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Archive for the ‘Workers’ Compensation’ Category

What are the Six Types of Worker’s Compensation in Pennsylvania, Part Two

Forging a new claim under the Pennsylvania Workers’ Compensation Act can be daunting. The beginning stages can be tough and can determine how smoothly your recovery will go. In the last blog post, we explored half of the six types of Worker’s Compensation and how they work to aid workers in their recovery process after a work-related injury.

In this post, we will look at the other three types of Worker’s Compensation in Pennsylvania and what can be covered by insurance after a work injury.

Medical Expenses

Any medical care that is necessary for recovery and is deemed reasonable and medically-related to your work injury is required to be covered by the employer. This can extend beyond the typical doctor’s visitations such as the cost of renovations to a home or vehicle for those that are severely injured. Unlike other types of compensation, there is no real limit or restriction on medical expense coverage. This is to ensure injured workers receive the necessary care to return to the work force.

worker injury safety shoe

Specific Loss Benefits

Not all cases are cut and dry. In some cases, an injury can result in a bigger loss than goes beyond typical coverage under the Act. Payment for such injuries is equal to total disability benefit rates for the same time period and healing periods after the injury. Examples of such injuries include loss of hearing or vision, along with amputation of a body part such as fingers, hands and toes.

Death Benefits

When injury leads to death, there can still be compensation involved. If the worker injured dies as the result of an occupational injury or illness within 300 weeks of the injury or of the last exposure to the hazard that led to the condition, the family may collect benefits. This includes $3,000 for funeral expenses and the widow or widower is entitled to the compensation the worker would have received if they did not die until he or she remarries.

Children of the worker are also entitled to compensation until the turn 18 years old, or 23 years old if they are in school such as an accredited college. The benefits collected by the children or the spouse is equal to the percentage of what the deceased worker would have made on average. This becomes the same amount that would have been collected in a total disability case.

If you or your loved one was injured at work, your family is entitled to compensation. Contact our law firm today to find out how our expertise can help your claim.

What are the Six Types of Worker’s Compensation in Pennsylvania, Part One

work injuryOriginally passed in 1915, the Pennsylvania Workers’ Compensation Act was set forth as a state-wide insurance system on a no-fault basis aimed to provide injured workers with benefits, lost wages and medical coverage. The intent of the Act is not to replace all wages for the worker but to give a percentage of wages to help aid recovery after a work-related injury. The Act also does not cover non-economic damages. This means if pain and suffering come as a result of injury, the worker will have to pursue those damages separately.

Depending on the injury, workers will be eligible for different coverage under the Act. There are six types of Worker’s Compensation in Pennsylvania, leading to better coverage for different types of injury. The categories are important to understand after injury as pursuing the wrong type could lead to denial of coverage or you may receive less coverage than you were entitled to.

Total Disability Benefits

In most cases, total disability benefits are paid as long as the person is not able to work if supported by medical documents. There will often be a medical exam after two years to determine if the person is able to return to work or if coverage will continue. In cases where the worker is found to have less than a 50% whole body impairment, the benefits may be limited to a maximum of 500 weeks and will be considered to be partially disabled and weekly payments will stay the same. However, insurance companies will be able to attempt to lower the disability benefits by offering vocational rehabilitation during those 500 weeks of partial disability benefits.

Partial Disability Benefits

These benefits are available for up to 500 weeks after the partial disability status has been determined either by an official exam or if the doctor under the insurance carrier feels the worker has the capacity to perform light-duty work. Partial disability is a way of saying the person is not fully recovered from the injury and be offered a new position to fit their disability. If the new position pays less than the position held prior to injury, the worker is entitled to two-thirds of the difference in average weekly wage.

Expenses for Travel

Under the Act, expenses to travel to and from medical providers are not reimbursable but workers may be entitled to compensation if the travel for treatment is not available in their community. If you are not able to travel on your own to the treatment, insurance is also required to provide transportation to the Independent Medical Examination needed to determine coverage.

These three are the first to understand the types of coverage when seeking Workers’ Compensation benefits. If you have questions about your claim, contact us today to work with a law firm well-versed in the laws surrounding Workers’ Compensation.

Understanding Mental Injuries Claims in Pennsylvania

While many are familiar with the idea of pain and suffering as it results from other injuries and incidents, few are aware that mental injuries themselves can be compensable. Mental injury claims often come from workplace stressors and are on the rise as claims. For employers, this raises a lot of issues and creates a lot of headaches, especially in their HR departments. It is much more difficult to successfully claim one of these cases, and the issue brings up a lot of questions for both employees and employers.

Understanding the link between stress in the workplace and the mental and physical disorders that result is problematic. For instance, it is not yet fully proven that workplace stress can directly cause anxiety and depression, and it is even more burdensome to prove that the anxiety and depression did not exist in any way prior to the work stress. Even further, it is not easy to prove ongoing stress at work is the cause of a heart attack versus genetics or at-home stressors.

However, it is an important aspect of work life that needs to be better understood. The National Institute of Health estimates that the American economy spends close to $150 billion each year on stress-related issues. This number was estimated based on decreased productivity, missing work and the massive increases in medical expenses. It is also not too uncommon, especially in larger corporations, for there to be millions spent each year on stress management programs.

However, these programs largely seem to not work. The claims of stress-related mental illness and cardiovascular injury continue to rise but most employers and employees are no closer to answering which work-related stress injuries are compensable and which are not. Distinguishing the two from one another comes down to understanding the medical concepts associated with stress along with an understanding of how the legal framework of these concepts should be applied, which is out of the scope of experience and knowledge of most employers.

The burden of proof is the biggest aspect of proving such a case. It is important to know there are three different classifications of these types of claims: physical/mental, mental/physical, and purely mental. In a physical/mental injury, a physical stimulus leads to a mental injury. In a mental/physical injury, a mental or emotional experience leads to a physical injury. In a purely mental incident, there is a mental or emotional stimulus that leads to a mental injury. If you have been victim to any of these three incidents, contact us today. Our team will help you build evidence to ease the burden of proof and bring you closer to the compensation you deserve.

Do I Qualify for Workers’ Compensation Benefits for an “Off the Clock” Injury?

Some injuries at work are more complicated than others. For instance, if you are asked to come in and pick something up for or from your boss and are injured on the premises, you may wonder if you are eligible to receive Workers’ Compensation benefits. While you were not on the clock, you were at your place of work and your actions were in benefit of the employer. In a lot of claims like this, you will have a good case for compensation. However, the devil is in the details when it comes to such claims.

The first question is whether it was in the scope of your employment or not. For instance, if you stopped in the office because you left your cell phone on your desk, it was not in the interest of your employer nor was it in the scope of your employment. However, running an errand for your boss or coming in to prepare for your next shift is a different story. In those cases, you would not have been on the premises and would not have been injured had it not been for your employment.

In most states, these benefits cover medical costs and lost wages when an employee is injured during the course of their employment. There are some exceptions to this general rule.

“Off the Clock” Exceptions

The law surrounding Workers’ Compensation is rarely black and white. The law tows the line between protecting the rights of workers while also looking out for the best interest of the company as a whole. Some of the exceptions for injuries that are technically off the clock but are still covered by Workers’ Compensation include:

  • Employer Benefits. If the employer is directly benefiting from the actions taken by the employee, they are covered. This includes when they have to travel between locations for work, but does not include regular commuting. For instance, traveling between a different location and a hotel is covered but driving to work from your home does not.
  • Special Mission. If your employer asks you to stop to drop off paperwork on your way home, that commute is now covered by Workers’ Compensation, especially when it takes them off their normal route.
  • Areas Controlled by Company. While a worker is not covered when they are driving to work, they are covered when they are walking back to their vehicle. This is because the company owes employees a duty of care in overseeing those common areas.

Working outside of regular business hours and coming by after hours are also usually covered by the exceptions. If you have been injured while off the clock but feel you still deserve compensation, contact us today. Our professionals will help you figure out your legal options.

Are the Benefits I Receive Through Workers’ Compensation Taxable?

The short answer to this question is “no,” but there are some caveats to the answer. While Workers’ Compensation benefits are not considered taxable income at the federal or state level, those receiving benefits through Social Security disability insurance or Supplemental Security Income in addition to Workers’ Compensation may have their benefits taxed.

For some, their SSDI or SSI may be reduced to ensure the combination with Workers’ Compensation is below a threshold of payment, known as the Workers’ Compensation offset. The amount of Worker’s Compensation that would be taxable is the amount your disability payments are lowered to stay within that threshold.

In these cases, it pays to have an experienced Workers’ Compensation attorney on your side. A good lawyer will be able to ensure the offset will be minimal and reduce how much of your income is subject to taxes. However, it is important to know that most people who have this offset most often don’t have enough taxable income to owe federal taxes. As such, it is unlikely you will owe taxes, even under this exception.

Reduce Taxable Income in Workers’ Compensation Settlement

Structuring your Workers’ Compensation with an experienced lawyer can alleviate a lot of taxable income concerns. Not only can it help minimize the Worker’s Compensation offset, it can limit the amount of taxes you will have to pay.

One way to avoid unnecessary taxable income is to receive a lump sum that should be treated as though it were to spread out throughout your expected lifetime. This will cover the rest of your lifespan while avoiding thresholds found in monthly payments.

When Does an Offset Apply?

When receiving both types of compensation, the total benefits cannot exceed 80% of your average earnings at your current employment. These average earnings are considered the largest out of the following:

  • Average monthly wage
  • One-sixtieth of total wages in highest earning five years
  • One-twelfth of total wages in highest earning year out of the last five years

If you are filing for Workers’ Compensation and are concerned about going over the threshold, contact our lawyers at Vanasse Law today. We will help structure the best payout for your individual needs and ensure your needs are financially met.

Can I Seek Damages for PTSD?

Post-Traumatic Stress Disorder (PTSD) can develop after a trauma in any setting. Despite this fact, not all states allow Workers’ Compensation claims based on PTSD. For the states that do, the worker must have experienced or witnessed an event that is deemed traumatic while acting the scope of employment, then show symptoms of PTSD that interfere with the ability to work in that employment. Furthermore, there must be an official diagnosis of PTSD from a certified psychiatrist or psychologist.

On the Job Traumatic Events

Some examples of what is considered a traumatic event at work include, but are not limited to:

  • Police, firefighters, or EMT respondents that see a horrendous or horrid situation.
  • A worker, such as in construction, that witnesses a serious injury or death of a coworker.
  • A teacher that was present for a school shooting.

These types of events can trigger PTSD symptoms that greatly affect ones’ ability to perform their job.

Signs and Symptoms

Not every traumatic event results in PTSD. On the other hand, not everyone with PTSD has been through a dangerous event. Symptoms can show up years after the event or right after it happens. Symptoms that last more than a month and are severe enough to interfere with relationships are considered PTSD.

For diagnosis, an adult must have the following for at least a month:

  • A minimum of one re-experiencing symptom
  • A minimum of one avoidance symptom
  • A minimum of two separate arousal and reactivity symptoms
  • A minimum of two separate cognition and mood symptoms

Re-experiencing symptoms include, but are not limited to, flashbacks where the trauma is relived, bad dreams, and frightening thoughts. Avoidance symptoms include staying away from places, events, or objects that remind the person of the event, or avoiding thoughts or feelings about the event.

Arousal and reactivity symptoms include being easily startled, feeling tense or on edge, trouble sleeping, or angry outbursts. Cognition and mood symptoms include trouble remembering important parts of the event, negative thoughts about themselves or the world, guilt or blame, or loss of interest in formally enjoyable activities.

If you are suffering from PTSD as the result of a traumatic event that happened on the job, you could be entitled to compensation. Contact our attorneys at Vanasse Law today to find out how we can help.

Workers’ Compensation Average Weekly Wage for Pennsylvania in 2017

Under the Workers’ Compensation Act, workers who are injured on the job are entitled to recover lost wages equal to two-thirds of their weekly wages. The Act also highlights the minimum and maximum adjustments with the benefit rate being set using the annual maximum that was in place when the injury occurred. This maximum is decided by the Department of Labor and Industry by calculating a maximum based on a state’s average weekly wage.

For the year of 2017 in Pennsylvania, the maximum weekly compensation rate for the calendar year is $995, which is a 1.7% increase from last year. This has been determined under the Workers’ Compensation Act, Section 105.1 and 105.2 by the Department of Labor & Industry. This new rate applies to injuries that were sustained on or after January 1, 2017.

This year, those whose average weekly wages are between $1,492.50 and $746.25 will be compensated for 66 2/3rds of their weekly wages. Workers who earn between $746.25 and $552.78 will receive a flat rate of $497.50 each week. For earnings under $552.77 each week, the injured worker will receive 90 percent of their average weekly wages.

Since Workers’ Compensation is the loss of one’s earning capacity, the benefits are not taxable unless under specific criteria, such as when someone is also receiving SSDI or SSI benefits. Unfortunately, wage increases an employee would typically receive are not factored into these benefits. This means those living off these benefits for an injury from years ago don’t have the same opportunity to negotiate their salary or have increased for cost of living raises.

Each case for Workers’ Compensation is unique. If you are starting a claim, contact us today. At Vanasse Law, we have an experienced legal team that can guide you through the process to ensure you get the most benefits possible to help your recovery.

Can an Employer Seek Reimbursement for Attorney Fees After an Unreasonable Contest?

Under the Workers’ Compensation Act, a Worker Compensation Judge is able to award a claimant attorney fees when after an unreasonable content is a petition. This type of award is based on the facts and legal issues that were involved in needing an attorney for the petition. A WCJ will also decide the amount and the length of time allowed for the claimant to be reimbursed for such fees and weigh the skills needed, how long the proceedings took, along with the time and effort expended.

This becomes complicated when an appeal on the award is successful. When a WCJ awards the claimant attorney fees and the decision is reversed, the claimant is technically no longer entitled to that compensation. However, there was no clear precedent on refunding that compensation. A decision in 2016 by the Commonwealth Court of Pennsylvania determined the Employer and Insurer could request that a WCJ order can direct claimant counsel to refund those contest fees when the Employer is successful in their appeal.

Reasoning Behind the Decision

The Court based its decision on Barrett v. WCAB (Sunoco Inc.) (Pa. Cmwlth. 2010). In the case, it was held that an employer and insurer can request reimbursement of litigation costs that were awarded and paid in the case when an appeal is successful. In Barrett, it was decided that allowing the claimant to keep the legal costs in which they were no longer entitled would be unjust enrichment. Furthermore, the Employer would be unable to recover legal cost awards from the supersedeas fund, meaning they would be deprived of any meaningful appeal after an incorrect award.

This reimbursement doesn’t put the claimant in any hardship as recovery is sought directly from the claimant’s counsel as opposed to the claimant. Prior to this decision, the Court believed the same reasoning could be considered just as applicable to the unreasonable contest attorney fee issue.

If you had an appeal go through successfully and are being asked to reimburse attorney fees directly, we can help. At Vanasse Law, our team understands the intricacies of these laws and will put together a defense in your favor. Contact us today to find out how we can help.

Understanding ERISA Plan Fiduciary Responsibilities

The Employee Retirement Income Security Act (ERISA) aims to protect the assets of your plan, but many are not well-informed on the responsibilities of the fiduciary who control or have authority over their plan. The first thing to understand is what a fiduciary is. Simply put, a fiduciary is someone who acts in your interests when it comes to your retirement plan.

The second part is understanding ERISA regulations of employee benefits.

Vanasse Law - ERISA

What ERISA Does

  • Requires plans to inform participants about plan features and funding.
  • Guarantees payment of certain benefits.
  • Requires plan fiduciaries to be accountable for following principles of conduct and may be responsible for restoring losses to the plan.
  • Requires plan sponsors to give enough funding for the plan.
  • Defines how long someone must work to be eligible for a plan.
  • Sets participation, vesting, benefit accrual and funding standards.
  • Gives participants the right to sue for breaches of fiduciary duties.

Fiduciary Standards Set by ERISA

ERISA has a specific set of standards of conduct for a fiduciary that acts on behalf of a plan’s beneficiary. These include:

  • Prudent Expert Rule. All fiduciaries must be experts in their field of decision-making. Even further, they must act with care and prudence when making those decisions, and should use the skill and diligence of others similarly situated.
  • Exclusive Benefit Rule. The functions performed must be in the interest of the plan’s participants rather than the company or the fiduciary. This helps alleviate the risk for conflicts of interest.
  • Diversification Rule. When a fiduciary has control and authority over the investment, they are required to ensure the assets are best diversified. This helps lower the risk for a huge investment loss.
  • Anti- Self-Dealing Rule. Every action must be conducted without any conflict of interest, along with any self-dealing. Under this rule, every type of prohibited transaction is legally required to be avoided.
  • Plan Documents Rule. The fiduciary is legally required to follow the terms and conditions of the plan. This means the fiduciary, no matter how well-meaning, cannot make decisions that fall outside of the plan in place.

If you have concerns about your retirement plan funds, talk to one of our Pennsylvania Workers Compensation lawyers at Vanasse Law today. We will help you navigate the intricacies of ERISA law.

Never Returning to Work is Not a Reasonable Accommodation

In a recent ruling, the Fifth Circuit Court of Appeals have reaffirmed that not returning to work is not considered a reasonable accommodation. The ruling came from a case where an employee felt he had accrued enough time and benefits to leave until the day after he was set to retire.

When there is no way to provide reasonable accommodations for an employee, or their leave has been deemed indefinite by a medical professional, the options in returning to work are limited. However, this does not leave the employer on the hook with an empty desk chair, even under the ADA.

Even if a worker is not considered permanently disabled, how well they can function in their essential duties can heavily impact whether they can be afforded accommodations. Additionally, an employee cannot leave work without a specific date in which they will return, nor can they leave without any intent of returning, even in the case where they have accrued time enough to retire.

What if I can’t return to work?

Medical Expenses and Workers Comp in Lancaster, PASometimes, returning to work is not an option. However, workers still have options to help them through these difficult times. If you are physically able to work but cannot perform the essential function of your job, you may qualify for the Supplemental Job Displacement Benefit. This is issued when you have reached Maximum Medical Improvement but your employer does not offer a job in which you can perform.

This benefit program helps to pay for necessities to return to work, such as a computer and re-vocational training. In some cases, you may also be able to get a re-vocational counselor to help with the transition.

It is important to know employers are not required to offer the same position as they do under FMLA leave. This means an employer can get a worker back in the workplace sooner under a new role, or training for a different position may be available. However, it could also mean a worker may not be as happy upon return. Planning ahead for these nuances could help both the employer and the employee find a solution to work best for the situation.

If you are unable to return to work, contact our Pennsylvania Workers’ Compensation lawyers at Vanasse Law today to find out your options. We will help develop a plan for your next stage of life.