
May other members of my family recover benefits in the event that I die as a result of a work injury or disease?
Orphaned children, parents, and brothers and sisters may be entitled to receive compensation benefits if they were dependent or partially dependent upon you at the time of death.
Are any burial expenses available?
Reasonable expenses of burial not to exceed $3,000 are available.
What medical benefits may I receive?
If you suffer an occupational injury or disease, your employer is obligated to pay for all reasonable and necessary medical expenses associated with the injury or disease. These benefits are paid directly to the medical provider in accordance with a strictly regulated fee schedule. The medical provider is not entitled to bill you the difference between the provider's charge and the amount allowed under the Act. Payment of medical expenses does not necessarily mean that your claim has been accepted.
If my claim has been denied, may I use my health insurance coverage?
Insurance department regulations impose upon health and accident insurers the obligation to pay benefits if your claim is denied. If your claim is denied, you should send a copy of the denial to your medical providers along with health insurance information.
ERISA plans are not subject to Pennsylvania Insurance Department regulations, and thus may refuse to pay for work related medical bills. If your health coverage is administered through an ERISA plan, you should contact the plan administrator to find out what requirements must be met before health or accident benefits are paid.
May I recover any penalties against my employer's insurance company for excessive delays in paying the benefits?
The Act imposes upon employers and insurance companies penalties of up to fifty percent on late or illegally suspended benefits. Attorney's fees may be recovered as well under certain circumstances.
May I sue my employer for negligence?
Your employer is immune from liability for negligence causing a work injury. Accordingly, you may only receive benefits under the Workers' Compensation Act.
What if someone other than my employer is responsible for my work injuries?
You are permitted to pursue a lawsuit against third parties who are responsible for your work injury. For example, if you are injured in an automobile accident as a result of the negligence of a driver other than a co-worker, you may sue the other driver. If you were injured as a result of a defective product, you may sue the manufacturer or seller of the product.
If I suspect that my injury resulted from a defective product, is there any action that I should take?
If you believe that your injury resulted from a defective product, it is essential that the accident scene be preserved. You should request that coWorkers' or your union take steps to ensure that the product causing the injury is not lost or destroyed. Your employer may be willing to cooperate in preserving the accident scene.
Do I have any obligation to treat with a company doctor?
The Act permits employers to require employees to treat with a physician or medical provider from a list that is to be posted prominently in the workplace. You have the right to choose which of the medical providers with whom you wish to treat. You must treat with the company doctor for ninety days from the date of first visit. Thereafter, you may treat with the physician or medical provider of your choice. If you treat with a physician or medical provider other than one who is on the employer's list, your employer may refuse to pay bills incurred during the ninety-day period. Under some circumstances you may wish to treat with your own physician even though you may have to pay for it. If the company doctors do not listen to you when you describe your symptoms, or if they fail to document what you are saying to them, you may wish to have the history of your injury and the symptoms you are suffering independently documented.
Should I continue to treat with the employer's physician after my claim has been denied?
There is no reason for you to continue to treat with employer-designated physicians after your claim has been denied. Insurance Department regulations require health insurances companies to pay bills where the Workers' compensation company has denied liability, and thus you may treat with the physician or medical provider of your choice.
Should I continue to treat with the employer-designated doctor after the required period?
After you have treated with an employer-designated physician for ninety days, you have the right to treat with the physician or medical provider of your choice. In general, you should exercise this right. While there are many, many employer-designated physicians who are competent, you will never be sure if the physician is placing your interests first. Accordingly, you should treat with physicians and medical providers who exercise independent medical judgment.
How can I ensure that my medical bills are paid promptly?
The Workers' compensation insurance company has an obligation only to pay medical bills for treatment that is related to the work injury. The bills are supposed to be submitted to the insurance company on appropriate billing forms with an attached medical report form which clearly identifies the nature of the treatment and confirms that the treatment was rendered in connection with a work related injury. The bills are supposed to be submitted to the insurance company on appropriate billing forms with an attached medical report form that clearly identifies the nature of the treatment and confirms that the treatment was rendered in connection with a work-related injury.
If you receive notice from your medical provider that bills have not been paid by the Workers' compensation insurance company, you should make sure that the bills have been submitted. If the bills have been submitted and are being processed, you should give the medical provider's billing department the name and phone number of the claims representative who confirmed that the bills were being processed. If the bills are being denied, you should ask the reason why the bills are being denied. If necessary, you should request a written denial so that the bills can be submitted to your insurance carrier. Whenever you submit bills to the insurance company, they should be organized and submitted with a cover letter that contains your claim number and describes the bills and treatment.
Does my employer have the right to challenge the reasonableness or the necessity of my medical treatment?
An employer may challenge the reasonableness and the necessity of medical treatment by filing a utilization review petition with the Bureau of Workers' Compensation. Bills submitted within thirty days of the filing of the petition may be reviewed. The petition will be assigned to a utilization review organization that will request your medical provider to send a copy of your medical records. The utilization review organization will issue a report that states whether your treatment was reasonable or necessary. If your physician or medical provider fails to provide copies of your medical records to the utilization review organization, the treatment will ordinarily be found to be unreasonable or unnecessary. It is therefore essential that your provider forward copies of your medical records to the utilization review organization if your treatment is being reviewed. If the utilization review organization finds that your treatment was wholly or partly unnecessary or unreasonable, you have the right to appeal this decision to a Workers' compensation judge.
Is the insurance company or employer entitled to have me examined by a physician of their choice?
Your employer or its Workers' compensation insurance company is entitled to periodic examinations of you by physicians of their choosing. You have a right to have your own physician present at such an examination, but you must pay the cost of having your physician present. When being evaluated by an insurance company physician, it is essential that you be accurate and honest with respect to your condition. If you are requested to undergo such an evaluation, you should contact Gregory J. Boles, Esquire at 1-866-586-9830 in order to receive a guide to attending independent medical evaluations.
Do I have any obligation to report information to insurance company?
You must report employment and self-employment information to the insurer when you are seeking or receiving compensation. You are also obliged to cooperate with efforts by your employer or its insurance company to investigate employment, self-employment, wages, and physical condition. You may be required to complete forms that set forth this information. If you fail to return these forms to the insurance company within thirty days of receipt, your benefits may be suspended until you provide the requested information.
What happens if I recover enough from my work injury to be able to return to some type of employment?
Once you are disabled as a result of a work injury, the Act presumes that you remain totally disabled from all forms of employment unless or until your employer offers you employment that is consistent with your medical restrictions or the employer legally establishes that you are partially disabled.
If you are released to return to work after you have suffered a work injury, it is essential that you speak with your physician about whether you have any restrictions on what you may do. If there are restrictions that have been placed on you because of your work injury, you may be entitled to receive partial disability benefits equal to two-thirds of the difference between your pre-injury average weekly wage and your return to work wages, up to a maximum o five-hundred weeks.
Must I sign any forms once I return to work?
Your employer may ask you to sign a document called a final receipt when you return to work. If you sign a final receipt, you admit that all disability related to your work injury has ceased. If you continue to suffer from your work injury, you should insist upon signing a document called a supplemental agreement that acts to suspend or modify your benefits but does not constitute an acknowledgment that you are recovered. The supplemental agreement may set forth a modified benefit rate if you are returning to work at less than your pre-injury wages.
What will happen if I refuse to sign a final receipt or supplemental agreement?
Your employer has the right to file a notice of suspension of benefits where you have returned to work at wages equal to or greater than your pre-injury wages. In order to do so, your employer or your insurance company must send written notice of the suspension to you. Once you have received notice of suspension, you have twenty days to file a challenge to the notice. If you do not do so, the notice of suspension will have the same effect as a supplemental agreement and your benefits will be suspended.
Are there any situations in which I must submit to a vocational interview?
For individuals who have suffered injuries after June 24, 1996, the Act grants employers the right to insist that you undergo a vocational interview.
You should not undergo an interview unless an attorney represents you.
Your employer or its insurance company will request a vocational interview as the first step in an attempt to relieve itself of the obligation to pay wage-loss benefits to you.
If I am receiving total disability benefits and I am not working, is there any way that my employer or its insurance company can demonstrate that I am only partially disabled?
For injuries occurring after June 24, 1996, if the insurance company receives medical evidence which indicates that you are capable of returning to perform some form of work, you may receive a form entitled “Notice of Ability to Return to Work” which states on its face that you have an obligation to look for available employment, that proof of available employment may jeopardize your right to receive ongoing benefits, and that you have the right to consult with an attorney in order to obtain evidence to challenge the insurer's contentions.
In order to reduce or eliminate your Workers' compensation benefits, the insurance company must establish that you have an “earning power.” The Act states that earning power is to be determined by analyzing work that you are capable of performing and will be based upon expert opinion evidence, including job listings with agencies of the Department, private job placements, agencies, and advertisements. Your disability will be considered “partial” if you are able to perform previous work, or considering your residual “productive skill, education, age, and work experience, can engage in other substantial gainful employment which exist in the usual employment area where you live in Pennsylvania.” The Act also states that if the employer has a job that you are capable of performing, it must be offered to you.
May my employer take legal action to reduce or terminate my Workers' compensation benefits?
If you and your employer disagree about the nature and extent of your disability, your employer may file a petition to reduce or terminate your benefits.
If your employer has received medical evidence that you are recovered in full from the effects of your work injury, the employer may file a petition to terminate your Workers' compensation benefits.
If the employer has evidence that they offered you employment that is consistent with medical restrictions that have been placed upon you by a physician who has examined you, the company may file a petition to suspend or modify your Workers' compensation benefits if you refuse such employment.
If such a petition is filed, the Bureau will assign the petition to a Workers' compensation judge in the county in which you live. The judge will schedule a hearing and a representative of the insurance company will present written evidence to the judge and argue that the employer is entitle to an immediate suspension or modification of your benefits. You should hire an attorney to represent you at such a hearing.
Are there any limitations on the time during which I may receive total disability benefits?
If you are totally disabled from all forms of employment, it is theoretically possible for you to receive wage-loss benefits for the rest of your life. This, however, is unlikely to occur. If your injury occurred after June 24, 1996, and you have received one hundred and four weeks of total disability benefits, the company has the right to require you to submit to a medical examination to determine the extent of your permanent impairment. If the examining physician determines that you have an impairment rating that is equal to or greater than fifty percent according to the guidelines of the American Medical Association, you will be entitled to continue to receive total disability benefits and will be presumed to be totally disabled. If the examining physician claims that you have an impairment rating of less than 50%, you will be deemed to be partially disabled, which will limit recovery of wage-loss benefits at that point to no more than an additional five hundred weeks. In order to receive an impairment rating of greater than 50%, you must be profoundly disabled.
What should I do if my claim is denied?
If your claim is denied, you have three years from the date of injury to file a claim petition for Workers' compensation benefits. I f you do not file the petition with the Bureau of Workers' Compensation within the time period required by law, you will lose forever your right to receive benefits. Under most circumstances, you should seek the assistance of an attorney in pursuing a claim for benefits.
How can I pay for any attorney?
The Workers' Compensation Act places limitations on how much an attorney can charge an injured claimant. Under most circumstances, you may be charged no more than 20% of any past due or on-going wage loss benefits. Most attorneys will charge this fee only if they are successful in obtaining or protecting your benefits.
My employer filed a petition against me. What happens next?
Every petition filed with the Bureau of Workers' Compensation is assigned to a Workers' compensation judge. It is crucial that you obtain legal representation to file an answer to the Petition in a timely fashion. The workers' compensation lawyers at Fenner & Boles have been representing claimants before workers' compensation judges for many years, and their specialized experience and knowledge will be vital in ensuring that you are successful in combating the employer's attempts to limit your right to ongoing benefits.
In general, there will be a series of hearings in which evidence in the case will be presented. If your employer has filed a petition to terminate, modify, or suspend your benefits, the judge will ordinarily take written evidence at the first hearing in the case and consider the employer's motion for suspension or modification of your benefits pending the final outcome of the case. It is crucial that you produce evidence at that hearing or your benefits will be modified within a matter of weeks. Only an experienced workers' compensation attorney such as the attorneys at Fenner & Boles can properly prepare the evidence needed to combat the employer at that point.
Further hearings will be scheduled in order to collect evidence from you and your employer. At a final hearing, you will testify. All through the process, you will need an experienced workers' compensation attorney.
May the parties settle a Workers' compensation claim?
The Act permits employer and injured Workers' to settle claims for Workers' compensation benefits, including medical expense benefits.
Your claim may be settled in whole or in part. You should carefully consider any proposal to settle your medical expense claim because your health insurer may refuse to pay for medical expense incurred due to your work injury.
What happens after the record in my case is closed?
At the conclusion of a Workers' compensation case, the judge will close the record in the case and direct the parties to submit proposed findings of fact and conclusions of law. The proposed findings summarize the evidence, the legal conclusions that follow from the evidence and the remedy that the parties wish to achieve. The parties may also submit a written brief in which they argue for their respective positions.
Are other benefits available to me pending the outcome of a claim petition?
Your employer may have sickness and accident insurance. Even if you do not have such benefits, you can apply for unemployment compensation, welfare, Veterans benefits, or pension benefits. If you are totally disabled from all forms of employment, you may seek recovery of social security disability benefits. Before you apply for such benefits, you should consult with an attorney.
Please note that an application for unemployment compensation benefits is not inconsistent with an application for Workers' compensation benefits. If you are disabled from your pre-injury position but are capable of performing sedentary or light work, you will qualify for unemployment compensation benefits if your employer refuses to supply such work to you. Your employer or its Workers' compensation insurance company will be entitled to a credit for any unemployment compensation benefits you receive while the petition is pending.
You may be eligible for social security benefits pursuant to two programs: disability insurance and supplemental security income. Social security disability is an early retirement program for profoundly disabled individuals. The Social Security Administration will consider all medical or psychiatric problems that you may have in determining whether you are eligible for Social Security disability benefits. Once you receive these benefits for two years, you are entitled to purchase Medicare coverage for your medical expenses. You are only entitled to receive Social Security disability benefits if you are suffering from a physical or medical condition that prevents performance of any substantial gainful work and the condition is expected to last or has lasted for at least 12 months, or is expected to result in death.
If your Social Security disability benefits are approved, the Social Security Administration is entitled to receive an off-set of Workers' compensation benefits that are paid to you. While in most circumstances you should apply for Social Security disability benefits if you qualify, it is possible that the Internal Revenue Service will take the position that your Workers' compensation benefits are rendered taxable by virtue of an award of Social Security disability benefits.
Supplemental Social Security becomes available to persons who have not made sufficient contributions to the Social Security system to qualify for Social Security disability benefits. The same disability test is applicable, but you will not qualify if you have more than minimal liquid assets.
Are there any additional benefits available to government employees?
There are a number of statutes, including local ordinances, which impose upon governmental entities the obligations to pay benefits to employees who have suffered work injuries. The two most commonly invoked statutes are the Heart and Lung Act and Act 534. The Heart and Lung Act applies to all state police officers, enforcement officers and investigators employed by the Pennsylvania Liquor Control Board, parole agents, enforcement officers and investigators of the Pennsylvania Board of Parole, any member of the Delaware River Port Authority, police or any policemen, firemen, or park guard of any county, city, borough, town, or township, who was injured in the performance of his or her duties. If you qualify, these benefits are available for any temporary incapacity which results from a work injury. If you are permanently incapacitated from returning to your pre-injury duties, you are ineligible for Heart and Lung Act benefits.
Act 534 covers any employee of a state penal institution or correction institution under the Department of Corrections, and any employee of a state mental hospital or youth development center under the Department of Public Welfare. The Act covers injuries that occur during the course of employment by an act of any inmate or any person confined in such an institution, or by any person who has been committed to an institution by any Court of the Commonwealth, or pursuant to any provision of the Mental Health Act. With respect to any employee of the County Board of Assistance, the injuries are covered if they result from the Act of an applicant or recipient of public assistance.
Any employee of the Department of Public Welfare who has been assigned to work or has volunteered to join the fire fighting force of any institution of the Department of Public Welfare and who is injured while on fire fighting duties is entitled to compensation.
Under both the Heart and Lung Act and Act 534, the injured employee is paid his or her full salary. Under the Heart and Lung Act, these benefits are paid during periods of temporary incapacity. Under Act 534, the injured employee is entitled to receive these benefits until he or she is no longer prevented from returning as an employee of the Department or institution at a salary equal to that earned at the time of the injury. There also are benefits available for the widow or widower and minor dependents of any employee who dies within one year as a result of an injury covered under Act 534.
May I receive welfare benefits if my claim is denied?
If you are disabled and have children under the age of eighteen, very limited family income, and few liquid assets, you may be eligible for temporary assistance to needy families through the Department of Public Welfare.
Adults without children must rely on general assistance benefits, which are very low. These applications are to be made with the Department of Public Welfare or County Board of Assistance. Food stamps are available to supplement the money available for buying groceries and some household goods for low income families or individuals. You may be entitled to food stamps even if you are receiving compensation benefits. An application for these benefits may be made with the Department of Public Welfare.
You made be eligible for Medicaid and Medicare benefits to cover medical expenses. The Department of Public Welfare administers Medicaid and the Social Security Administration administers Medicare, which is available only to retired Workers' or persons receiving Social Security disability benefits for two years or more.
Should I collect my pension benefits?
If you are receiving Workers' compensation benefits, you should consult an attorney before you file an application for pension benefits.
The Workers' compensation insurance company is entitled to receive a credit for any pension benefits to the extent that those benefits were funded by your time of injury employer. If you defer collecting your pension, you may be able to collect larger benefits later on and may be able to settle your Workers' compensation case on favorable terms. Your pension plan may give you the right to recover disability pension benefits. You should check with your personnel office to determine what benefits are available.
Must my employer keep my position open if I suffer a work injury?
The Workers' Compensation Act is silent regarding this issue. Accordingly, there is nothing in the Workers' Compensation Act that would prevent your employer from firing you suffer a work injury. If your employment is terminated because you filed a Workers' compensation claim, you may have the right to pursue a wrongful discharge lawsuit. If you are a union member, your collective bargaining unit may contain provisions that strictly limit your employer's right to terminate you.
The Family and Medical Leave Act grants you the right to 12 weeks of unpaid leave time per year if you are suffering from a serious medical condition. This protection is available only if you have worked a sufficient number of hours in the year preceding the first day of leave.
The Americans with Disability Act prohibits employers from discriminating against qualified individuals with permanent disabilities. The Act imposes upon employers the obligation to make reasonable accommodations to know physical and mental impairments provided the person can perform the essential functions of the job. The Americans with Disability Act does not distinguish between work related and non-work-related impairments.
Companies that have federal government contracts over $2,500 and hire subcontractors are subject to Section 503 of the Federal Rehabilitation Act of 1973, which provides that such firms may not discriminate against disabled workers, must maintain affirmative action programs, and must make reasonable accommodations to retain and hire Workers' with a wide range of handicaps. If they do not comply with these provisions, the Federal Government may cancel their federal contracts.
The termination of a disabled employee may be an attempt to discharge an older worker in violation of state and federal statutes prohibiting age discrimination. If you are between the ages of 40 and 70, you should consider an age discrimination lawsuit. Please remember that prompt action must be taken on such claims, as complaints with the Equal Employment Opportunity Commission must be filed within 180 days of the alleged discriminatory act.
