What do I do if I think I am injured?
The first step is to get medical attention as soon as possible and contact your supervisor. For emergencies during off hours, contact crew scheduling. They will put you in touch with a supervisor on duty.
From this point forward, take extensive notes and retain copies of all forms and correspondence. If possible, take photographs and seek medical attention within 24 hours of the incident. Even if you do not think you need a doctor, file an incident report (US Airways: SS194) to document the event and get the names and phone numbers of any witnesses. Protect yourself!
Do I have to be treated by a company physician?
Under the Workers’ Compensation Act, "[i]f your employer has posted a list of six or more physicians or health care providers in your workplace, then you are required to visit one of them 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." If you do not seek treatment with a company physician, the workers’ compensation insurance company will not pay the medical bills that you incurred during those 90 days.
You are perfectly free to be treated by any medical provider at any time, but you may be responsible to pay the provider’s bills during this 90-day period if the provider is not on the company's list. To obtain a copy of "Physicians’ List Defined," contact our office. Please note:
- You have a right to choose from among the physicians or medical providers on the list.
- The company does not have the right to require you to be treated by a particular physician or medical facility.
- You have the right to switch to other providers on the list at any time during the 90 days.
- You have no obligation to inform the company that you are switching to another provider on the list, though you may wish to inform the claims representative.
Our law firm has been monitoring treatment received by US Airways employees from physicians on the US Airways physicians list. If you wish, you can call us directly to obtain information concerning the past experience of flight attendants dealing with some of the physicians on this list. This service will be provided to you at no charge.
Must I submit to medical examinations by US Airways physicians?
The Workers’ Compensation Act gives an employer the right to demand so-called “independent medical examinations” up to once every six months. This right is separate from the right of the company to require you to be treated by listed physicians for the first 90 days. You have the right to object to an examination that requires excessive travel, but there is at least one case in which a Pennsylvania court required an out-of-state employee to submit to an examination in Pennsylvania, where the employer agreed to pay all transportation and lodging costs.
There may be practical reasons to agree to an examination in Pennsylvania. Pennsylvania judges are familiar with the reputations of local physicians. Pennsylvania judge will not know the reputation of an out-of-state physician who may have a poor reputation for credibility in his or her home state.
For US Airways flight attendants: Section 23(E)(1) of your contract requires the company to make “every effort” to conduct such an examination in the area in which the employee resides. US Airways denies that this provision requires the company to schedule workers’ compensation medical examinations in the area of the flight attendant’s residence. Our Philadelphia attorneys take the position that the provision applies to “any medical examination required by the Company.” Sec. 23(E)(2) of your contract requires US Airways to provide space positive travel when "it is not feasible" to provide an examination near the flight attendant's home.
Do I have the right to an impartial examination?
For US Airways flight attendants: Section 22(H)(2) of your contract gives you the right to make a written request for an examination by a disinterested physician. This physician is chosen by agreement of your doctor and the company doctor.
There are practical reasons why you may not want to choose to exercise this option. If your physician is from out-of-state, he or she is not likely to know the reputations of Pennsylvania physicians, giving a possibly decisive advantage to the company doctor. Furthermore, the decision of this physician binds the parties conclusively, rendering the use of this provision risky.
When am I entitled to receive benefits?
Under the Workers' Compensation Act, you are entitled to receive reimbursement for all reasonable and necessary medical expenses that are causally related to your work injury, regardless of whether you have lost time from work. These expenses are payable pursuant to a schedule set forth in the Workers' Compensation Act.
A medical provider providing treatment for a work injury covered under Pennsylvania law may only bill the workers' compensation insurance company for these services and is not legally entitled to bill you for treatment for your work injury. When treating with a medical provider outside of Pennsylvania, discuss billing prior to beginning treatment. Although the Pennsylvania Bureau of Workers’ Compensation takes the position that Pennsylvania law binds medical providers outside the state, such providers may refuse to honor the law and might bill you for the difference between their normal charge and the amount paid by the workers’ compensation insurance company. Under Pennsylvania law, you are entitled to receive wage loss benefits only if you are disabled for seven days or more, including weekends. It is not necessary that these days be consecutive.
How much will I receive in wage loss benefits?
All Pennsylvania-based flight crews who are injured in work accidents are entitled to workers' compensation wage benefits pursuant to the Pennsylvania Workers’ Compensation Act. This portion is generally two thirds of your salary and is tax free. Your workers’ compensation wage loss benefits are calculated by adding up the wages from all sources of employment. Accordingly, if you work for more than one employer, you should gather your wage stubs for a full year preceding the date of injury.
For US Airways flight attendants: Section 22(H)(1) of your Collective Bargaining Agreement provides that you are entitled to receive your regular salary until either your doctor or the company doctor releases you for duty, or you are deemed to be totally disabled. If you are deemed totally disabled, you are entitled to receive your regular salary for a total period of up to six months as a result of that particular injury. The period may be extended to 36 months for certain injuries resulting from an aircraft accident. A flight attendant remaining disabled after exhausting the 15/36 month salary continuance may commence long-term disability coverage according to the contract.
The income from the workers’ compensation and "salary continuation" portions should add up to your average monthly salary over the past six months as an active flight attendant. To determine the amount of benefit you are entitled to receive, you should consult Section 22(H) of your Collective Bargaining Agreement and contact our office.
Under the Pennsylvania Workers' Compensation Act, you are entitled to continue to receive workers' compensation benefits even after your right to salary continuation expires. Although your workers' compensation benefits are tax-free, the "salary continuance" portion is taxable. You may have to file a grievance under Section 24 of your contract if the company pays workers’ compensation benefits but refuses to pay salary continuation. A workers’ compensation judge does not have the power to order US Airways to comply with the contract.
How can I avoid payment delays or denials?
Although it is the insurer’s responsibility to investigate and process your claim within 21 days of the date that you provide notice to your employer of your work injury, the 21-day deadline is frequently missed. If you want to ensure speedy claims handling, you should obtain copies of your medical records from your physician and send them directly to your adjuster. You should send these records to the adjuster even if you are being treated by a US Airways physician. Contact our office immediately concerning your rights and responsibilities if the 21-day deadline is missed.
To ensure that medical bills are paid, your doctor should submit bills in an organized and timely fashion. The bills must be made either on the HCFA 1500 form or the UB42 form (HCFA 1450), which your doctor or medical provider should already have. The bills should contain complete and adequate information, including correct names, dates and treatments, services provided, and cost of treatment. Finally, a “Medical Report Form,” a copy of which is attached as Exhibit “D,” should accompany the bills.
If your claim has been accepted, the insurance company is obligated to pay bills within 30 days of receipt. If the bills are not paid within 30 days, your doctor or other medical provider should file a petition with the Bureau of Workers' Compensation for payment.
If the insurer denies your claim or refuses to pay some or all of your medical bills, you may be able to use your health insurance coverage. Your physician may obtain free assistance regarding payment for the treatment rendered to you by calling (215) 259-5879 and asking to speak with an attorney at our office.
How will my claim be processed?
Once you have provided the company with notice of your injury, the company has 21 days from the date of injury to investigate and make a decision to accept or deny the claim and to make the first payment of compensation due. Your employer or the insurance carrier may make payments of temporary compensation for up to 90 days, even if your claim is not accepted
Upon receiving notice of your claim, the workers’ compensation insurance company will assign an insurance adjuster to investigate your claim, decide whether to accept it, monitor your medical treatment, and perform other tasks. A medical expense claim may be assigned to another department.
When you receive your notice of claim acceptance from the insurance company, make certain the disability is EXACTLY as listed on the incident report (US Airways: SS194) that you filed with your supervisor.
Please note that when your claim is assigned to an adjuster, the claim will be given a claim number. If you call or write the adjuster handling your claim, you must be prepared to give your claim number. Any correspondence sent to the insurance company should have the claim number clearly written on the top of the correspondence.
What should I do if my claim is denied?
You have the right to appeal a claim denial to a workers' compensation judge. You should gather your medical records so that a claim petition can be filed with the Bureau of Workers' Compensation. It is crucial to have an attorney represent you at this stage of the proceedings because it will be necessary to provide testimony—both your own testimony and the testimony of medical experts who support your benefits.
Through an arrangement with AFA in Philadelphia, the attorneys at The Boles Firm have agreed to charge a reduced fee and accept all legitimate claims, no matter how small. Furthermore, the attorneys at The Boles Firm will provide you with a half-hour free consultation concerning your claim.
For US Airways flight attendants: under your contract, you are entitled to use time in your sick bank while your claim is pending. If you are capable of light duty work and the company offers none, you may be entitled to unemployment compensation benefits.
Under Section 22(F)(2) of your contract, you may collect long–term disability benefits. Any flight attendant suffering from a disabling condition should carefully review Section 22 of the contract and immediately contact the AFA benefits representative. If the judge reverses the denial, Section 22(H)(3) of your contract provides that appropriate adjustments will be made for any sick time used and "salary continuance along with related benefits will be paid retroactively to the date of the incident for all lost time."
May I work during my period of work-related disability?
As a general rule, you may work during the period of disability; however, any benefits you receive will be reduced by your earnings.
For US Airways flight attendants: your Collective Bargaining Agreement provides that you are not required to work light-duty in order to qualify for salary continuance pursuant to Section 22(H). Under some circumstances, you may wish to seek outside employment during the period of work-related disability because you are capable of performing restricted duties.
Before you accept alternate employment, however, you should obtain written permission from US Airways. Section 20(J)(3) provides that a flight attendant who "without prior permission of the company engages in other employment while on a leave of absence, shall be deemed to have resigned and his or her name shall be removed from the System Seniority List." In the past, US Airways has denied permission to employees to accept outside employment while their workers' compensation claims were pending.
Am I permitted to file a lawsuit in connection with my work injury?
The Workers' Compensation Act provides that the employer and any fellow employee of the injured worker are absolutely protected from suit by the injured employee with one exception. In the event that the injury is at the hand of a fellow employee who has caused an intentional injury to a worker, then the fellow employee (but not the employer) might no longer be immune from suit. Otherwise, as long as the injury arises from the work relationship, workers' compensation benefits are the only recourse of an injured employee against his employer or fellow employee. In a great number of situations, however, the victim has been injured not by a fellow employee or his or her employer, but by a "third party." In this circumstance, the victim is entitled both to compensation benefits and to bring a suit for "pain and suffering" against the negligent third party.
Perhaps the most frequent occasion where the Workers' Compensation Act does not prevent a negligence action arising is when an employee is injured in a car accident during work. Assuming the other driver was negligent, a lawsuit may be brought as long as the other driver was not in the hire of the same employer. An employee whose work takes him or her off the premise of the employer onto the premise of others is exposed to the possibility of defective conditions of those premises, and these defects that might serve as a basis for negligence claims.
These are just a few examples of situations where the Workers' Compensation Act does not prevent an act for pain and suffering. You should not simply assume that suit is prohibited. If you would like to discuss the possibility of a third party claim arising from your work injury, please feel free to call the law office of Fenner and Boles (215) 259-5879 for a free consultation.
Should I give a taped statement?
Although you may have to explain your version of the events underlying your claim to an investigator or claims adjuster, there is nothing in the Act that requires you to give a taped statement. You would be perfectly within your rights to refuse to allow your statement to be taped.
If you choose to give a taped statement, be very careful about what you say. You should not give such a statement without first taking some time to think about what occurred. You must be truthful and accurate, and you must be careful not to let anger or frustration affect the statements you make. On the other hand, no matter how friendly the claims examiner may be, you must assume that your statements will be used against you. The adjuster may have medical records or other documents in front of her while questioning you and may attempt to get you to make statements that are contradicted by the documents.
In sum, you must recognize that your livelihood may depend on the words you use during a taped statement, and you must act accordingly. If you have any doubt about the wisdom of giving any statement to a claims investigator, call the lawyers of The Boles Firm, for free assistance.
Is other information available about my rights under Pennsylvania law?
You may obtain a free copy of “The Consumers’ Guide to Pennsylvania Workers’ Compensation” by calling the law offices of The Boles Firm toll-free at (215) 259-5879. You may also obtain a free copy of "Worker's Compensation and the Injured Worker" from:
Bureau of Worker's Compensation, 1171 South Cameron St., Room 324, Harrisburg, PA 17104-2501
phone: (717) 783-5421
the US Airways’ Philadelphia union office: (215) 259-5879