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Worker’s Compensation FAQs

The Pennsylvania Workers' Compensation Act is humanitarian legislation that is designed to protect workers who are injured on the job.The law requires employers to pay medical expenses related to the injury and wage loss benefits if the worker is unable to work as a result of the injury. As a general rule, the Workers' Compensation Act provides the exclusive remedy against the employer for injuries sustained in the course of employment.

Attorney Greg Kunkel has been handling workers' compensation cases for 30 years and has helped hundreds of workers in their claims against their employer. If you were injured on the job claim or simply need advice about your benefits, contact attorney Kunkel at (724) 438-3020 or email him at [email protected].

1. What types of injuries does workers' compensation cover?

An injured worker is entitled to workers' compensation benefits if he or she suffers an injury which arises from and is related to his or her employment.The law defines the term injury very broadly and includes any injury to an employee, regardless of his previous physical condition, including injuries resulting from harmful chemicals or substances.

2. Do I have to prove that I was injured in an “accident” at work?

No.Although many injuries are caused by accidents at work, the law does not require you to prove that you were injured in a particular accident.The injury does not have to be pinpointed into a specific event or a particular incident so long as there is proof that the injury arose from and is related to your employment.For example, cumulative trauma injuries resulting from repetitive movements at work such as repetitive back movements or repetitive use of the hands may be shown to be work related.

3. Am I entitled to workers' compensation if I have a pre-existing condition?

Under the Workers' Compensation Act, an employee who suffers an aggravation of a preexisting condition is eligible to receive workers' compensation benefits.

4. What do I have to prove to receive workers' compensation benefits?

To obtain workers' compensation benefits, you must prove that you were employed at the time of the injury, that you were working or in the course and scope of your employment at the time of injury, and that your injury is related to your employment.You are not required to prove that injury was caused by someone's negligent conduct.

5. How much will I receive in workers' compensation benefits?

There are essentially two components of workers' compensation benefits:Wage loss and medical.The employee's wage loss benefits are based upon the employee's average weekly wage.In general an employee's benefit rate is two thirds of his average weekly wage up to a statewide maximum rate that changes on an annual basis.Wage loss benefits are not paid for the first 7 days that an employee is off work unless the employee misses a total of 14 days.Employers are also required to pay for reasonable and necessary medical expenses related to the work injury.The Workers' Compensation Act also provides payment for specific loss benefits if you sustain facial disfigurement or suffer the loss of a specified body part.

6. Do I have to treat with the employer's “panel” doctors?

If the employer has a posted list of six designated healthcare providers, the injured workers are required to treat with one of the designated providers for the first 90 days after the injury.Employees may not be forced to treat with a particular provider on the panel and are free to treat with other healthcare providers after the 90 days have expired.

7. What is a Utilization Review Request?

The utilization review procedure allows an employer to challenge the reasonableness and necessity of a particular course of treatment.The injured employee's treating physician or chiropractor must provide the reviewing doctor with copies of treatment records and usually will discuss the injured worker's treatment over the telephone.The employee has the right to appeal an adverse utilization review decision to a Workers' Compensation Judge.

8. Do I have to return to work if my doctor has not released me?

Employers frequently demand that injured workers return to work based upon an opinion from a physician who performed an IME (“Independent Medical Examination”), even though the employee's treating physician has not released him or her to return to work.The Workers' Compensation Act generally requires injured workers to follow through on job offers for positions that they are capable of performing.Once cleared to return to work by a physician or chiropractor, the employee runs the risk of losing his or her benefits if he does not return to work.If you disagree with the recommendation to return to work, you should consult a lawyer as soon as possible to discuss the specifics of your case.

9.What is an Impairment Rating Evaluation (“IRE”)?

Under recent amendments to the Workers' Compensation Act, your employer has the right to request that you undergo an impairment rating evaluation that must be performed by a qualified physician after you have received 2 years of total disability benefits.If you are determined to have a “whole body impairmen” of 35% or higher, then total disability is presumed to continue.If you are under the 35% threshold, however, you will be considered partially disabled and the employer may request a hearing for the purpose of determining your earning power.The impairment rating is based upon the degree of impairment as determined under the Sixth Edition of the American Medical Associations “Guides to the Evaluation of Permanent Impairment.”

10. How much time do I have to make a workers' compensation claim?

There are two limitation periods to keep in mind in workers' compensation.First you must provide the employer with notice that you were injured at work within 120 days of the date of the injury or the date that the employee knew, or should have known, of the existence of the injury and its relationship to his employment.Notice should be given to a supervisor or other member of management and should clearly state that the injury is work related.Second, a claim for workers' compensation benefits must be filed within 3 years of the date of injury.

11. When should I file a claim for workers' compensation benefits?

Technically, an employer is required to accept or deny a claim for workers' compensation benefits within 21‑days that notice was given.If your claim is denied or you do not get a response from your employer or its insurance carrier within 21 days after you report the injury, you should seek legal advice about pursuing your claim.

12. How long does it take to get benefits?

The amount of time that it takes to obtain benefits can vary greatly from one person to another.If your employer denies your claim for benefits it can take several months to litigate a disputed claim before a workers' compensation judge.

13. What is a termination or suspension petition?

An employer may seek to terminate or stop your workers' compensation benefits if it obtains a medical opinion that you have fully recovered from your work injury.Similarly, an employer may seek to suspend or reduce your benefits if it has evidence that work is available to you within your physical restrictions.We recommend that you seek legal advice as soon as you receive a termination or a suspension petition from your employer or its insurance carrier.

14. What are the fees for representation?

An initial consultation with our firm is free.If we accept your case, our firm charges a contingent fee for representation in workers' compensation cases which means there is no fee unless we obtain a recovery or successfully defend against any attempt to stop or reduce your benefits.We will fully explain all fees and costs to you before proceeding with your case and together, as a team, we will decide on the best course of action in your case.

If you have any additional questions about workers' compensation, please contact attorney Greg Kunkel at (724) 438-3020 or e-mail him at [email protected].

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