When the COVID pandemic took away our ability to meet in person, many people began meeting online via platforms such as Zoom and Microsoft Teams. These are often referred to as virtual meetings.
Hearings in workers’ compensation cases are now held online through Microsoft Teams as well. You might be tempted to call them “virtual hearings,” but that name is misleading. Something that is virtual is not quite real. But an online hearing is very real. The procedures used are just as formal, and the results are just as critical as those from in-person hearings.
This catches many workers’ compensation claimants off guard, and they make mistakes that severely damage their ability to receive benefits for the losses they have suffered. It is important to understand how to manage tech requirements and what to do to succeed in a digital hearing if you want to receive the full benefits available under the law.
Much of the information you have regarding your injuries and how they affect your ability to work may be printed on paper, but to process a claim for benefits, you will need to know how to submit information electronically. All workers’ comp claims are managed through the Pennsylvania Workers’ Compensation Automation and Integration System, often abbreviated as WCAIS.
The WCAIS is designed to enable workers’ comp claimants to submit documents related to their claims. This can make it much faster to provide information, and it offers a way to index and access critical information quickly. The digital submission of information may allow decision-makers to receive and evaluate it sooner. However, digital information can be lost, so it is a good idea to keep copies both in print and digitally, in a place where you know how to access them.
The WCAIS system uses Electronic Data Interchange (EDI), enabling staff at the Department of Labor and Industry to view and annotate documents electronically and providing similar capabilities for claimants. Judges handling workers’ comp claims frequently want all communications to be submitted through the WCAIS system, including not just briefs and evidence but also letters and requests made directly to the judge.
Many judges will not answer requests made via email or other methods. So it is important to understand how to use the WCAIS system. If you’re working with an experienced workers’ compensation attorney, your legal representative should know how to use the system to your best advantage, and you can rely on your lawyer to manage communications and submit evidence on your behalf.
Participating in a digital hearing remotely differs significantly from attending a hearing in person. The differences can cause problems if you’re not prepared. To begin with, you will not be able to hand the judge any evidence, so it is vital to ensure that the evidence is uploaded to the appropriate place in the correct format well before the hearing.
It will also be important to ensure that technical preparations are made so that the hearing can proceed with full audio and video capabilities. Judges are busier today than they’ve ever been, and they have no time to wait while someone on your end tries to resolve technical problems. However, even when everything appears to be set up appropriately, problems can occur suddenly during an online proceeding, and you need to be mentally prepared. Audio and video might become out of sync, or a connection could be disrupted. It is helpful to know what you plan to say so that, if you have to repeat it, you will not be at a loss.
Perhaps most importantly, you need to approach a digital hearing with the same decorum that you would use in a courtroom or other official setting. You might feel like the proceedings are casual, but they are not. You will be speaking to a judge with authority to override determinations made against you earlier, and you want to impress the judge with your sincerity and the validity of your claim.
Your attorney can work with you on how to answer questions honestly and completely. While you never want to exaggerate your injuries, you do want the full extent of your disabilities to be evident to the judge, and this can be much harder to do through a digital hearing than when the judge can see you in person.
The easiest and most effective step you can take to prepare for a digital workers’ compensation hearing is to work with an attorney who is experienced in successfully representing claimants in this format. Having a dedicated attorney who can provide guidance tailored to your specific situation should help you be prepared, both legally and mentally, for the process.
You will need to find the right place to make your digital appearance. It should be somewhere quiet with a neutral background. In addition, you will need to ensure you know how to use the software and can transmit and receive audio and video effectively.
It is also vital to ensure the documents and other evidence supporting your claim have been uploaded to the appropriate place in the WCAIS system and that nothing is missing. You should be familiar with the documents so that if the judge asks you a question, you will know what they are talking about. Hopefully, your attorney will have reviewed the questions you’re likely to be asked so that you can feel confident responding. But if you don’t know an answer, it is better to admit that you don’t know than to answer in a way that could be contradictory to the written evidence you’ve submitted under the advice of your lawyer.
At Vanasse Law, we have been helping workers’ compensation claimants recover full benefits for decades. We know what it takes to succeed in person and in digital hearings, and we work to ensure our clients are prepared to take advantage of the best opportunities available, regardless of the format.
Whether you are just starting the claims process or you’re struggling with a denial or termination of benefits, we invite you to contact us to schedule a free consultation so you can learn about the assistance we may be able to provide in your situation. To get started, call us at 717-397-1010 or contact us online today.
According to recent studies, one out of every seven first responders suffers from a post traumatic stress injury. That’s over 14% of firefighters, police, EMTs, and others who serve and protect the public. Changes in Pennsylvania law recently took effect that are designed to make it easier for these workers to obtain workers’ compensation benefits.
Traditionally, first responders have had a difficult time qualifying for benefits because of standards that were in place specifying that injuries of this type had to result from “abnormal working conditions” to be covered. The unfortunate reality for first police, firefighters, and emergency workers is that their everyday working conditions are often horrific and traumatic. Under the new laws, first responders should now be eligible for benefits, but they will need to prove that they meet eligibility requirements.
The new provisions added to the workers’ compensation laws apply to workers who meet the definition of “first responders,” which includes the following public servants:
It should be noted that the definition includes both employees and volunteers.
Other workers who suffer from PTSD symptoms are still required to follow the previous standards. They must show that “abnormal working conditions” led to their PTSI.
The new law retains the current definition of a “post-traumatic stress injury,” which is found in 35 Pa. C.S. 75A01. That definition states that a post-traumatic stress injury is the same as a post-traumatic stress disorder, as defined by the American Psychiatric Association. This definition is documented in the Association’s Diagnostic and Statistical Manual of Mental Disorders. In brief terms, it consists of a mental health condition caused by exposure to a serious, threatening, or traumatic event that causes intrusive symptoms, triggers avoidance, causes negative cognitions or memory loss, and leads to reactivity issues such as reckless behavior or sleep difficulties.
What is the difference between a post-traumatic stress injury and post-traumatic stress disorder? Both essentially refer to the same set of symptoms, such as flashbacks and anxiety, but with a different focus. PTSD is seen as a mental health disorder, while PTSI is viewed as a physical injury that has been inflicted on the body’s nervous system. PTSI focuses on the biological changes in the brain as a result of the trauma, and treatment may emphasize physical interventions as well as mental health therapy.
Since Pennsylvania lawmakers refer to PTSI but link the definition to PTSD, and the symptoms are essentially identical, it could be safe to assume that the changes in workers’ compensation law apply to a diagnosis of either PTSD or PTSI.
According to the new law, when a first responder files a claim for workers’ compensation benefits based on a post-traumatic stress injury, the claimant will need to prove that the injury/symptoms resulted from their experience of a “qualifying traumatic event.” This is defined as an episode that resulted in either:
Experience of the traumatic event must come during the “course and scope of the individual’s employment as a first responder.” This is true of any injury that qualifies for workers’ compensation benefits. One feature that is different now, however, is that the law says “[a] post-traumatic stress injury suffered by a first responder shall not be required to be the result of an abnormal working condition to be a compensable injury under this act.” Before this new law was enacted, first responders were almost systematically excluded from receiving benefits for PTSD because the trauma was usually the result of working conditions that were part of their normal job.
While it might seem clear that the public servants who respond to emergency situations and put their own safety on the line for the benefit of others should be granted assistance for PTSD with no questions asked, that is not the case. First responders still need to prove their condition with evidence of an assessment and diagnosis by a licensed psychologist or psychiatrist. The requirement of a specific diagnosis is often used by workers’ compensation insurance providers as grounds to deny claims, so it can be very helpful to work with a knowledgeable attorney when filing a claim based on PTSD.
Claims must be filed within three years of the diagnosis of a PTSI. However, the qualifying traumatic event that triggered PTSD symptoms could have occurred up to five years previously. Wage loss benefits for workers suffering from a PTSI cannot continue for more than two years. There may not be a limit on how long a first responder can continue to receive treatment for the symptoms, however.
Workers’ compensation is supposed to help workers who are injured on the job. Unfortunately, the insurance companies that pay for medical benefits and wage benefits challenge the details of every claim and find arguments to deny benefits, no matter how much a worker is suffering.
If you need to file a claim for a PTSI or any other injury caused by your experience at work, the experienced team at Vanasse Law may be able to assist. We invite you to contact us to discuss your claim, whether you have not yet started the claims process or you’ve received notice that your claim was denied. We understand how to successfully appeal denials to get workers the benefits they deserve. To schedule a free consultation, call us at 717-397-1010 or contact us online today.
The Pennsylvania Department of Labor & Industry recently announced that the statewide average weekly wage is increasing to $1,394. It’s important to understand what that could mean for workers’ compensation claims in progress, new claims about to be filed, and workers currently receiving benefits. In addition, it is also important to understand the new rules about direct deposit of wage benefits.
The workers’ compensation program in Pennsylvania pays workers’ benefits if they are unable to work because of an on-the-job injury or occupational illness. To receive full benefits, an employee must be rated as totally disabled. Temporary total disability benefits are calculated based on 2/3 of an employee’s average weekly wage. But the calculation is not as simple as it may sound.
Mistakes can be made when determining what the “average” should be. And then there are caps that apply.
Your average weekly wage should include not just regular gross wages, but also other forms of compensation. This includes bonuses, vacation pay, tips, overtime, and other benefits such as food and lodging paid for by your employer. For many people, wages vary according to workload at different times of the year. To determine a fair average, it is important to look at an entire year rather than the pay at the time of the injury.
The workers’ compensation program only supplements lost income up to a certain point. If your earnings exceed a threshold amount, your benefits will be less than 2/3 of your average weekly earnings. Starting in 2026, the maximum amount you can receive is $1,394.00 per week.
Those whose average weekly earnings fall between $2,091 and $1,045.51 will receive 2/3 of their average weekly wage amount. Workers with an average weekly wage in the range from $1,045.50 to $774.44 will receive a flat rate of $697 per week, so for those on the lower end of that range, the amount equals more than 2/3 of their average weekly amount. Workers with an average rate below $774.44 receive 90% of their average pay.
The rate that applies to your benefits is determined by the date of your injury rather than the year that benefits are paid. So, the new rates apply to workers who suffer injuries in 2026. If you were hurt in 2025, then lower rates will apply in your situation, even if you don’t file a claim until 2026. Unlike Social Security retirement benefits, there is no cost-of-living increase for temporary total disability benefits.
When a workplace injury limits your ability to work and prevents you from performing your regular job but allows you to work fewer hours or lighter duties, then you can still receive workers’ compensation wage benefits, but they are calculated differently. The benefits are based on the difference between your average weekly wage before you were injured and the amounts you earn working while partially disabled.
Many workers in this situation would receive benefits equal to 2/3 of the difference between their pre-injury earnings and their post-injury earnings. While these benefits are also subject to caps, there are generally no minimum provisions or adjustments for those in lower income brackets.
New laws recently took effect requiring all employers and insurers participating in the workers’ comp program to offer direct deposit as a means of receiving wage benefit payments. They were given more than a year to set up direct deposit systems.
The way the new laws are written indicates that direct deposit is meant to be the default rule for workers’ comp wage benefit payments. Current wording of the law states that “[c]ompensation payable under this article shall be paid by direct deposit to the account of the person entitled to the compensation.” However, the law continues to specify that if a worker receiving benefits requests payment by check and does not have an account with a financial institution that accepts direct deposit, the worker can receive payment by check instead.
While this appears to give employees the option to continue receiving payments by check, the law also states that the insurance company or employer paying workers’ comp benefits can “permit or require” that payments be made by direct deposit. The apparent contradiction in the law could prove problematic for workers without traditional bank accounts.
Access to traditional bank accounts is limited for some workers due to credit problems. Others lack physical access to banking or do not trust or understand traditional banks. These employees often receive wages via a pay card that works like a debit card. It is unclear whether a direct deposit payment for workers’ compensation benefits could be made to a pay card.
Workers do not have the option to split payments between two accounts or to have some amounts paid by check while others are paid by direct deposit.
When an employer fails to calculate your average weekly wage properly, you could lose out on significant benefits. Even worse, if you can’t access benefits because your claim is denied, the process of evaluating your claim is delayed, or payment is made in the wrong format, then you can find yourself in a difficult situation very quickly.
An experienced workers’ compensation lawyer at Vanasse Law may be able to assist. For over 30 years, we have dedicated our practice to helping injured workers receive full benefits from the Pennsylvania workers’ compensation program. We understand how to prevent problems and overcome them when they arise. To discuss the assistance we may be able to provide in your situation, contact us online for a free case evaluation. You can also call us at 717-397-1010 (after hours, call or text 717-471-2168).
When you’ve been injured on the job, the Pennsylvania workers’ compensation system will not pay you outrageous sums of money, but it is supposed to provide medical care to meet your needs and funds to make up for much of the income that you are missing because you’re unable to work. These benefits are critical to meeting your basic needs.
Unfortunately, the insurance company or employer responsible for providing those benefits may decide that you’re not eligible to receive them. This is what they “determine” after reviewing most claims. They seem to routinely deny everything and hope they can get away without paying. And many times, employees give up. They accept the insurance company’s answer and try to manage on their own. Or they try to appeal the denial, but they lack the knowledge and experience necessary to succeed.
There’s a better way. If your workers’ compensation claim is denied in Lancaster or elsewhere in Pennsylvania, an experienced attorney can work to pursue the benefits you deserve. But it is important to act quickly to protect your rights because time is limited.
If you have filed a workers’ compensation claim and received notice telling you that your claim was denied, it is important to examine the notice closely and take note of the reasons given for the denial. Claims are frequently denied in Pennsylvania because:
In some cases, insurance companies issue a conditional denial because they have not yet received or reviewed the evidence of the injury. It is a good idea to contact the workers’ compensation insurance company to determine whether they have received documentation of your injury. While the employer is obligated to report your injury to their insurance company and to the Pennsylvania Bureau of Workers’ Compensation, employers do not always fulfill their obligations. An experienced attorney can work to obtain benefits in this type of situation.
Understanding the reason a claim was denied is the first step toward remedying the situation. It will be important to build a record of evidence to refute the reason given for the denial.
The first formal step in the process of appealing a claim denial is to file a Workers’ Compensation Claim Petition with the Pennsylvania Department of Labor & Industry’s Workers’ Compensation Office of Adjudication. It is vitally important to ensure that proper procedures are followed when filing and that the submission contains all the evidence needed to support the claim. The evidence and assertions you submit will be reviewed by a judge to determine whether the claim should be approved.
While the workers’ compensation program does not require claimants to work with an attorney in the appeals process, it is important to remember that the insurance company and employer who are fighting to deny the claim will have experienced legal teams arguing on their behalf, and it is difficult to overcome this type of legal assault without having a knowledgeable legal advocate on your side.
When making legal arguments to support a claim for benefits, it is important to remember that nothing should be taken for granted or assumed, even if it appears to be obvious. You will need to present evidence of every detail. Missing a single link in the legal chain of reasoning can give the judge grounds to deny your claim. Examples of information that must be submitted authoritatively:
The Pennsylvania Department of Labor & Industry’s Workers’ Compensation Office of Adjudication has specific requirements for what to include and how to submit it. If you work with an experienced attorney during the appeals process, your attorney can manage the details. If you’re proceeding on your own, be sure to review the Department’s requirements carefully. While the law allows three years from the time of injury to file a Claim Petition, it usually makes sense to file as soon as you are prepared.
A hearing will usually be held based on the evidence presented by both sides. An administrative judge will review the written materials and may ask questions from both sides. Although the hearing is less formal than a courtroom jury trial, it is still an official proceeding, and it is essential to follow proper procedures.
If the judge renders an unfavorable decision, it is possible to appeal to the Workers’ Compensation Appeal Board. An appeal must be filed no later than 20 days after the decision. Further appeals may be made in Pennsylvania courts if necessary.
The workers’ compensation system was intended to be simple, but insurance companies have made it a complex nightmare. Workers who try to obtain benefits find themselves pitted against corporate insurance teams intent on denying everything they can. To receive appropriate benefits, many workers have no choice but to fight back with their own legal representation.
At Vanasse Law, we know how employers and workers’ compensation insurance providers fight to keep workers from receiving full benefits for injuries caused by workplace conditions. We also know how to work effectively to recover full benefits for injured workers. For a free, confidential discussion about the assistance we could provide with a claim or an appeal, call us at 717-397-1010 (after hours, our call and text line is 717-471-2168) or contact us online.
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.
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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