Workers’ compensation provides valuable support for employees who get injured or become ill on the job, but that support is limited. Wage benefits don’t cover all lost pay. And workers’ comp won’t pay for every medical expense just because it provides relief.
Expenses must be “reasonable and necessary” and related to the work injury in order to be covered by workers’ compensation insurance. This means that insurers that provide workers’ compensation coverage will contest a medical expense whenever they believe they can prevail in having it denied. Claimants frequently have to fight for their right to reasonable medical needs in court.
However, it is still often unclear when an expense is considered reasonable and necessary under Pennsylvania’s Workers’ Compensation scheme. Questions frequently arise concerning treatments that go beyond traditional methods and that are considered “alternative medicine.” While we cannot explore every type of treatment in this article, here are some examples of how Pennsylvania law has been clarified on this issue.
Any treatments or practices that are not considered part of the “standard” medical care traditionally prescribed by physicians can be considered alternative medicine. This could include using manipulative and massage practices instead of surgery, or herbs instead of standard chemically-produced medications. Many physicians now recommend treatments that are still considered “alternative” by traditional standards, particularly when these options are used to complement standard medical treatments. The use of standard and alternative therapies in combination is often referred to as integrative or complementary medicine.
CBD oil is a product with the active ingredient cannabidiol extracted from the hemp plant, which is closely related to marijuana. Although CBD is a prevalent active ingredient in marijuana, the component itself does not cause the “high” or impairment of marijuana because it lacks THC.
Cannabidiol has been praised as a treatment for conditions such as:
Although the U.S. Food and Drug Administration has approved a medicine containing CBD as a treatment for certain seizure disorders, the substance is not approved for treating other conditions at this time. Nevertheless, it is frequently recommended by doctors for pain relief applied topically and internally.
The Pennsylvania Supreme Court recently ruled that an employer was required to reimburse an employee for the purchase of CBD oil prescribed by his doctor to supplement medications for severe back pain. Although the Pennsylvania Workers’ Compensation Act requires employers to pay for “medicines and supplies,” the employer had argued that CBD oil could not be considered a supply under the Act because the FDA had not concluded that the substance was either safe or effective for treating pain.
Although an administrative judge initially ruled in favor of the employee, the decision was overturned on appeal in favor of the employer’s interpretation. Ultimately, however, the Supreme Court sided with the employee. Pennsylvania’s highest court concluded that the obligation to pay for “medicines and supplies” under the Workers’ Compensation Act includes “any item that is part of a health care provider’s treatment plan for a work-related injury” regardless of whether the item is precisely defined as a medicine or supply. The question, according to the Court, is not whether an item is a medicine or supply but rather whether it is part of the treatment plan prescribed for the injury. In addition, the Court observed that nothing in the Workers’ Compensation Act requires covered medicines and supplies to be approved by the FDA.
While this ruling by the Court addressed a particular worker’s situation, the ruling could have broad implications for the coverage of alternative medicine in workers’ compensation cases.
Chiropractic care, which uses manual therapy to improve the function of the spine and other parts of the musculoskeletal system, is not considered a conventional medical treatment and therefore it is usually treated as alternative medicine. However, the Pennsylvania Workers’ Compensation Act specifically includes chiropractors among the list of health care providers whose services should be covered by an employer when an employee is receiving treatment for a work injury.
Employees are required to see health care providers who are approved by the employer, but the Pennsylvania Supreme Court has held that if an employer’s list of approved providers does not include a chiropractor, the employer can be required to pay for treatment provided by an outside professional if the treatment was reasonable and necessary.
Determining whether a treatment is reasonable and necessary is not a clear-cut issue. Courts have held acupuncture to be a covered treatment even when evidence indicated that the pain relief provided lasted only a couple of days. The treatments provided pain management that enabled the employee to refrain from using opioid drugs, and that may have played a large role in the decision.
Many acupuncture clinics advertise that their services are covered by workers’ compensation if they are considered medically necessary—but they also admit that they are in no position to determine medical necessity.
Courts have also held that while employers do not have to cover purchases of medical marijuana directly, they must reimburse employees for purchasing the substance when it is prescribed as reasonable and necessary.
Licensing can sometimes play a role in determining whether a service will be covered. Workers have been denied coverage of treatment by a massage therapist, even though the services were prescribed by a doctor. The denial was based on the therapist’s lack of licensure or supervision. Similarly, a Pennsylvania court denied an employee’s request for reimbursement for Ayurvedic treatment because the services were not provided under the supervision of, or by referral from, a physician licensed in Pennsylvania.
When you need medical treatment and wage benefits because of a workplace injury, the insurance companies that handle workers’ compensation claims just don’t seem to care. They try to deny everything to keep their profit levels as high as possible.
At Vanasse Law, we fight for the rights of injured employees, and we know how to achieve the optimum results in a workers’ compensation claim. To learn how we may be able to assist with your workers’ compensation claim, call us at 717-397-1010 or contact us online now.
If you are receiving benefits through the Pennsylvania workers’ compensation system, you might be told that you are expected to go through an IRE or Impairment Rating Evaluation. While this is no immediate cause to panic, it should cause you to take note, because it indicates that the insurance company is looking for a way to reduce the amount they are currently paying because of your inability to work. It is important to understand how to safeguard your rights during and after the IRE process.
Pennsylvania law provides certain protections to workers injured on the job, but they can easily forfeit their rights without realizing it, leaving them with no opportunity to recover what they have lost. A Lancaster job injury lawyer can answer specific questions about what to do in your particular situation, but here are some general facts about IREs to keep in mind as you approach the process.
An Impairment Rating Evaluation is a medical exam, like an IME (Independent Medical Examination), but performed for a different purpose. Insurance companies ask injured workers to undergo an IRE to assess the worker’s condition and determine whether they have reached the maximum level of medical improvement that can be expected. Pennsylvania maintains a listing of approved physicians authorized to perform the exam. Generally, the worker does not have a say in choosing the doctor.
The physician conducting an IRE will be determining whether your medical condition is likely to improve any further or whether your recovery has essentially stalled. If the doctor decides that you have recovered as much as you’re going to, they will rate your condition. This rating will produce a “whole body impairment” percentage number based on guidelines established by the American Medical Association. The percentage rating describes your legal level of impairment stemming from the work injury. An impairment is defined as a “significant loss” in the use of a body part or function.
If the doctor determines that you are still recovering and have not yet reached your maximum medical improvement, then the doctor will write up that finding and will not assign an impairment rating. However, the employer has the right to request additional IREs in the future. If a worker refuses to attend an IRE, they can lose the right to receive workers’ compensation benefits.
Insurance companies request IREs to justify reducing or terminating benefits, so it is always important to approach these exams with caution. An insurer may request an IRE after a worker has received total disability benefits for 2 years (104 weeks). If the doctor reports that a worker has an impairment rating of 35%, then total disability benefits will continue. However, if the impairment rating is less than 35%, the status of benefits changes from total disability to partial disability. There is even the potential for the insurer to discontinue benefits completely.
When a change from total to partial disability occurs, the amount of weekly benefits remains the same, but the duration of benefits will be limited. Workers with total disability status can continue to collect benefits indefinitely, but those with partial disability status are limited to 500 weeks of benefits. This limitation affects future payments and reduces the amount a worker may be offered in a lump-sum settlement.
The insurance company requests IREs for its own potential benefit, and it generally chooses the physician who will conduct the exam. That means the doctor is working for the insurance company and is aware that they owe allegiance to the insurer to continue receiving business from the company. That allegiance often causes doctors conducting IREs to look for factors that justify reporting in favor of the insurance company.
If an IRE results in a change from total disability to partial disability status, you have the right to challenge the finding, although it can be difficult to do this successfully without an experienced attorney. A knowledgeable Lancaster job injury lawyer may be able to help you reverse the determination based on factors such as:
For instance, your attorney may obtain testimony from a medical expert showing that your impairment rating is inappropriately low because the doctor conducting the exam failed to consider all the disabling conditions that were caused by the work injury. Or you might introduce a doctor’s recommendation for surgery to improve the condition, showing that you have not yet reached your full level of recovery.
A skilled workers’ comp attorney will know how to obtain the most persuasive evidence to appeal an unfavorable ruling and how to present that ruling to the greatest legal effect. In addition, a dedicated attorney can help you prepare for the exam so that you do not say or do something unintentionally that could work against your interests.
You’re not going to get rich from the percentage of salary you receive through workers’ compensation, but that income is essential when you are unable to work due to an injury on the job. If an insurance company tries to take advantage of the IRE process to unfairly decrease or discontinue your benefits, it makes sense to do what you can to protect your rights and your future support.
At Vanasse Law, we focus our practice solely on workers’ compensation issues, so we’ve seen the underhanded tactics insurance companies use to avoid paying fair benefits to injured workers. We also know the right strategies to overcome those tactics. If you are facing an IRE or any other issue related to applying for benefits, returning to work after an injury, or denial of a claim, contact us for a free consultation to learn more about the ways we may be able to assist. You can reach us online, call during business hours at 717-397-1010, or call or text after hours at 717-471-2168. We’re here for you.
Many workers’ compensation cases in Pennsylvania involve accidents in situations you might expect. A warehouse worker suffered injuries in a forklift accident, for instance, or a nursing assistant injured her back while moving heavy patients.
But a Lancaster job injury lawyer with decades of experience helping injured workers recover full benefits through the Pennsylvania workers’ comp system knows that there are many occasions where workers suffer unexpected injuries due to highly unusual causes, and these should be covered too, as long as they occur in the scope of employment.
Here are some examples of cases we’ve encountered over the years that illustrate what may be covered and what may be outside the workers’ compensation scheme in Pennsylvania.
In one of the weirdest workers’ comp cases we’ve ever run across, the Commonwealth Court of Pennsylvania ruled that a woman whose son slit her throat and stabbed her while she was sleeping was entitled to workers’ compensation benefits for her injuries. The son was living in her home, and she provided attendant care to him while he recovered from leg amputation surgery.
The caregiving arrangement had been suggested by the rehabilitation center where the son had been in residence after the surgery. Caregiving services were paid for by the Pennsylvania Department of Welfare, with the son acting as her employer. The services did not include 24-hour care, but the employer/son could ask for services at night if the caregiver was already awake. The care position paid for 64 hours of care each week.
Although the mother routinely provided care in the evenings on weekends and had assisted her son at 11:30 p.m. on the night in question, it was 1:30 a.m. at the time she sustained her injuries in the attack, and she had been sleeping. The Workers’ Compensation Appeal Board ruled that the mother was not engaged in the furtherance of the employer’s affairs at the time of the attack, so she did not qualify for benefits.
However, the court disagreed. Observing that the only “feasible way” for the employee to fulfill her obligations to the employer was for him to reside in her home, and that the agencies paying for care approved the arrangement, the court concluded that the claimant was “practically required” to live with her son by the nature of her employment and that her injuries were caused by the operation of the employer’s affairs.
Our next weird case involves a worker who got bored while waiting for asphalt to be delivered to a job site. He and his co-workers found a bowling ball lying nearby and amused themselves by throwing it around for a while. Then, they changed the game to a contest to see who could smash it with a sledgehammer.
The foreman told them to “knock it off.” But instead of listening, one of the workers hit the ball again, causing a piece to splinter off and strike him in the eye. The injury led to the loss of his eye.
He also lost his workers’ comp case. The Workers’ Compensation Appeal Board ruled that the foreman’s verbal instruction was sufficient to constitute a “positive work order” and that the worker’s injury occurred while he was violating the order. The Commonwealth Court of Pennsylvania agreed.
In most cases, employees in Pennsylvania are not able to receive workers’ compensation benefits for injuries they suffer while commuting to or from work. But sometimes, those injuries are covered, and here’s an example. The worker in this case was employed in demolition work and had finished working for the day. A co-worker was driving him home in a company truck filled with scrap, which they intended to drop off before continuing to the worker’s home. On the way, they were involved in an accident that resulted in injuries.
Although the Workers’ Compensation Appeal Board held that the worker was not injured in the course and scope of employment, the Court disagreed. Noting that the worker was traveling in the employer’s vehicle to transport material removed from the job site, the court found that the worker was traveling in furtherance of the employer’s business and therefore the injuries should be covered by workers’ compensation.
This bizarre case shows the importance of witnesses in a workers’ comp case. A worker claimed he was assaulted by a co-worker while he was in the process of signing out for the day. He asserted that a co-worker picked him up and shook him violently from side to side, causing serious injuries. However, witnesses testified that the co-worker had simply given him a big hug as a thank you for a t-shirt. Moreover, the worker waited two months to report the incident and didn’t see a doctor until a year afterward. The Court upheld the judge’s determination that the claimant was not credible in claiming he suffered injuries from an assault.
In many cases, when a worker is hurt by an incident, such as a heart attack or stroke, or a worker suffers psychological illness, the employee is not considered eligible for workers’ compensation benefits because the event is not proven to be work-related. A worker who had a heart attack while holding a termination letter from his employer was not entitled to benefits, for instance. Nor was an employee who suffered post-traumatic stress disorder after being the victim of an armed robbery. (This was held to be a normal working condition.)
However, on occasion, a judge will agree that a physical or mental condition was caused by the stress of job conditions and award compensation. For instance, a foundry worker who suffered a stroke after more than 20 years of sporadic employment as an auto pour operator near two furnaces, carrying heavy loads while encumbered by a fire suit and welding clothes was awarded disability benefits. The judge found that the heat and the physical requirements of the job caused the stroke, even though some co-workers testified that job conditions were not as bad as the worker claimed.
While there are many different lessons to be learned from these cases, the one common factor is unpredictability. It can be hard to determine how an administrative judge or court will react to evidence, so it is important to pay attention to every detail and not assume that an issue will be ruled for or against you. Your attorney needs to present evidence and solid arguments to support every single facet of your case.
It is also important to follow your employer’s directions, report injuries promptly, and preserve evidence that can show what the workplace conditions were at the time of the injury. If you have questions or need assistance filing a claim or appealing the denial of workers’ compensation benefits, contact a Lancaster job injury lawyer at Vanasse Law to learn how we may be able to help. To reach us by phone, call 717-397-1010 or, after hours, call 717-471-2168.
Many workers’ compensation cases in Pennsylvania involve accidents in situations you might expect. A warehouse worker suffered injuries in a forklift accident, for instance, or a nursing assistant injured her back while moving heavy patients.
But a Lancaster job injury lawyer with decades of experience helping injured workers recover full benefits through the Pennsylvania workers’ comp system knows that there are many occasions where workers suffer unexpected injuries due to highly unusual causes, and these should be covered too, as long as they occur in the scope of employment.
Here are some examples of cases we’ve run across over the years that help illustrate the concept of what may be covered and what may be outside the workers’ compensation scheme in Pennsylvania.
In one of the weirdest workers’ comp cases we’ve ever run across, the Commonwealth Court of Pennsylvania ruled that a woman whose son slit her throat and stabbed her while she was sleeping was entitled to workers’ compensation benefits for her injuries. The son was living in her home, and she provided attendant care to him while he recovered from leg amputation surgery.
The caregiving arrangement had been suggested by the rehabilitation center where the son had been in residence after the surgery. Caregiving services were paid for by the Pennsylvania Department of Welfare, with the son acting as her employer. The services did not include 24-hour care, but the employer/son could ask for services at night if the caregiver was already awake. The care position paid for 64 hours of care each week.
Although the mother routinely provided care in the evenings on weekends and had assisted her son at 11:30 p.m. on the night in question, it was 1:30 a.m. at the time she sustained her injuries in the attack, and she had been sleeping. The Workers’ Compensation Appeal Board ruled that the mother was not engaged in the furtherance of the employer’s affairs at the time of the attack, so she did not qualify for benefits.
However, the court disagreed. Observing that the only “feasible way” for the employee to fulfill her obligations to the employer was for him to reside in her home, and that the agencies paying for care approved the arrangement, the court concluded that the claimant was “practically required” to live with her son by the nature of her employment and that her injuries were caused by the operation of the employer’s affairs.
Our next weird case involves a worker who got bored while waiting for asphalt to be delivered to a job site. He and his co-workers found a bowling ball lying nearby, and they amused themselves by throwing it around for a while before they changed the game to a contest to see who could smash it with a sledgehammer.
The foreman told them to “knock it off.” But instead of listening, one of the workers hit the ball again, causing a piece to splinter off and strike him in the eye. The injury led to the loss of his eye.
He also lost his workers’ comp case. The Workers’ Compensation Appeal Board ruled that the foreman’s verbal instruction was sufficient to constitute a “positive work order” and that the worker’s injury occurred while he was violating the order. The Commonwealth Court of Pennsylvania agreed.
In most cases, employees in Pennsylvania are not able to receive workers’ compensation benefits for injuries they suffer while commuting to or from work. But sometimes, those injuries are covered, and here’s an example. The worker in this case was employed in demolition work and had finished working for the day. A co-worker was driving him home in a company truck filled with scrap that they were intending to drop off before continuing on to the worker’s home. On the way, they were involved in an accident that resulted in injuries.
Although the Workers’ Compensation Appeal Board held that the worker was not injured in the course and scope of employment, the Court disagreed. Noting that the worker was traveling in the employer’s vehicle to transport material removed from the job site, the court found that the worker was traveling in furtherance of the employer’s business and therefore the injuries should be covered by workers’ compensation.
This bizarre case shows the importance of witnesses in a workers’ comp case. A worker claimed he was assaulted by a co-worker while he was in the process of signing out for the day. He asserted that a co-worker picked him up and shook him violently from side to side, causing serious injuries. However, witnesses testified that the co-worker had simply given him a big hug as a thank you for a t-shirt. Moreover, the worker waited two months to report the incident and didn’t see a doctor until a year afterward. The Court upheld the judge’s determination that the claimant was not credible in claiming he suffered injuries from an assault.
In many cases, where a worker is hurt by an incident such as a heart attack or stroke, or a worker suffers psychological illness, the employee is not considered eligible for workers’ compensation benefits because the event is not proven to be work-related. A worker who had a heart attack while holding a termination letter from his employer was not entitled to benefits, for instance. Nor was an employee who suffered post-traumatic stress disorder after being the victim of an armed robbery. (This was held to be a normal working condition.)
However, on occasion, a judge will agree that a physical or mental condition was caused by the stress of job conditions and award compensation. For instance, a foundry worker who suffered a stroke after more than 20 years of sporadic employment as an auto pour operator near two furnaces, carrying heavy loads while encumbered by a fire suit and welding clothes, was awarded disability benefits. The judge found that the heat and the physical requirements of the job caused the stroke, even though some co-workers testified that job conditions were not as bad as the worker claimed.
While there are many different lessons to be learned from these cases, the one common factor is unpredictability. It can be hard to determine how an administrative judge or court will react to evidence, so it is important to pay attention to every detail and not assume that an issue will be ruled for or against you. Your attorney needs to present evidence and solid arguments to support every single facet of your case.
It is also important to follow your employer’s directions, report injuries promptly, and preserve evidence that can demonstrate the workplace conditions at the time of the injury. If you have questions or need assistance filing a claim or appealing the denial of workers’ compensation benefits, contact a Lancaster job injury lawyer at Vanasse Law to learn how we may be able to help. To reach us by phone, call 717-397-1010 or, after hours, call 717-471-2168.
We all know that working with heavy machinery or performing tasks at great heights can be extremely dangerous. Industries like construction and manufacturing are particularly hazardous for workers for these reasons.
But workers in Pennsylvania suffer injuries and illnesses all the time that are caused by workplace conditions they may have never even considered to pose a risk. You don’t have to have a “dangerous” job to be in danger from workplace hazards.
Unfortunately, Insurance companies can make it difficult for injured workers to recover workers’ compensation benefits when they suffer on-the-job injuries from an unexpected source. At Vanasse Law, we know how to effectively fight for injured workers to secure the benefits they deserve, even when the insurance company claims the workplace is safe or the injury is unlikely.
Here are just a few examples of workplace hazards that are more dangerous than you might expect.
The stories about what workers have tripped over or slipped on during the workday might almost be funny if those stories didn’t have such painful endings. Someone in a poultry processing plant slipped on a turkey lung that fell on the floor and suffered permanent back damage. Another employee tripped over a co-worker’s dog during bring-your-pet-to-work day.
People trip on loose carpeting, slip on doormats, and lose their balance after stepping on substances their co-workers drop by accident, including food items that have fallen in the break room. Falls on stairs are pretty common, particularly when steps are slick, treads are loose, or railings aren’t adequately secured. But even when a stairway is safe and well-lit, falls can still occur. Stairs are simply hazardous by their very nature.
When a worker falls under any situation, the injuries can have surprisingly long-term consequences.
The way that ordinary supplies are stored can pose a hazard in all types of environments. For instance, cartons of paper might be stacked so high in an office storage room that they become unstable and are likely to fall. Files and extra supplies are often stored in cabinets located high up, and workers must stand on a ladder or step stool to pull down heavy items over their heads. Even worse, many times workers are not given a safe way to access upper cabinets, so they stand on chairs, which are easy to tip over.
Storage of dangerous chemicals is also not given proper consideration in many workplaces. Workers can come into contact with harsh chemicals by accident.
An act as simple as sitting down in a chair can become hazardous if the chair collapses and slams to the floor. Defects in office furniture can often lead to workplace injuries.
In a workers’ compensation claim, it is not necessary to prove that an employer was negligent; only that the employee was hurt in the course of employment is required. If an employee is engaging in an activity that is clearly unwise and unrelated to their job, such as stacking six chairs on top of one another to create a video to share on their personal online social media, then a workers’ compensation insurer might be justified in denying or reducing benefits.
However, in most cases where office furniture malfunctions cause injuries, the worker is behaving normally and is caught by surprise. A table leg might collapse, spilling hot coffee onto the legs of an employee on break. Or the padded cover on a chair might come off, exposing sharp metal underneath that cuts deep into the employee’s arm. We all take furniture for granted, but it can be unexpectedly dangerous at times, especially when subjected to daily use in the workplace.
Sudden loud noises attract our attention, and when these noises occur close to an employee’s ear, it can lead to permanent damage, including hearing loss, headaches, and sensitivity. However, hearing damage is more common when employees are constantly exposed to loud noises that they get “used to.” The noise might be fans that run constantly or even loud music. Exposure to high-decibel noise for an extended period can cause permanent hearing loss.
We use electric devices in virtually any job you can think of. Those devices can short out or workers can come in contact with exposed wires, even while doing something as simple as plugging in an adding machine.
Overloaded power strips and worn wiring can also lead to fires in the workplace, exposing workers to the risks of smoke inhalation and burns.
As noted above, the examples we’ve addressed are only a few of the potential hazards we work around on a daily basis. Other examples include:
Additionally, you expose yourself to various dangers if you need to drive your personal vehicle for work purposes, especially when loading heavy work equipment into the vehicle. If you have to stop suddenly, even something as light as a laptop computer can fly forward with deadly force.
Workers can suffer devastating injuries even while completing ordinary everyday tasks that appear to pose no risk to their health. The workers’ compensation scheme in Pennsylvania is designed to provide workers with the medical care and income benefits they need to recover and move forward with their lives after on-the-job injuries. However, workers’ compensation insurance companies frequently deny claims, particularly when the connection between the injury and the workplace is not immediately apparent.
At Vanasse Law, we recognize that this is unfair, and we fight to ensure that injured workers receive the benefits they need and the justice they deserve. If you’ve been injured at work and need to know what to do to apply for workers’ compensation or how to respond if your claim is ignored or denied, contact us for a free consultation to learn how we may be able to assist. You can call us at 717-397-1010, text us after hours at 717-471-2168, or reach us through our website.
Side jobs can bring in much-needed additional income and help provide the foundation for a career change, making them quite important to workers in all types of fields in Pennsylvania. But a side hustle can cause problems if you need workers’ compensation benefits due to an injury in your primary job. It is essential to understand the rules and how to remain within limits that will enable your benefits to continue under the requirements of Pennsylvania law.
If you are in the process of filing a claim and want help ensuring that you comply with requirements, or you had your benefits denied or discontinued and believe the insurance company is acting improperly, it is a good idea to consult an experienced workers’ comp attorney for advice and assistance.
Workers in Pennsylvania have the right to work while receiving workers’ compensation benefits, but this right comes with strict limitations. If you are receiving income benefits to make up for wages that you are not able to earn due to an inability to do your job, then there’s an assumption that your abilities are currently limited. If you continue to work at a side job that requires extensive abilities, you could make your claim look fraudulent, particularly if you are receiving full disability benefits.
It is important to ensure that the work you perform in your side hustle does not violate the restrictions doctors have placed on you. If your doctor advised you not to bend down, reach up, or carry weight, it is reasonable to assume that you should not work in a job such as HVAC installation, where such actions would be required regularly. If your side hustle involves designing websites, a job that requires you to sit in a stationary position, then continuing that work should not interfere with workers’ compensation benefits from your HVAC job.
However, if you continue to do side work fabricating or inspecting ductwork—which requires physical movement—that could cause your claim of disability into question. For instance, it could be argued that your disabilities are not the result of an accident or stresses at your primary job but stem from your side work. Or they might claim that you would have healed from the initial injury if you had not continued your side job, which is outside the scope of workers’ compensation coverage. This would provide grounds for discontinuing benefits.
Even if you believe your employer “doesn’t care” what you do while you’re out, it is important to remember that your employer is not the one paying your workers’ compensation benefits. Those benefits are being paid by an insurance company, and insurance companies are known for doing everything they can to keep their costs down. When they stop paying benefits to a workers’ comp recipient, they get to keep that money.
Therefore, workers’ comp insurers often monitor workers who file claims or who are currently receiving benefits to see whether they are truly as injured as they claim to be. Insurance companies have been known to hire private investigators to follow workers’ comp claimants around during the course of the day. But it can be easier for them to try to monitor you online.
They might try to friend you on social media or simply conduct searches of what others have posted. If they find posts that discuss your involvement in activities that seem to be more strenuous than you should be capable of performing based on your claim, they could use that as “evidence” that your claims are fraudulent. They might make assumptions based on incomplete records. For instance, they might see your name among the participants in a 5K and claim you were healthy enough to run when what really happened is that your best friend pushed you along in a wheelchair. Or they might find a photo of you riding a horse or roller coaster and not realize that the photo is ten years old.
It may be very easy for investigators to find evidence of your side hustle online. Much of that information may also be outdated. But even if they find old information, if it calls attention to current actions and those are inconsistent with your workers’ comp claim, you could be at risk of losing your workers’ comp benefits.
Whether you are continuing a side hustle that you’ve been doing for a while or you’re considering starting something new, it is important to report what you’re doing to the insurance company that is providing workers’ compensation benefits. If they don’t need the information, it will not harm your claim. If the policy requires you to inform the insurer and you fail to do so, you risk having your benefits terminated and could potentially face other negative consequences.
The workers’ comp scheme in Pennsylvania makes it difficult for workers to succeed in getting and keeping the benefits they should be entitled to receive for on-the-job injuries. Unfortunately, injured workers often need to take legal action to succeed with their claims. To work so hard to obtain benefits and then have them taken away due to complaints about a side hustle can seem like a double curse.
Allow the team at Vanasse Law to assist. We focus on helping workers in Pennsylvania recover full and fair benefits for on-the-job injuries. We know the tactics insurance companies use to deny claims and discontinue benefits, and we work to overcome the challenges so workers receive the benefits they need. For a free consultation to learn how we may be able to assist in your case, call us at 717-397-1010 or contact us online today.
It almost seems illogical, but the insurance companies that handle workers’ comp claims will actually invest considerable amounts of money into efforts that essentially spy on injured workers. They’re hoping to find an excuse to deny claims or discontinue benefits. And they may try to use an excuse based on faulty or misleading evidence, so it is essential for injured workers to be aware of how they’re being monitored and the ways their words and actions can be used against them.
Whether you have just filed a claim for workers’ compensation benefits in Pennsylvania or you have been approved and are currently receiving benefits, you could be the target of a variety of surveillance methods. It is essential to understand how the insurance company may be monitoring you. While insurance companies do have the right to monitor workers who file claims to prevent fraud, they are required to honor privacy laws and legal obligations.
In workers’ compensation cases, surveillance involves observing and documenting the activities of an injured worker who has filed a claim or is currently receiving benefits. The team conducting surveillance activities is trying to identify inconsistencies between the workers’ reported conditions and injuries and their actual behavior in daily life.
Workers’ compensation insurers engage in surveillance to help assess whether a claim is legitimate or whether there is potential for fraud. If a worker has been receiving benefits and the insurer believes they should have recovered, they may engage in surveillance to determine if the injury still prevents the worker from performing tasks required for their job.
Surveillance can be conducted by either insurance company employees or independent private investigators. Whether in-house or under contract, insurance investigators are trained to monitor and report actions that could indicate that a worker is exaggerating their injuries or the impact of those injuries.
It is not uncommon for investigators to find themselves in a position where they can observe an injured worker during the course of their daily activities. They may park near the house and use a zoom lens to observe what you do when you come out of the house. An investigator might follow you to the store or doctor’s office to see how you get around. If you claim that you’re unable to walk due to your injuries and they see you taking a brisk walk around the block, for instance, they can video your actions and use that as evidence to dispute the claims about your injuries.
What is not always apparent from an observation, however, is that injured individuals have good and bad days, and that sometimes they are able to undertake an activity for only a few moments. An investigator might see you walk a few feet from your house to your car, but you might have to sit for half an hour to recover from the stress on your back or breathing. It is important to keep your own records of your condition and to keep in close contact with your doctor about the effects of your injuries so that you have evidence that tells the full story.
Insurance companies can often obtain video footage from security cameras and other devices showing how you are moving around. As with in-person observations, the images on video only capture brief moments in time. Therefore, it is helpful for you to keep journals and records that document what you are able (or unable) to do during the course of an entire day.
The job of workers’ comp investigators has been made easier by the advent of social media. Instead of following a claimant to observe their activities throughout the day, some investigators sit at a desk, poring over social media accounts using facial recognition software.
They might send a fake friend request to get access to your posts or just look for public posts uploaded by others. Unfortunately, surveillance through social media posts often reveals outdated information that can make it appear as if you are much more active than you currently are. A friend’s reminiscences about a camping trip or hike may refer to something that happened 20 years ago, but that might not be obvious from a post in which they mention you by name. An investigator could try to use old information to argue that you are not actually disabled by a work injury.
One very sneaky way insurance companies engage in surveillance is to have an investigator strike up casual conversations with friends, family members, or even the claimant directly to gather information about what the claimant is doing and how they’re feeling. If you say you’re feeling “fine” or “better,” an investigator might try to use that as evidence that you are not injured as badly as you claim.
An investigator might conduct a more straightforward interview in which they ask direct questions. However, they often believe that they will gain more accurate information through covert questioning, so it is essential to be aware that what you say and do at any moment could be subject to analysis. Don’t try to pretend that you’re feeling better than you are, even though you want to keep friends and family from worrying about you. An investigator could ask them about your condition, and they might end up providing inaccurate information because you’ve been trying to protect them from understanding the full extent of your pain and disabilities.
Workers’ comp insurers will often try to use any argument they can to avoid paying you benefits for an on-the-job injury. They may invest substantial sums in surveillance to “prove” you do not need surgery or that you should be able to return to work when it simply isn’t true.
It is very helpful to have a legal advisor and advocate who knows how to fight back effectively against these unfair tactics. At Vanasse Law, we are dedicated to helping workers get the benefits they need to recover and move forward after a work injury. If you have questions about how to handle surveillance or need help with a workers’ comp claim, contact us today for a free consultation and case evaluation.
Workers’ compensation in Pennsylvania is a system designed to help you receive the medical care and income support you need if you’ve been hurt on the job. It’s intended to be a simple system that enables you to get the right care quickly without the need for a long legal claim. But the insurance companies that are supposed to provide benefits in your time of need often try to avoid doing so to keep their profits high. They are looking for any evidence they can use to deny your claim or discontinue paying benefits.
You may be giving them that evidence without realizing it if you have any presence at all on social media. Even if you don’t have any accounts on Facebook, Instagram, Twitter, TikTok, or other platforms, you may be appearing in other people’s posts, and the information online can be used against you. If you need to file a claim, are in the midst of the claims process, or even if you’re already receiving workers’ compensation benefits in Pennsylvania, you need to be aware of what social media can do to your workers’ comp case and how you can protect yourself.
In a workers’ comp case, you don’t have to prove that your employer did anything wrong or negligent in order to receive benefits after a work injury. So, insurance companies can’t focus on liability as a reason to deny a claim. Instead, they focus on issues such as whether your disability is truly connected with work and whether your disabling condition actually prevents you from working. They may use multiple investigation tactics hoping to uncover information that shows that your injury occurred when you were away from work, maybe participating in a hobby.
They will also be checking to see whether your condition is as disabling as you claim. Statements you make on social media can be taken out of context and used to demonstrate why you should not be receiving benefits. For instance, if you celebrate a win at a volleyball game, they may see that as proof that you are healthy enough to be playing an active sport. Your post may have been talking about your daughter’s volleyball game that you had to watch from a wheelchair, but that may not be obvious from the quote taken from your social media post. You need to be prepared to counter the insurance company’s evidence with evidence of your own.
Sometimes we all do things that we know will cause pain later out of love for our children or grandchildren. You might bend down for a hug even though it causes back pain. You might go to a birthday party even though you can only stay for half an hour, and you’re so wiped out afterward that you have to stay in bed for three days. Social media shows only a quick snapshot of the positive moments in our lives, so the pain after is left out. But if you post anything on social media while you’re in the middle of a workers’ comp claim or receiving workers’ comp benefits, you need to keep records to show the full story. Document the accommodations you needed to make to attend that party and how it affected you afterward. Then, if the insurance company points to a picture of you hugging your grandchild and says your back must not be injured, you have evidence to counter that argument.
Even if you are not posting images or statements on social media, you might appear in posts from friends, family, or people you don’t even know. Facial recognition software has become very sophisticated, and insurance companies can search for your image through a vast array of sources with very little effort. They might find images of you at that birthday party or volleyball game. Those images might not show that you had to have help getting into the room, that you needed to sit with back support, or that you only stayed a short time. They only give a small part of the story.
People post information not only about what’s happening in their lives currently but also show images from years or even decades ago. You could be tagged in an old photo showing you moving around in ways you can’t even begin to manage now.
While there is no failproof method to prevent insurance companies from wrongfully denying your claim due to social media posts, there are a few steps you can take to protect yourself:
In addition, you should be wary of communicating about your condition via email other than with your attorney. Your communications with your lawyer are protected by attorney-client privilege, but the same is not true of messages sent to anyone else.
Whether they know it or not, insurance companies often base their decisions on incomplete information when they’re evaluating workers’ compensation claims. In many cases, the only way to ensure that your claim receives full and fair consideration is to consult an attorney who knows how to overcome insurance company tactics.
At Vanasse Law, we’ve dedicated our practice to helping workers get the care and resources they need after an injury on the job, so we know what it takes to succeed against the insurance companies. To discuss your claim with us for free, contact us online or call 717-397-1010 for a same-day response. After hours, you can text us at 717-471-2168 because every minute counts when you’re dealing with a disability.
When people think of workers’ compensation, they often picture serious workplace accidents—slips and falls, machinery malfunctions, or hazardous material exposure. But what happens when your workplace injury is, well, embarrassing? If you’ve suffered a workplace injury that feels too awkward to talk about, you might worry about whether you even have a case. The good news is that in Pennsylvania, workers’ compensation law doesn’t discriminate based on how your injury happened—as long as it occurred in the course of your employment.
Pennsylvania’s workers’ compensation system is designed to protect employees who suffer work-related injuries or illnesses. Whether your injury happened because you tripped over your own feet, fell off a chair while reaching for a file, or slipped in the breakroom, you are still entitled to benefits. These benefits may include medical expenses, wage loss compensation, and even vocational rehabilitation if you’re unable to return to your previous job.
The key requirement for workers’ compensation eligibility in Pennsylvania is that the injury must arise out of and in the course of employment. That means as long as you were performing job-related duties when the injury occurred, you may qualify for benefits—even if the circumstances were unusual or embarrassing.
Some workplace injuries may seem too ridiculous to take seriously, but they are still covered under workers’ compensation. Here are a few examples:
Embarrassment can prevent many workers from filing a legitimate claim. You may feel ashamed to admit how your injury happened, or you might worry that your employer and coworkers will make fun of you. Some employees are also concerned that their claim won’t be taken seriously, particularly if the injury seems minor or the circumstances were unusual.
Additionally, many employees fear retaliation or judgment from their employer. Even though Pennsylvania law prohibits employers from firing or punishing workers for filing a workers’ compensation claim, some employees worry about being labeled as clumsy, careless, or a troublemaker. These concerns can discourage workers from reporting their injuries, leading to untreated conditions that could worsen over time.
There is also the misconception that embarrassing injuries are not severe enough to warrant compensation. However, even minor incidents can lead to serious consequences. A simple slip in the breakroom can result in a concussion, a fall from a chair can lead to a broken wrist, or an awkward stretch can cause a herniated disc. Without proper medical attention and benefits, workers may face unnecessary hardships due to their reluctance to file a claim.
However, delaying or failing to report an injury can make it more difficult to receive the benefits you deserve. Pennsylvania law requires employees to notify their employer of a workplace injury within 120 days, but it’s always best to report it as soon as possible.
An experienced workers’ compensation attorney can make the process easier and ensure your claim is handled properly. Here are five ways in which a workers’ comp attorney can help:
Many workers aren’t aware of their full rights under Pennsylvania law. An attorney can evaluate your case, explain what benefits you may be entitled to, and address any concerns you have about filing a claim.
One of the biggest challenges in a workers’ comp case is proving that the injury occurred in the course of employment. A lawyer will help you gather the necessary medical records, witness statements, and workplace incident reports to support your claim.
Some employers may try to deny or minimize claims, particularly if they believe the injury was caused by employee negligence or an embarrassing mishap. An attorney can counter these tactics and ensure your employer and their insurance company follow the law.
The workers’ compensation process in Pennsylvania can be complex, with strict deadlines and procedural requirements. A lawyer will guide you through filing your claim, responding to requests from insurers, and appealing denials if necessary.
If your claim is denied or disputed, your case may require a hearing before a workers’ compensation judge. Having a legal advocate on your side can significantly improve your chances of a successful outcome.
Your injury may feel awkward, but that doesn’t mean it isn’t serious. Even minor injuries can lead to lost work time, medical bills, and long-term complications. Workers’ compensation exists to protect all employees, regardless of how the injury occurred.
If you’re hesitating to file a claim because you’re embarrassed, don’t let that stop you. A workers’ compensation attorney in Pennsylvania can help you navigate the process with dignity and ensure you receive the benefits you deserve.
If you’ve been injured at work—even in an unusual or embarrassing way—don’t wait to seek help. Contact a qualified workers’ compensation attorney in Pennsylvania to discuss your case and get the support you need. The sooner you act, the better your chances of securing the benefits you’re entitled to under the law.
Suffering an injury on the job is stressful enough without your employer trying to mislead you about your rights. Unfortunately, many Pennsylvania employers try to discourage workers from filing for workers’ compensation benefits by spreading misinformation. If you’ve been hurt at work, you deserve to know the truth. Below, our Lancaster workers’ comp lawyer debunks five of the most common myths employers use to scare injured workers.
One of the biggest fears injured workers have is losing their job if they file a workers’ compensation claim. Employers often imply—or outright say—that seeking benefits will result in termination. However, in Pennsylvania, it is illegal for an employer to fire you simply because you filed a legitimate workers’ comp claim. This would be considered retaliation, and there are legal protections in place to prevent it.
That being said, Pennsylvania is an at-will employment state, meaning employers can fire employees for almost any reason that is not illegal. While they may try to find another excuse to terminate your employment, an experienced workers’ comp attorney can help you identify and fight back against wrongful termination.
Additionally, if you experience retaliation, you may be able to file a separate legal claim against your employer. This could include compensation for lost wages, reinstatement, and other damages. Keeping detailed records of any retaliation and seeking legal counsel as soon as possible can strengthen your case.
Some employers tell workers that they can only receive workers’ compensation if their injury is someone else’s fault. This is completely false. Pennsylvania operates under a no-fault workers’ compensation system, meaning you are entitled to benefits regardless of who caused the accident—whether it was you, a co-worker, or even your employer’s negligence.
The only exceptions to this rule are if you were intoxicated, under the influence of drugs, or engaging in intentional misconduct at the time of your injury. Otherwise, your fault does not impact your right to receive medical treatment and wage-loss benefits through workers’ compensation.
It’s also important to note that even if you believe your actions contributed to your injury, you should still report the accident and file a claim. Trying to determine fault on your own could lead to unnecessary delays or loss of benefits.
Employers often tell injured workers that they are required to see a company-approved doctor for all of their medical care. While it is true that, under Pennsylvania law, you may have to see an employer-designated physician for the first 90 days after your injury, you are not required to stay with that doctor beyond that period.
Even within those 90 days, you have rights. You can choose from a list of approved doctors provided by your employer, and if your employer does not provide a list, you can seek treatment from any doctor of your choice. After the 90-day period, you are free to see any doctor you prefer for continued treatment.
If you feel the company’s doctor is not providing appropriate care, you may be able to seek a second opinion or request a change in medical providers. Keeping documentation of your treatment and any concerns about the quality of care can help protect your rights.
Many employers and insurance companies try to discourage workers by claiming that a denied workers’ comp claim is the end of the road. This is far from the truth. In Pennsylvania, you have the right to appeal a denial through the Workers’ Compensation Appeal Board.
The appeals process can be complex, but with the help of a knowledgeable workers’ comp attorney, you can challenge the denial, present evidence, and argue your case before a judge. Many initial denials are reversed on appeal, particularly when workers have legal representation to navigate the system and counter insurance company tactics.
Understanding the reason for the denial is crucial. Common reasons include lack of medical evidence, disputes over whether the injury is work-related, or missing paperwork. Addressing these issues and gathering the necessary documentation can significantly increase your chances of a successful appeal.
Some employers try to convince injured workers that it’s easier or better to use their personal health insurance rather than filing a workers’ compensation claim. This deceptive tactic is meant to save the company money at your expense.
Workers’ compensation covers all necessary medical treatment related to your injury, with no out-of-pocket costs to you. If you use your health insurance instead, you could end up paying co-pays, deductibles, and other expenses that workers’ comp should have covered. Additionally, health insurance won’t cover lost wages due to your injury, whereas workers’ compensation provides wage-loss benefits while you’re unable to work.
Furthermore, using health insurance instead of workers’ compensation could create medical billing and reimbursement complications. If your insurance company learns that your injury was work-related, they may refuse to cover the costs, leaving you with unexpected medical bills.
Employers and their insurance companies often rely on misinformation and intimidation to keep workers from seeking the benefits they deserve. If you’re injured on the job, don’t take your employer’s word as the final authority. Instead, educate yourself about Pennsylvania workers’ compensation laws and seek legal guidance if necessary.
If you’ve been injured at work and believe your employer is misleading you about your rights, don’t hesitate to contact a workers’ compensation attorney. You deserve fair treatment, medical care, and financial support while you recover. The law is on your side—don’t let fear keep you from getting the benefits you’re entitled to. Taking the right steps from the start can make all the difference in securing the compensation you need for your recovery and financial well-being.
30 East Roseville Road, Suite C
Lancaster, PA 17601
Phone: 717-397-1010
Office Hours:
After Hours: 717-471-2168
Fax: 717-397-2644
Vanasse Law LLC is conveniently located just north of center city Lancaster just off Route 30. We are in Sterling Center just off Lititz Pike/Route 501. Our office has plenty of free parking and is handicapped accessible.
Located in Lancaster, Pennsylvania, Vanasse Law LLC serves injured workers throughout Lancaster County and surrounding communities.
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