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Archive for the ‘Workers’ Compensation’ Category

Do Temporary Workers Have Access to Workers’ Compensation Insurance?

Back Injury - Lancaster Workers Comp - Vanasse LawSummer is on the horizon, and that means that students and teachers are going to be searching for employment. Whether you’re enmeshed in the 9-months-per year world of education or seek temporary or seasonal work for any other reason or at any other time of year, temporary workers are an important part of the workforce. Where full time and part-time employees are entitled to workers’ compensation insurance in case they get hurt on the job, many seasonal workers wonder whether temporary workers also have access to these important protections.

Workers’ compensation insurance exists to provide medical expenses and wage replacement for injuries or illnesses that occur on the job or as a result of the job. Injured workers can file claims to have their medical expenses fully compensated, while wages are reimbursed at a specified rate and percentage based on established schedules. In the state of Pennsylvania, this coverage is extended to temporary and seasonal workers, though there can sometimes be questions as to who is responsible for providing them with coverage.

The reason for this confusion revolves around who has actually hired the employee. If a temporary worker has applied directly to a company for a job and that company has employed them, then that company is responsible for providing their workers’ compensation coverage: the injured employee would report their injury directly to them and they would be listed as their employer on their workers’ compensation claim. But many temporary workers are placed in jobs through staffing or placement agencies that they list themselves with, and that means that the agency is their employer. Their workers’ compensation insurance is provided by the staffing agency unless their contract with the employee or the contracting client specifically states otherwise.

To apply for workers’ compensation, a temporary worker needs to report their injury to the company that has hired them. The notification should include details such as when and where the injury took place and how the injury occurred. Workers’ compensation is a no-fault type of insurance, so workers do not need to worry about attributing blame or having made a mistake before their injury. If you are a temporary or seasonal worker who has suffered an injury and you need more information on your rights, contact us today to set up a convenient time to meet and discuss your case.

Pennsylvania’s Amish and Mennonite Communities Skip Workers’ Compensation Due to Religious Exemption

workers' compensation

When employees in the state of Pennsylvania are injured on the job, they can rest secure in the knowledge that their medical expenses and time away from work is covered by Workers’ Compensation insurance. But few realize that if they are working for a company owned by either Amish or Mennonite owners, there is a chance that no such insurance coverage has been purchased for them. This is because Pennsylvania’s religious exemption laws permit participation in what is an otherwise mandated form of protection.

The Amish and Mennonite religions specifically bar against insurance. The religious sects make it an employer’s responsibility to pay the expenses for an injured worker on their own. The religions emphasize personal responsibility and, as a result, Amish businesses also don’t have to purchase commercial liability insurance. Ironically when considering companies that do not have to pay workers’ compensation, they are also granted an exception to U.S. Department of Labor workplace safety rules involving the use of hard hats.

The Amish have long argued against having to pay insurance premiums, as they say they will never make a claim because it is against their religious beliefs, which mandate taking care of their own liabilities. They also believe that filing an insurance claim goes against the Biblical principles of trusting in God. Many pay into separate church aid funds, which they are able to tap if they are unable to afford an injured workers’ expenses on their own.

An article published in the Philadelphia Inquirer several years ago highlighted this practice while discussing the disparity of prices charged between Amish businesses and non-Amish businesses. Though owners of the non-Amish businesses blamed the price differential on the Amish not having to purchase workers’ compensation insurance, the paper’s investigation revealed that not all firms take advantage of the religious exemption. Those who do generally set up their businesses as partnerships, with each member named as an owner. This exempts them from having to have workers’ compensation.

The religious exemption for Amish employers that nullifies their requirement to provide workers’ compensation coverage for their employees can create a dilemma for an employee working for the firm who is injured on the job. What are they to do if they are injured and their employer has not purchased insurance to cover their injuries? In instances like these, you need an experienced and knowledgeable workers’ compensation attorney who can work as your advocate. Contact us today to learn how we can help.

Is PTSD a Valid Basis for a Workers’ Compensation Claim?

PTSDWe’ve all heard of PTSD or Post-Traumatic Stress Disorder. It first came into the lexicon in association with military personnel who had witnessed trauma that affected them psychologically or physically, but the term has now been extended to apply to anybody that has been exposed to a severe shock such as an accident or a terrorist attack. Just as injuries that can happen outside of work can also happen on the job, the same is true of PTSD. This means that if a traumatic event occurs in the workplace an employee requires treatment or is unable to function as a result, it is a valid basis for a workers’ compensation claim.

It is important to understand that there is a significant difference between PTSD and other mental injuries that might result from an unpleasant workplace. An employee who finds themselves experiencing anxiety because of a disruptive co-worker or depression because of losing their job is not entitled to workers’ compensation benefits. Hating your job is not the same as PTSD. Post-Traumatic Stress Disorder that is work related is very specifically a psychological injury that is caused by a psychological stimulus that represents an abnormal working condition: a person cannot successfully be approved for workers’ compensation benefits because their boss favors other employees over them but may be able to if they witnessed their boss physically attacking another employee.

PTSD can also be a result of having suffered a physical injury or illness on the job. In other words, an employee who suffered a horrific burn, or who fell off a scaffold and was badly injured, as a result, could conceivably suffer the symptoms associated with PTSD in the aftermath. These symptoms include:

  • Having flashbacks or nightmares in which they relive the accident
  • Becoming fixated on the accident
  • Withdrawing emotionally and becoming depressed or anxious as a result of the accident
  • Being in a constant state of anger or stress following the accident
  • Having difficulty sleeping after the accident

PTSD is generally treatable through medication, therapy, or a combination of the two. Workers’ compensation benefits can provide for these medical expenses, as well as for temporary disability if the condition prevents you from returning to work. For more information on filing a workers’ compensation claim for your PTSD diagnosis following a workplace event or injury, contact us today.

How Do Insurers Investigate a Workers’ Compensation Claim?

investigate a workers' compensation claimThough the vast majority of workers’ compensation claims are filed by people who have suffered legitimate injury or illness on the job, there is a small percentage of people who file fraudulent claims. As a result, workers’ compensation insurers need to investigate suspicious filings to make sure that they are valid. Though it may feel intrusive to those who simply want to get better or get the compensation they deserve, the work is also necessary: workers’ compensation fraud perpetrated by both employers and employees account for 25 percent of all insurance fraud. The news media has covered some of the most notorious of these crimes, including a woman who claimed to have been disabled and then appeared doing something strenuous on a daytime television game show, and another employee who was videotaped water skiing.

To rout out this type of crime, investigators use several different investigative techniques, including:

  • Video and audio surveillance – Investigators can follow an individual worker around and record evidence that shows that they are not as disabled as they claim to be.
  • Social media surveillance – Investigators can review social media postings that provide contradictory evidence of disability.
  • Interviews with colleagues and others – Investigators are able to question friends and family members, co-workers, and others in a claimant’s community to determine whether their claims are legitimate.
  • Background checks and medical records research – Investigators can look into a claimant’s medical records to determine whether their reported illness or injury was actually a pre-existing condition. They can also pull records on previous insurance claims.

Though workers’ compensation insurance investigators may seem like the enemy, it is important to understand that workers’ compensation attorneys also investigate insurers and employers to make sure that claims are being appropriately paid. It is also important to note that there are limits to how far investigators for workers’ compensation insurance companies are allowed to go while pursuing their investigations. They are not permitted to be deceptive in their approach, and those that have used deceptive tactics have faced successful legal action.

Workers’ compensation insurance fraud is a crime that costs all of us. It drives up the rates of workers’ compensation insurance premiums and makes it more challenging for those who have been legitimately hurt on the job to get the compensation and benefits that they deserve. If you have been hurt on the job, contact us today to set up a consultation to discuss your case.

How Does the Farm Labor Exemption Affect Workers’ Compensation in Pennsylvania?

Workers Compensation - TractorWorkers’ compensation is a no-fault form of insurance that covers injuries that workers incur on the job. It is available for the protection of both the employer and the employee. For the employee, it provides compensation for medical expenses for injuries or illnesses that occur on the job, as well as compensation for lost wages and disability if applicable. For the employer, workers’ compensation offers protection against getting sued for injuries that take place on your farm: the availability of insurance precludes the workers’ right to file a personal injury claim. Though there is a Farm Labor Exemption for certain farm sites in Pennsylvania, most farms in the Commonwealth will not qualify for these exemptions, as they generally only apply to extremely small operations who hire workers for very short periods of time.

Pennsylvania’s Workers’ Compensation Act has a subsection that is specifically devoted to agricultural worksites. This section indicates that workers’ compensation is to be provided for employees if during a calendar year they pay wages to a single employee totaling $1,200 or more, or who employs a single employee for 30 or more days. Even if the farm has just one employee that meets that description, the workers’ compensation insurance coverage needs to be provided for all employees. The employers’ spouse or child under the age of 18 is not considered an employee under the law unless there is a specific written employment contract in place.

Many farm owners in Pennsylvania make the mistake of believing that they do not need to have workers’ compensation insurance because of the agricultural employee exemption, but the only farms for which this applies are generally those who only hire seasonal labor for extremely short periods of time. If an employer is required under the state’s rules does not purchase workers’ compensation insurance, they can be penalized for their failure to do so. They are also likely to be held liable for any injury that occurs on the job as a result of negligence.

If you are an agricultural worker who has been injured on the job, you are entitled to compensation for your injuries, but you need an experienced workers’ compensation attorney to guide you through the process and advise you of your rights. Contact the attorneys at Vanasse Law today to learn more.

What Injuries are NOT Covered by Workers’ Compensation?

Work Injury - Stepping On A NailTo most people, workers’ compensation is little more than a line item in their paycheck. They don’t know whether it’s something that they pay for or whether it’s provided by their employer, and they’re not entirely sure what it’s there for. That all changes once you’re injured on the job and suddenly realize that it’s there for you – to make sure that your medical expenses are covered, and you’ll be able to pay your bills, even if your injury keeps you from going back to work. Though workers’ compensation is what’s known as a ‘no-fault’ insurance policy that’s paid without having to prove who’s at fault, there are a couple of notable exceptions.  Here are the circumstances under which injuries sustained at work are not covered.

  • Being intoxicated or having used illegal drugs. If you fall at work and you hurt yourself, it doesn’t matter whether it happened because the floor was slippery or because you weren’t watching where you were going: you’re covered either way. But if you fell because you were high, or it’s discovered that you’d been drinking, you are not entitled to workers’ compensation benefits.
  • Injuries that are self-inflicted or a result of having started a fight. It’s hard to imagine, but there have been unethical employees who have purposely hurt themselves at work to try to collect workers’ comp. Not only are those injuries not covered, but neither are injuries sustained in an on-the-job fight if you’re the one that instigated it.
  • Injuries sustained while committing a serious crime or while violating company policy. Rules are rules, and whether they are federal laws, state or local rules, or the rules that are posted in your company’s employee manual, if you’re breaking them and you hurt yourself while you’re doing it, then you lose many of your privileges, including workers’ compensation benefits.
  • Injuries sustained while not on the job. Being an employee does not mean that you’re always covered by workers’ compensation. If you’re hurt on your day off and you’re not working, then you’re not covered by workers’ compensation – even if you’re visiting the job site. However, if you’re off-site and working, or running a work-related errand then you are eligible for workers’ compensation benefits

If you’ve been hurt while on the job and you’re not sure whether workers’ compensation benefits are available to you or not, contact the workers’ compensation attorneys at Vanasse Law to set up a consultation to discuss your situation.

Are There Advantages to a Lump Sum Settlement Rather than a Structured Settlement?

Tort Personal InjuryLump Sum Settlements

A lump sum settlement pays your workers’ compensation payment on a full and final basis, closing your claim. The disadvantage of this is that you will not be able to file any additional treatments that you need later or any additional diagnosis that may arise as a result of the injury. The biggest advantage of a lump sum settlement would be the ability to invest the money in a way that might provide you with an additional source of income.

Structured Settlement

A structured settlement provides guaranteed payments, usually on a weekly, monthly or annual basis. It may be set up as a payment for a specific duration, or it may be set up as a payment for the rest of the injured worker’s life. The advantages of a structured settlement are twofold: first, it guarantees income over an extended period, providing for both medical expenses and living expenses. It also has the advantage of being paid in nontaxable payments, where the interest earned on a lump sum settlement will be taxable. The downside of a structured settlement is that if you decide in the future that you’d prefer to have all the balance of your compensation paid out in a single payment, it may be impossible or subject to financial penalties.

Making the decision between a lump sum or structured settlement requires careful thought and consideration of your needs and level of discipline. There’s no doubt that a structured settlement will prevent you from spending more than you should and provide you with a completely reliable source of income. For guidance on this and other workers’ compensation questions, contact Vanasse Law to set up a personal consultation.

What is a Judge Able to do in a Workers’ Compensation Case in PA?

workers compensationWhile it is considered common knowledge that Workers’ Compensation cases go before a judge, it is often not understood what role a judge plays in such a case. Even further, it is not typical that the average worker knows what power the judge has or what the judge is able to do or accomplish during such a case. However, understanding that role could mean a stronger case and a more informed worker. When it comes to collect these benefits, being a self-advocate and understanding your rights is imperative.

Getting the right lawyer is the most important element. Lawyers have a deep understanding of the role and power of a judge, which enables them to make different legal decisions to strengthen a case and move things along. However, knowing this on your own can only help your case.

What Does the Judge Do?

The first thing a judge in Pennsylvania must do when considering a Workers’ Compensation case is to determine whether mediation is required, which is often the case. In fact, some judges force all cases to go to mediation first. Other judges only require mediation when it seems the action will lead to a quicker conclusion. Mediation in Workers’ Compensation cases entails sitting both parties down, meaning the injured worker and the insurance company with their respective legal counsel, to attempt to find a settlement during a neutral discussion.

In mediation, the judge cannot force a decision. Instead, the two parties must work together to find a settlement both can agree on. The judge sitting on the mediation will promote compromise but is not in the position to force it or make a judgment. In these cases, it’s best to refer to your own legal counsel, who is the only one with your individual interests in mind, as the judge is looking for a quicker conclusion. When proposals are made, you are free to reject them as there is not a judgment being made. If a conclusion is reached, a compromise and release hearing must be held.

Court

If an agreement was made in mediation, the judge must ensure the injured worker understands the legal significance of the agreement and that they understand what the worker is doing by settling the case. The judge does not have the power to reject an unfair settlement, but it is their duty to ensure the worker knows what they are gaining and giving up for their settlement. For instance, the worker should know if they are getting a lump sum or how long monthly payments will last. Only the plaintiff and their legal counsel can accept or reject an offer.

At the end of the day, having the right lawyer is what makes or breaks a Workers’ Compensation case. Contact our team today to find out how we can help with your Workers’ Compensation claim.

Fact or Fiction: Important Information on Workers’ Compensation, Part Two

workers compensationWading through the waters of Workers’ Compensation can lead to a lot of confusion and misinformation. By understanding ahead of time what the common myths and the real truth behind them, workers can better advocate on their own behalf when it comes to filing for benefits. In the last post, we covered two myths and one truth, continuing with other common misconceptions below.

Fiction: Technology Will Solve All Problems

While technology has certainly helped the claim process and made it simpler, it won’t solve everything. The advances that have been made in recent years have worked wonders in making things operate smoother and creating a faster and more efficient way to file claims. However, there are now too many companies that put their focus on decisions based on technology selection rather than looking at the end result.

Having foresight is not something technology can accommodate. Instead, technology should be used for identifying what needs to be accomplished and tracking solutions. However, technology should not be relied on for creating goals and individualization of solutions.

Fact: Private Sector Case Management Practice Work, even in FECA

Many believe that due to the differences between state Workers’ Compensation systems and FECA, the best practices associated with private sector case management won’t work as well. Evidence, however, suggests that the best practices work in both, despite the often-cited differences such as federal agencies’ inability to choose a third-party administrator, no settlements, 45 days of continuation of regular pay, a lack of system for routine utilization review, free choice in the treatment provider, and the limited clinical resources.

However, the best practices include agency directed case management over the phone, intervention at an early time, a focused approach to case management, initiatives for stay-at-work and return-to-work initiatives, and trend analysis for metrics and audits. These practices can be applied to both FECA and private sector case management as they address many of the same issues they both have.

The best course of action when it comes to Workers’ Compensation claims is to find the right legal counsel. At Vanasse Law, we understand the Workers’ Compensation process in Pennsylvania and will put our experience to work for your claim’s success. Contact us today to find out more.

Fact or Fiction: Important Information on Workers’ Compensation, Part One

workers' compensation disabilityUnderstanding the system in the benefits being part of the workforce makes available shouldn’t require a law degree. There is a lot of misinformation about Workers’ Compensation benefits out there, which leads to many injured workers not filing for benefits when they should. By separating fact from fiction, it is much easier to navigate through the myths that surround Workers’ Compensation.

Fiction: The Best Bet in Workers’ Compensation is Using Large Networks

The price might be right, but large discount networks can be unsustainable. There has been a plateau, for the most part, in which these networks can control medical cost. Having a layered approach to coverage is a better way to see what is being spent and where. Every employee is unique, so every company won’t need the same one-size-fits-all approach. While that approach can work well with vehicles, human beings don’t all face the same dangers that cars do. Instead, we all have different occupations and are at risk for different injuries. While each car drives on the road, risking collisions, there is a major difference in the occupational diseases that may befall a desk worker compared to a miner.

Fact: Employers Have a Continued Role, Even After a Claim is Paid

In fact, it is after the claim is paid when an employer plays the most pivotal role. The employer must make regular contact with the employee to stay abreast of the changes in the healing process which can help inform the approach to the employee’s return to work. While 86% of companies have a return to work program, very few have finessed a program that helps workers slowly return to work based on where they are in their recovery. By maintaining regular contact, it is much easier to know when the right time is to reintroduce them slowly into the workplace.

Fiction: Claims Get Better Over Time

In most cases, they can actually become more complex. Many adjusters assume that the person will go through a healing process, leading to fewer and fewer expenses until the bills end. But this is more often false than true. In the past decade, medical costs have inflated by 48% which means the same medical treatments will increase in cost, even if the treatment doesn’t change. In some cases due to inflation, someone could receive less care and cost more down the line. Further, the longer someone is out of work, the more likely it is that they won’t return.

Getting the most out of your claim can come down to having the right legal counsel on your side. Contact our team at Vanasse Law today to find out how we can help guide you through the Workers’ Compensation process.