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MEGAN MEDICAL AND PHYSICAL THERAPY.
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FOR GREEN CARD/VISA MEDICAL EXAMS-WE CAN SEE YOU.=CALL US TODAY FOR NEXT SERVICE DATE-NO APPOINTMENT NECESSARY.
PHYSICAL THERAPY FOR WORKMAN'S COMPENSATION CASES MOTOR VEHICLE ACCIDENTS AND SLIP AND FALLS.
MEDICAL CONSULTATION FOR CHECKUPS.NEW WORK/ JOB PHYSICALS, CNA PHYSICALS JUST 40
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THIS MONTH'S FEATURED ARTICLE:
The 14 Most Common Health Concerns for Seniors
Getting older can bring senior health challenges. By being aware of these common chronic conditions, you can take steps to stave off disease as you age
People in America today can expect to live longer than ever before. Once you make it to 65, the data suggest that you can live another 19.2 years, on average. For many, then, senior living includes carefully managing chronic conditions to stay healthy. “You need to be physically active and eat a healthy diet" and also make healthy lifestyle choices, like quitting smoking and losing weight, to avoid senior health risks, explained Jeanne Wei, MD, director of the Institute on Aging at the University of Arkansas Medical School in Little Rock. Also, including a geriatrician, a doctor who specializes in the health concerns of aging, on your senior health care team can help older adults learn how to live better with any chronic diseases. Then you too can be among the 76 percent of people over 65 who say their health is good or excellent.
Arthritis
“Arthritis is probably the number one condition that people 65 or older contend with,” said geriatrician Marie Bernard, MD, deputy director of the National Institute on Aging in Bethesda, Md. It affects about 51 percent of all adults over 65 and can lead to pain and lower quality of life for some seniors. Although arthritis can discourage you from being active, it’s important to work with your doctor to develop a personalized activity plan that, along with other treatment, can help maintain senior health.
Heart Disease
According to the U.S. Centers for Disease Control and Prevention (CDC), heart disease remains the leading killer of adults over age 65, accounting for 1,156 deaths per 100,000 people in 2009, the most recent statistics. As a chronic condition, heart disease affects 37 percent of men and 26 percent of women 65 and older. As people age, they're increasingly living with risk factors, such as high blood pressure and high cholesterol, that increase the chances of having a stroke or developing heart disease. Dr. Bernard’s advice for addressing this senior health risk not only helps with heart disease but can improve senior health across the board: “Exercise, eat well, get a good night’s rest. Eating well means eating in a fashion that will allow you to keep a healthy weight with a well-balanced and healthy diet."
Cancer
Cancer is the second leading cause of death among people over age 65, with 982 deaths a year per 100,000 people. According to the CDC, 28 percent of men and 21 percent of women over age 65 are living with cancer. If caught early through screenings such as mammograms, colonoscopies, and skin checks, many types of cancer are treatable. And though you're not always able to prevent cancer, you can improve quality of life as a senior living with cancer, including during treatment, by working with your medical team and maintaining their healthy senior living recommendations.
Respiratory Diseases
Chronic lower respiratory diseases, such as COPD, are the third most common cause of death among people 65 and older, annually taking 291 lives per 100,000 people. About 10 percent of men and 13 percent of women are living with asthma, and another 10 percent of men and 11 percent of women are living with chronic bronchitis or emphysema. Although having a chronic respiratory disease increases senior health risks, making you more vulnerable to infections such as pneumonia, getting lung function tests and taking the correct medications or using oxygen as instructed will go a long way toward preserving senior health and your quality of life.
Alzheimer’s Disease
Alzheimer’s disease accounts for about 184 deaths per 100,000 people over age 65 each year. The Alzheimer’s Association reports that as many as 5 million adults over 65 live with Alzheimer’s disease, but because diagnosis is challenging, it’s difficult to know exactly how many people are living with this chronic condition. However, experts acknowledge that cognitive impairment has a significant impact on senior health across the spectrum, from issues of safety and self-care to the cost burden of care in the home or a residential facility.
Osteoporosis
“Osteoporosis can contribute to becoming less mobile and potentially disabled should you fall and have a fracture or as the collapse of vertebral bodies,” Bernard said. The National Osteoporosis Foundation estimates that 52 million Americans are affected by low bone mass or osteoporosis, putting them at risk for a fracture or break that could lead to poor senior health and reduced quality of life.
Diabetes
About 24 percent of men and 18 percent of women older than 65 are living with diabetes, a significant senior health risk. According to CDC data, diabetes causes 121 deaths annually among 100,000 adults over age 65. Diabetes can be identified and addressed early with simple blood tests for blood sugar levels. The sooner you know that you have or are at risk for diabetes, the sooner you can start making changes to control the disease and improve your long-term senior health outlook.
Influenza and Pneumonia
Although the flu and pneumonia are not chronic conditions, these infections are among the top seven causes of death in people over age 65, at 104 per 100,000 adults a year. Seniors are more vulnerable to these diseases and less able to fight them off. Senior health care recommendations include getting an annual flu shot and getting the pneumonia vaccine if recommended by your doctor to prevent these infections and their life-threatening complications.
Falls and Other Injuries
The number of physical injuries from falls, accidents, and violence is hard to track, but data from the CDC suggest that 29.1 percent of emergency room visits by seniors are related to injury and 13.5 percent are due to unintentional falls. It's also known that the risk for falls requiring emergency room care increases with age. Most falls occur in the home, where tripping hazards include area rugs and slippery bathroom floors, according to the January 2013 issue of the Journal of Injury and Violence Research.
Substance Abuse
An analysis of data from the National Epidemiologic Survey of Alcohol and Related Conditions suggests that one in five people over 65 have had a substance or alcohol abuse problem at some point in their lives. Alcohol and tobacco topped the list of nonmedical substances abused by survey participants. Substance and alcohol abuse are a concern for senior health because of possible interactions with prescription medications, their impact on overall health, and the increased senior health risks, such as falls, associated with intoxication.
Obesity
About 40 percent of adults 65 to 74 years old are obese, although that proportion drops somewhat after age 75, to 27.8 percent. Obesity is an important senior health risk factor for heart disease, diabetes, and cancer -- chronic conditions that impact quality of life. It can also be a signal that an older adult isn’t as active or mobile as he or she once was.
Depression
About 16 percent of women over age 65 and 11 percent of men of that age report symptoms that suggest clinical depression, a threat to senior health. Depression appears to become more common as people age. In addition to treatment with medication and therapy to improve mood, possible solutions to improve senior living might be to increase physical activity -- only 11 percent of seniors meet national recommendations for exercise -- or to interact more socially -- seniors report spending just 8 to 11 percent of their free time with family and friends.
Oral Health
Healthy teeth and gums are important not just for a pretty smile and easy eating, but also for overall senior health. According to the CDC, 25 percent of women and 24 percent of men over 65 have no natural teeth. As you age, your mouth tends to become dryer and cavities are more difficult to prevent, so proper oral health care, including regular dental checkups, should be a senior health care priority, Dr. Wei said.
Poverty
About 9 percent of adults over 65 are living in poverty. Older women are slightly more likely than men to be living in poverty, and single older adults are also significantly more likely to live alone with fewer resources. Poverty affects senior health if you're unable to afford doctor visits, medication for chronic conditions, and other essential senior health care needs.
The 14 Most Common Health Concerns for Seniors
Getting older can bring senior health challenges. By being aware of these common chronic conditions, you can take steps to stave off disease as you age
People in America today can expect to live longer than ever before. Once you make it to 65, the data suggest that you can live another 19.2 years, on average. For many, then, senior living includes carefully managing chronic conditions to stay healthy. “You need to be physically active and eat a healthy diet" and also make healthy lifestyle choices, like quitting smoking and losing weight, to avoid senior health risks, explained Jeanne Wei, MD, director of the Institute on Aging at the University of Arkansas Medical School in Little Rock. Also, including a geriatrician, a doctor who specializes in the health concerns of aging, on your senior health care team can help older adults learn how to live better with any chronic diseases. Then you too can be among the 76 percent of people over 65 who say their health is good or excellent.
Arthritis
“Arthritis is probably the number one condition that people 65 or older contend with,” said geriatrician Marie Bernard, MD, deputy director of the National Institute on Aging in Bethesda, Md. It affects about 51 percent of all adults over 65 and can lead to pain and lower quality of life for some seniors. Although arthritis can discourage you from being active, it’s important to work with your doctor to develop a personalized activity plan that, along with other treatment, can help maintain senior health.
Heart Disease
According to the U.S. Centers for Disease Control and Prevention (CDC), heart disease remains the leading killer of adults over age 65, accounting for 1,156 deaths per 100,000 people in 2009, the most recent statistics. As a chronic condition, heart disease affects 37 percent of men and 26 percent of women 65 and older. As people age, they're increasingly living with risk factors, such as high blood pressure and high cholesterol, that increase the chances of having a stroke or developing heart disease. Dr. Bernard’s advice for addressing this senior health risk not only helps with heart disease but can improve senior health across the board: “Exercise, eat well, get a good night’s rest. Eating well means eating in a fashion that will allow you to keep a healthy weight with a well-balanced and healthy diet."
Cancer
Cancer is the second leading cause of death among people over age 65, with 982 deaths a year per 100,000 people. According to the CDC, 28 percent of men and 21 percent of women over age 65 are living with cancer. If caught early through screenings such as mammograms, colonoscopies, and skin checks, many types of cancer are treatable. And though you're not always able to prevent cancer, you can improve quality of life as a senior living with cancer, including during treatment, by working with your medical team and maintaining their healthy senior living recommendations.
Respiratory Diseases
Chronic lower respiratory diseases, such as COPD, are the third most common cause of death among people 65 and older, annually taking 291 lives per 100,000 people. About 10 percent of men and 13 percent of women are living with asthma, and another 10 percent of men and 11 percent of women are living with chronic bronchitis or emphysema. Although having a chronic respiratory disease increases senior health risks, making you more vulnerable to infections such as pneumonia, getting lung function tests and taking the correct medications or using oxygen as instructed will go a long way toward preserving senior health and your quality of life.
Alzheimer’s Disease
Alzheimer’s disease accounts for about 184 deaths per 100,000 people over age 65 each year. The Alzheimer’s Association reports that as many as 5 million adults over 65 live with Alzheimer’s disease, but because diagnosis is challenging, it’s difficult to know exactly how many people are living with this chronic condition. However, experts acknowledge that cognitive impairment has a significant impact on senior health across the spectrum, from issues of safety and self-care to the cost burden of care in the home or a residential facility.
Osteoporosis
“Osteoporosis can contribute to becoming less mobile and potentially disabled should you fall and have a fracture or as the collapse of vertebral bodies,” Bernard said. The National Osteoporosis Foundation estimates that 52 million Americans are affected by low bone mass or osteoporosis, putting them at risk for a fracture or break that could lead to poor senior health and reduced quality of life.
Diabetes
About 24 percent of men and 18 percent of women older than 65 are living with diabetes, a significant senior health risk. According to CDC data, diabetes causes 121 deaths annually among 100,000 adults over age 65. Diabetes can be identified and addressed early with simple blood tests for blood sugar levels. The sooner you know that you have or are at risk for diabetes, the sooner you can start making changes to control the disease and improve your long-term senior health outlook.
Influenza and Pneumonia
Although the flu and pneumonia are not chronic conditions, these infections are among the top seven causes of death in people over age 65, at 104 per 100,000 adults a year. Seniors are more vulnerable to these diseases and less able to fight them off. Senior health care recommendations include getting an annual flu shot and getting the pneumonia vaccine if recommended by your doctor to prevent these infections and their life-threatening complications.
Falls and Other Injuries
The number of physical injuries from falls, accidents, and violence is hard to track, but data from the CDC suggest that 29.1 percent of emergency room visits by seniors are related to injury and 13.5 percent are due to unintentional falls. It's also known that the risk for falls requiring emergency room care increases with age. Most falls occur in the home, where tripping hazards include area rugs and slippery bathroom floors, according to the January 2013 issue of the Journal of Injury and Violence Research.
Substance Abuse
An analysis of data from the National Epidemiologic Survey of Alcohol and Related Conditions suggests that one in five people over 65 have had a substance or alcohol abuse problem at some point in their lives. Alcohol and tobacco topped the list of nonmedical substances abused by survey participants. Substance and alcohol abuse are a concern for senior health because of possible interactions with prescription medications, their impact on overall health, and the increased senior health risks, such as falls, associated with intoxication.
Obesity
About 40 percent of adults 65 to 74 years old are obese, although that proportion drops somewhat after age 75, to 27.8 percent. Obesity is an important senior health risk factor for heart disease, diabetes, and cancer -- chronic conditions that impact quality of life. It can also be a signal that an older adult isn’t as active or mobile as he or she once was.
Depression
About 16 percent of women over age 65 and 11 percent of men of that age report symptoms that suggest clinical depression, a threat to senior health. Depression appears to become more common as people age. In addition to treatment with medication and therapy to improve mood, possible solutions to improve senior living might be to increase physical activity -- only 11 percent of seniors meet national recommendations for exercise -- or to interact more socially -- seniors report spending just 8 to 11 percent of their free time with family and friends.
Oral Health
Healthy teeth and gums are important not just for a pretty smile and easy eating, but also for overall senior health. According to the CDC, 25 percent of women and 24 percent of men over 65 have no natural teeth. As you age, your mouth tends to become dryer and cavities are more difficult to prevent, so proper oral health care, including regular dental checkups, should be a senior health care priority, Dr. Wei said.
Poverty
About 9 percent of adults over 65 are living in poverty. Older women are slightly more likely than men to be living in poverty, and single older adults are also significantly more likely to live alone with fewer resources. Poverty affects senior health if you're unable to afford doctor visits, medication for chronic conditions, and other essential senior health care needs.
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OUR WORKMAN'S COMP CASES HAVE INCLUDED:
WE HANDLE PAIN. WE HANDLE CASES FOR THE UNINSURED. WE HANDLE WORK RELATED NECK INJURIES, BACK INJURIES,LEG INJURIES AS WELL AS INJURIES TO THE ARM AND HAND .
WE'LL TREAT YOU WHEN OTHERS HAVE STOPPED; AND YOU'RE STILL CASE PENDING......
WE ALSO HAVE CERTIFIED ACUPUNCTURE AND PROLOTHERAPY TREATMENT PROGRAMS FOR YOUR PAIN AND DISCOMFORT.
WE'LL TREAT YOU WHEN OTHERS HAVE STOPPED; AND YOU'RE STILL CASE PENDING......
WE ALSO HAVE CERTIFIED ACUPUNCTURE AND PROLOTHERAPY TREATMENT PROGRAMS FOR YOUR PAIN AND DISCOMFORT.
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WHEN THEY SAY YOU'RE NOT HURT,BUT YOU'RE IN PAIN....WE LISTEN.
SOME OF OUR ADS........
In Pennsylvania the statute of limitations for a workers' compensation claim is three years. If you file a workers' compensation claim and your claim is denied, then you have to file a Claim Petition within three years of the date of the injury or onset of symptoms or you will lose your right to benefits.
YOUR RIGHTS, AS A BUSINESS OWNER.
WORKERS' COMPENSATION FAQS
HEALTH & SAFETY INFORMATION
Q. If I have multiple locations, how many safety committees are required and can they have a centralized committee; or is each location required to have its own committee?
A. An employer may have either a centralized committee or single committees. Ideally for a centralized committee, a representative from each location should be a committee member, but it is not necessary as long as there are measures in place to communicate safety concerns between all locations and safety committee members. If a single committee for each location is elected, then each committee must be approved and must meet all basic minimum requirements.
Q. What must I do to become certified?
A. An employer must meet the basic requirements and complete and submit an application for approval. Requirement information is available on our website at www.dli.pa.gov.
Q. Are safety committees required to meet every month after they are certified?
A. Yes. Safety committees must meet at least monthly, documenting a quorum of committee members present for a minimum of six months prior to signing, dating, and submitting their Initial Application for Certification. Upon certification, safety committees must document monthly meetings thereafter.
Q. My company has been bought by another person or company. Does the certification remain in effect? What name would I list on the Renewal Application?
A. Yes, you are still certified as long as the basic minimum requirements are being met. You would change the name of the company on the Renewal Affidavit and change workplace names as necessary. If you retain the same Federal Employer Identification Number (FEIN), that is all that is required. If you change the FEIN number as well as the company name, you must provide a detailed explanation as to why the FEIN was changed on the Renewal Affidavit.
Q. How is an organization selected for an on-site audit?
A. Each organization of the regulated community (insurers, self-insured employers, group funds and certified workplace safety committees) is assigned a record number. Record numbers are selected by the computer application. The record number is then matched with the “Master List,” which identifies the organization to be audited.
Q. How frequently should an organization expect to be audited?
A. On-site audits began in 1997, and currently less than 12 organizations have had a second on-site audit. The Health and Safety regulations allow for an organization to be audited at least once every two years.COMPLIANCE WITH THE WORKERS' COMPENSATION ACT
Q. Is a subcontractor required to carry workers’ compensation insurance if he/she is a sole proprietor?
A. Sole proprietors with no employees are not required to carry workers’ compensation insurance. However, detailed information must be provided to your insurer to prove that the individual is a true independent contractor. If your insurer determines that the sole proprietor is your employee, you will be charged for his/her payroll as per the appropriate classes on your policy. It is your responsibility to provide your insurer with all appropriate documentation to resolve their employment status.
Q. As owner of a trucking operation, must I show proof of workers’ compensation insurance if I use owner/operator drivers?
A. If an insured utilizes owner/operators and is part of a trucking operation, proof of workers’ compensation insurance coverage may be required. For those drivers deemed to be employees, your insurer will need proof of workers’ compensation insurance coverage. Otherwise, that part of the total remuneration that is wages will be included in the premium calculation. If payroll cannot be obtained, then 1/3 of the contract price will be considered payroll for premium calculation purposes.
Q. Do members of limited liability companies (LLC) have an obligation to ensure workers’ compensation liability on their members?
A. Section 301(a) of the Workers’ Compensation Act (Act), 77 P.S. Section 431, only requires employers to maintain workers’ compensation coverage of their employees. Section 104 of the Act, 77 P.S. Section 22, states that the “employee” as used in the Act is synonymous with servant and includes “[a]ll natural persons who perform services for another for a valuable consideration, exclusive of persons whose employment is casual in character and not in the regular course of the business of the employer…” To the extent that LLCs have no employees, i.e., its only workers are partners, it has no employees and, thus, no workers’ compensation liability. However, should a partner withdraw from the partnership and become an employee or the business adds a part-time or a full-time employee, it would then be required to insure its workers’ compensation liability.
Q. Do family members and minors have to be covered by workers’ compensation insurance?
A. Pennsylvania state law does require you to cover any employee, regardless of the number of hours worked per week or whether the person is your spouse or child. The Pennsylvania Workers’ Compensation Act can be viewed in its entirety on our website at www.dli.state.pa.us or can be obtained in hard copy from the State Bookstore of Pennsylvania, Commonwealth Keystone Building, Plaza Level, 400 North Street, Harrisburg, PA 17120, telephone number (717) 787-5109. You may want to look specifically at Sections 103, 104, 301 and 305(a).SELF-INSURING FOR WORKERS' COMPENSATION
Q. What are the requirements to be self-insured?
A. To be authorized by the Department of Labor and Industry’s Bureau of Workers’ Compensation to self-insure under the Workers’ Compensation Act (Act), an employer must first demonstrate that it has the financial ability to guaranty the payment of all benefits it may incur under the Act while it is approved as a self-insurer and that it has an adequate accident and illness prevention program. See question below for further explanation on financial ability. Additionally, an approved self-insurer must post security, such as a bond or letter of credit, covering its liability; must purchase excess insurance to protect it and its workers from losses resulting from a large claim or a catastrophic situation; and, must arrange for the proper adjusting and administration of its potential claims, either through in-house resources or the retention of an authorized claims services company.
Q. What factors does the Bureau of Workers’ Compensation consider in determining whether an applicant has the financial ability to self-insure?
A. In determining whether an applicant has the financial ability to self-insure, the Bureau first considers whether an applicant has the financial resources and capacity to liquidate easily the liability it could incur as a self-insurer, including the liability resulting from a catastrophe. The Bureau analyzes the applicant’s liquid assets, exposure to large losses, and excess insurance protection in making this determination. A successful applicant for self-insurance must also show that its current long-term financial condition and solvency indicates that it will be available and able to liquidate in the future the liability incurred as a self-insurer. The Bureau performs an analysis of an applicant’s audited financial statements and reviews other financial information in its consideration of an applicant’s financial health.
Q. How much security must a self-insured post with the Bureau of Workers’ Compensation?
A. The Bureau’s regulations require a private sector self-insurer to post security in the amount equal to or greater than the self-insurer’s outstanding liability for workers’ compensation plus a standard additive calculated by formula. The self-insurer’s amount of outstanding liability is calculated by the Bureau, generally using actuarial loss development techniques, or the outstanding liability is calculated by an independent actuary retained by the self-insurer.
Q. What annual special fund assessments do self-insurers pay and how much are they?
A. Self-insured employers must pay annual assessments for the maintenance of the Workmen’s Compensation Administration Fund, the Workmen’s Compensation Supersedeas Fund, the Subsequent Injury Fund, and the Self-Insurance Guaranty Fund. Assessments against a self-insurer are based on its pro rata share of all compensation paid by all self-insurers and insurers in the calendar year prior to a particular assessment multiplied against the amount needed to finance the operation of the special fund. While assessment rates vary each year depending on the amount needed to maintain the special funds and the amount of compensation paid, generally, total assessments against a self-insurer for all special funds have been averaging between 4 percent to 5 percent of the amount of compensation it paid in the prior year.
CLAIMS:
Q. How do I request my claims records?
A. Your request must be made in writing and either mailed or faxed to the Bureau of Workers’ Compensation. If you are representing the injured worker or are a party to the claim, you must specify your relationship in the request. Requests should be sent to:
Records Section, Claims Management Division
Bureau of Workers’ Compensation
1171 S. Cameron St., Room 109
Harrisburg, PA 17104-2501
Fax: 717-783-6365 or 717-783-6366
Q. How long does it take to get results to a request for records?
A. Processing usually takes about 7 to 10 days – depending upon the availability of records.
Q. I received a letter about a missing FEIN number. Can I give you the information over the telephone?
A. Yes, you can give this information by calling 717-787-3561.
Q. Why can’t I print a copy of the form I submitted over the Internet?
A. The form may be printed after it has been submitted using the print button provided on the screen. If you would like to print the form from the summary screen prior to submission, do a right click on your mouse to show the print command and left click on the print command to print. Note: The summary screen should only be used to review your data as you have filed your form at this point.
Q. How do you measure compliance with the 21-day filing requirements of the Workers’ Compensation Act?
A. The disability date or employer-notified date, whichever is later, is deducted from the file date to determine whether a particular filing is timely. The file date is the date the Bureau of Workers’ Compensation receives the form unless there is a legible, United States postal mark present on the envelope. In the case of a United States postal mark, the file date is the date of the postal mark.
Q.What is SWIF's written premium for 2015 and 2016?
A.2015 = $216,000,000
2016 = $187,000,000
Q.What is SWIF's Lost Cost Multiplier?
A. As of April 1, 2017: Commercial 3.187% and Coal 1.904%
Q.What is SWIF's calendar year loss ratio for the past three years?
A.2014 - 119.5%
2015 - 117.63%
2016 - 97.2%
(percentages are tentative pending SWIF's reserve estimate completion)
AS A WORKER.
QUESTIONS AND ANSWERS:
Q.What is a PPO?
A. A PPO is a Preferred Provider Organization, it is a list or “panel” of designated health care providers specializing in workers’ compensation by providing goal oriented medical treatment from board certified physicians that will facilitate a prompt recovery and a successful return to work.
Q.Why post a panel?
A.The Pennsylvania Workers’ Compensation Act gives employers the right to establish a panel of designated health care providers, when properly posted in the workplace and acknowledged by all employees, injured workers must seek treatment for their work related injuries with one of the designated providers for 90 days from the date of the first visit.
Q.Why is SWIF offering a panel of providers?
A.SWIF realizes that it’s vital that businesses take prudent steps in controlling their workers’ compensations costs.
Q.What are the benefits of posting a panel?
A.Reduced workers’ compensation medical and indemnity costs, a goal orientated treatment plan for your injured workers and improved treatment outcomes.
Q.How can I get my own panel from SWIF?
A.Contact Cathleen Fitzpatrick at 717-728-5502 ext. 1117 or by email at cfitzpatrick@hooverinc.com.
Q.Does SWIF have a Pharmacy Program?
A.Yes, administerd through KeyScripts.
Q.If I’m an injured worker how will I receive my prescription card?
A.Injured workers with compensable claims will automatically receive a pharmacy card listing the 4 closest pharmacies near your home.
Q.What are the benefits in using this service?
A.You will receive your prescriptions faster, pay nothing out of pocket, reduce unnecessary phone calls and become eligible for home delivery.
Q.How can I receive additional information on SWIF Pharmacy program?
A.Contact KeyScripts at 1-866-446-2848 with questions, or to locate the KeyScripts Network pharmacy nearest you.
Q.What is a Return to Work Program (RTW)?
A. A RTW program is a proactive approach in restoring injured workers back to their former lifestyle in the safest and most effective manner possible.
Q.Why implement a RTW Program?
A.Workplace injuries, illnesses and accidents are costly to the employer and the employees. Preventing injuries is the best way to protect workers while controlling workers compensation costs. Employers and workers need a way to manage injuries if they occur. An effective RTW program assists in assuring that the worker obtains medical care during the initial stages of recovery, and during the subsequent return to productive employment.
Q.What are the benefits of a RTW program?
A.For the Employer - Reduced staff turnover and training costs, reduced fraudulent claims, saves indemnity expenses, overtime costs, improve morale and employee relations.
For the Employee - Increase self-esteem, contributes to a faster recovery by keeping the injured worker mentally and physically conditioned, maintains social contact with fellow employees and reduces negative financial impact many injured employees experience.
Final Result - A Win-Win for everyone.Back to Top
UNDERWRITINGQHow does SWIF price Workers' Compensation coverage?
ASWIF assigns the appropriate classification code(s) and multiplies the rate by every $100 of payroll to produce the base premium. The base premium is then multiplied by any applicable Experience Modification or Premium Discount. The total is the Estimated Annual Premium.
Q.When does Minimum Premium apply?
A.The minimum premium applies whenever the actual premium is less than the minimum premium for the selected classification code(s).
Q.What is an Officer Exemption Form (LIBC 509 - Application for Executive Officer Exemption; LIBC 513 - Executive Officer Declaration), and when is it needed?
A.An Officer Exemption Form is a notice of rejection for Workers' Compensation coverage. When an Officer of a Corporation elects not to be covered by Workers' Compensation, they complete an "Application for Executive Officer Exemption Form" (LIBC 509) and an "Executive Officer Declaration Form" (LIBC 513). An Officer Exemption Form is only necessary for Corporations, since Sole Proprietors and Partners are automatically excluded from coverage. These Forms can be obtained from SWIF or the Bureau of Workers' Compensation, 1171 S. Cameron Street, Harrisburg, PA 17104-2501; telephone (717) 787-3567.
Q.Are employees covered while working in another state?
ASWIF does not provide Workers' Compensation Insurance coverage for states other than Pennsylvania. It does, however, afford coverage for Pennsylvania hired employees who are injured out-of-state pursuant to the Extraterritorial Provisions of the Workers' Compensation Act. Although it is a very fact specific area of the law, the general rule is that coverage will be afforded to an individual hired in Pennsylvania, but assigned to work out-of-state on a temporary basis. Any benefits paid will be made pursuant to Pennsylvania law and not the law of the state where the work injury occurred. This is a complex and difficult area of the law, where questions of coverage and compensability often turn on the facts surrounding the employee's hire and the insured's business presence out-of-state. Such questions often require the advice of an insurance broker or lawyer. Obviously, it is better that these questions be addressed before an injury occurs.Back to Top
SAFETYQHow do I establish a certified workplace safety committee and earn the 5 percent premium discount on my next policy renewal date?
A.See Certified Safety Committee Information under Resources.
Q.What Loss Control Services are available?
A.The services include, but are not limited to, on-site surveys, accident prevention training programs, and safety committee training. (See Loss Control Notice of Availability of Services)
Q.How do I get started?
A.Contact the Loss Control Manager at (570) 941-1653 to discuss your needs.
Q.What resources do you have to help me?
A.SWIF offers posters, and videos that can assist you in training your employees or raising their level of awareness about Workplace Safety. (See Available Safety Materials)
Q.Is there a cost to me for Loss Control Services and materials?
ANo. These services are included in your policy premium.Back to Top
CLAIMSQWhen, and to whom, do I report my injury?
A.Report any work related injury immediately to your employer. Your employer will then report your injury to SWIF.
Q.Who will contact me?
A.On all reported claims, you will be contacted by letter from SWIF assigning a # to your claim. If your injury causes you to lose work for 7 days, you will be contacted by a SWIF Investigator working from the district office serving your geographic location..
Q.What will my lost time benefits be?
A.Your benefits are based on your wages at the time of your injury.
Q.Will my medical bills be paid?
A.All medical bills falling under the Workers' Compensation Act and applying to your accepted claim will be honored.
Q.When will I receive payment of lost wage benefits?
A.After your lost time claim is investigated and accepted, you should expect to receive a check within ten (10) working days.
Q.What if I cannot do the job that I did before being injured?
A.SWIF offers several services to see that you receive the best medical care for your injuries and the best vocational opportunities for your return to the workforce.
What is a work injury?
A “work injury” is any injury, medical condition or disease that is caused by an individual’s job. The Pennsylvania Workers’ Compensation Act does not list specific injuries that are covered other than to specify that the injury must be work-related.
Who is eligible for workers' compensation?
If you work for a Pennsylvania company with three or more employees, you are covered by the Pennsylvania Workers’ Compensation Act for any work-related injury.
How do I file a workers' compensation claim?
If you’re injured on the job, you need to provide notice to your employer as soon as possible. It is important that you provide this notice in writing. If you have any questions about the Workers’ Compensation application process, we offer a free consultation to help you understand your options.
Is there a statute of limitations for reporting my accident?
Yes. Under the Pennsylvania Workers’ Compensation Act, a worker is required to provide notice to their employer that they have been injured on the job within twenty-one (21) days of the date of injury. Notice given after that time could result in a loss of benefits.
The absolute latest one can notify one’s employer of a workplace injury is one-hundred and twenty (120) days after the injury.In general, it’s best to inform your supervisor or boss as soon as you are hurt, even if you think you only suffered a minor injury that will go away without medical care.
When is my employer required to start paying my workers' compensation benefits?
Under the Pennsylvania Workers’ Compensation Act, an employer and its insurance company have twenty-one (21) days from when they are notified of a workplace injury to either agree that an injury is a “work injury” and pay benefits or to deny the claim.
Prior to receiving lost wages, there must be medical documentation confirming that you have the injuries you say you have and determining whether you can return to work and whether there are restrictions on your working abilities due to the accident.
Typically, insurance companies will mail checks to injured workers who qualify for Workers’ Compensation benefits every other week.
Do I need to see the company's doctor?
Under the Pennsylvania Workers’ Compensation Act, an injured worker only needs to treat with a “company doctor” for the first ninety (90) days from the first visit only if the employer:
Yes. It is possible to receive Social Security Disability, Unemployment or other benefits as a result of your work injury. However, in some cases, receiving Workers’ Compensation in addition to these other benefits can result in a reduced benefit amount for either Workers’ Compensation or for one of the other programs. Feel free to contact our attorneys to discuss potential benefit offsets.
How are workers’ compensation claims handled in Pennsylvania?
In Pennsylvania, workers’ compensation claims are governed by two separate laws, the Pennsylvania Workers’ Compensation Act and the Occupational Disease Act. Claims are processed through the Pennsylvania Bureau of Workers’ Compensation located in Harrisburg. These laws are enforced by special administrative judges, called workers’ compensation judges, who are located in each county, and appeals are handled by a deliberative body known as the Workers’ Compensation Appeal Board. Only rarely will your local Court of Common Pleas, which handles most civil matters, be involved in your case. As the rules, procedures, and practices in Workers’ Compensation differ than in civil court, a law firm that has the knowledge and experience in workers’ compensation law which features several lawyers who practice in this area is best suited to get you a good result.
What is my most important right?
Your right to have a lawyer is your most important right in successfully protecting your interests in your work injury claim. It is extremely difficult for a layperson to handle a workers’ compensation case. It is even difficult for attorneys who do not specialize in compensation law. This is because workers’ compensation as it has developed is a specialized practice where knowledge of specific rules, decisions, and practices which are important to protecting your rights. Most Workers’ Compensation Judges tell Claimants they should get an attorney at the first hearing. Indeed, an attorney is certainly necessary in most cases involving serious work injuries (those which will last over a year) because you will need a doctor to testify on your behalf “within a reasonable degree of medical certainty” at a medical expert deposition.
When should I give notice to my employer of my work injury?
You should give notice about your injury to your employer immediately as there are time limits which will effect your right to benefits. There are many and crucial advantages to giving notice as soon as possible and no disadvantages.
Will my employer retaliate against me for reporting my work injury?
It is against public policy for an employer to retaliate against you for reporting your own work injury or that of another injured worker. Most employers follow the law and will not terminate your employment for rights asserted pertaining to a work injury. Employers know they can be sued in civil court if they violate public policy by retaliating against you. If your employer retaliates against you for reporting a work injury, SEEK LEGAL COUNSEL.
What should I do if my employer refuses to recognize my work injury?
You will need in most circumstances to file a workers’ compensation claim. To do this, the basic rule is that you will need to file a Claim Petition within three years of the date of injury. But it is best to file it as soon as possible. This three-year period can be extended under certain circumstances. Sometimes the payment by your employer or its insurance company of wage loss or medical benefits can extend the three-year period. There are other rarer circumstances which must be analyzed on a case-by-case basis.
How much time does an employer’s insurance company have to pay my medical expenses?
An insurer must pay medical expenses within 30 days after receipt of the required bills and records from your healthcare provider. Often, insurance companies will not pay your bills without telling you. You only find out about the failure to pay because your healthcare provider tells you.
An insurance company that unilaterally stops payment of a claimant’s medical bills assumes the risk that it will be subject to a penalty for non-payment of bills. This penalty is within a workers’ compensation judge’s discretion but can be up to 50% of the outstanding amount of unpaid bills.
Do I need to respond to a Petition relating to my work injury filed by my employer or its insurance company?
Yes, it is essential that you respond promptly to a Petition filed by your employer or its insurance company. If you do not respond, eventually the employer will be granted the relief it requested in the Petition. It is essential to contact an attorney as soon as you receive a Petition.
There are many types of Petitions which can be filed against you which could effect your continuing right to wage loss benefits or medical treatment. The Bureau of Workers’ Compensation has developed specific forms which are to be used to answer the Petitions of your employer or its insurance company. Our attorneys have years of experience in handling the various types of Petitions employers file.
If your employer has filed a Termination, Modification or Suspension Petition against you, you will need at the first hearing to submit appropriate evidence, including medical evidence, on your behalf in a proceeding known as “Supersedeas.” This hearing is important for you to win as it will determine whether you will receive work loss benefits or not during the time you are fighting the employer’s Petition.
Can I receive workers’ compensation again where I was working “light duty” at my job and have been laid off?
Yes, it is quite possible that your employer is required to start on an ongoing basis your workers’ compensation benefits where you suffered a previous work injury, you have been laid off or terminated, and you were working with restrictions. Often the employer will not voluntarily fulfill its obligation to start your compensation again. You will be forced to file a “Reinstatement Petition” and litigate your entitlement to continued benefits.
At WusiA Reinstatement Petition,IS AN OPTION.
Do I have to follow up with job openings that the insurance company has sent me in the mail?
This is a good question, but has a complex answer. When you receive jobs in the mail, the insurance company is likely going to be trying to cut off or cut back your entitlements soon. If your work injury claim occurred before 1995, you will need to apply to each job in person or risk losing your benefits. Claims after 1995 are subject to Act 57 where there is no particular requirement that you follow up with jobs. However, it is still advisable that you do follow up with the proposed job openings.
In either case, it is advisable that you consult an established workers’ compensation firm once you receive a letter informing you of job openings. You will need in all probability to take actions concerning your rights either immediately or in the near future.
Am I eligible for a lump sum settlement of my workers’ compensation claim?
Yes, almost any Claimant is eligible for lump sum settlement. The amount of the settlement is dependent on the severity of your injury, how much you earned pre-injury in wages, what your doctor opines about your injury, and other factors.
A LEGAL GOAL IS to obtain for you the highest possible settlement.
Which doctor can I go to after I am injured?
One of the harsher aspects of workers’ compensation law is that under most circumstances you are required to go to a doctor on an employer-designated list for 90 days after your work injury. If you refuse to go to a doctor on the employer’s list, the employer does not have to pay for your medical treatment. The employer, however, remains liable for your expenses if it fails to give you written notice that treatment with a panel physician is required. This notice should be given to you at the time you begin work as well as after the work injury.
For cases that involve injuries that last over ninety days, you should consider seeking your own doctor to review your condition and treat you. Our experience has been that some doctors on the employer’s panel list tend not to treat your condition with the attention it deserves, while others give excellent care. As consistent treatment is one of the things that workers’ compensation judges look for in determining your case, it is important that you are comfortable with your doctor’s level of skill and interest.
Do I have a lawsuit outside of the workers’ compensation system?
This is a commonly asked question, and our attorneys are uniquely fit to answer in the specific factual context of your case. The answer depends on the unique facts of your case.
A person injured at work typically has as his sole and exclusive remedy the right to pursue his employer in a workers’ compensation claim. The major exception to this rule is if there are other(s) who may be liable for your injury besides your employer.
What are “litigation costs”?
“Litigation costs” is a term used to describe the cost of litigating each case by a Claimant. “Litigations costs” can be very expensive and may involve the expenditure of thousands of dollars. These costs include the cost for a doctor’s medical deposition and costs for deposition transcripts. A growing practice among many practitioners of work injury cases is to require their client to pay their own litigation costs as the case is ongoing. This places you in the awkward position of being charged for something at a time when you can least afford it.
THIS PRACTICE NORMALLY IS NOT FOLLOWED BY LEGAL COUNSEL.
MOST FIRMS will not pass EXPENSES on to clients who cannot afford to pay. We believe this practice is best suited to the interests of clients who usually live day-to-day on their paychecks.
HOW DO I KNOW IF I AM GETTING THE RIGHT AMOUNT OF BENEFITS?
Under the workers' compensation act, you are entitled to two-thirds of your pre-injury average weekly wage. This is subject to both a minimum and a maximum. Your average weekly wage is determined by analyzing your earnings during the year prior to your injury. Often, your employer or the insurance company will miscalculate your average weekly wage and you will be underpaid. An attorney will make sure that your benefits are properly calculated and he will get you the retroactive benefits you are entitled to, plus interest.
3. IF I HIRE A LAWYER, WON'T I LOSE 20% OF MY BENEFIT CHECK? NO! As long as the insurance company doesn't try to stop or reduce your benefits, there is no fee. When you hire an attorney during that time to monitor your case, it costs you nothing. Your attorney will advise you with regard to independent medical examinations and vocational interviews. If your check is late or your bills aren't being paid, your attorney will contact the insurance company on your behalf and make sure that those things are taken care of. The only time you will pay a 20% fee is if your attorney defeats a petition to reduce or cut off your benefits or if the attorney gets you benefits your are not currently receiving, either through settlement or a judge's award.
4. HOW LONG CAN I GET WORKERS' COMPENSATION BENEFITS?You can receive total disability benefits for the rest of your life. You can receive partial disability benefits for 500 weeks. You receive partial disability benefits if you return to work and earn less than you did per week before your injury. In addition, once you have received 104 weeks (two years) of total disability benefits, the insurance company can request that an impairment rating examination take place. A doctor selected by the Bureau of Workers Compensation will assess your "impairment rating". If that rating is less than 50%, then you will be deemed "partially disabled" and you will only be entitled to another 500 weeks of benefits. It is important that you have an attorney to advise you during this process so that he can help you avoid being labeled "partially disabled".
5. HOW IS A SETTLEMENT VALUED? Settlements are based on many factors. The extent of the injury, the type of work performed, the age and education of the claimant are some of the factors that go into calculating value. However, the most important factor is the pre-injury average weekly wage. This is the weekly amount of money that the insurance company calculated that you earned prior to your date of injury. If it was improperly calculated this could lead to your case being undervalued for settlement. An important factor that is not part of the calculation is pain and suffering. While workplace injuries are often highly traumatic and place great pressure on the injured worker and his family, the Pennsylvania Workers' Compensation Act does not provide for compensation for pain and suffering.
How Does Returning To Work Affect My Workers' Compensation Disability Benefits?
If you are receiving benefits from workers' compensation for a disability, the effect of going back to work will depend on the type of benefit involved and the laws in your state. Although the details of each state's workers' compensation plans vary, there are characteristics that most plans share in common.
Is Your Disability Temporary Or Permanent?
There are two major categories of disability benefits: temporary and permanent. Temporary benefits are given when an employee needs to be away from work for a short period of time for medical attention or recovery. These benefits are intended to be temporary and expire when the employee returns to work.
Permanent disability benefits are given when the employee will never fully recover from their injury and therefore, their future earning potential is affected. The amount of the benefit reflects future lost wages (the difference between what the person would have earned and what they are able to earn with the disability). In cases where the employee is unable to do any work as a result of their injury, the individual would receive total disability benefits (these can be temporary or permanent depending on how long the disability prevents the person from working). This amount is generally calculated considering what the employee was able to earn before his or her injury.
Temporary Disability Benefits Will End
When a person returns to work, temporary disability benefits are terminated, since there is no need to compensate the person for lost wages since they are now able to work. In some states, the mere fact that the person returns to their former position would be enough to end the disability benefits, but other states require a letter from the doctor saying that an employee is able to return to full duty.
Total disability benefits are given when an employee is considered unable to do any work. Therefore, if the employee returns to work or finds a new job they will be unable to collect benefits. In general, if the person resumes working their benefits will terminate. Different states use different standards to determine when benefits will end. Some states will ask whether the person is capable of finding sustained gainful employment while other states will require that the person actually has an opportunity to perform a gainful and suitable occupation. The question is not just whether or not the person is capable of performing at a job but whether the person actually has a present opportunity for employment, such as a job offer.
Permanent Disability Benefits Will Likely Continue
Individuals who receive permanent disability benefits generally receive an amount that is based on their previous earnings and compensates them for future lost wages. The idea is that the employee may be able to find another job but they may not be able to earn the same wage. If an employee is receiving benefits and ends up finding a job that pays the same wage or more, their disability benefits will generally not terminate. In general, fluctuations in the amount that the employee earns will not cause his or her benefits to be reduced or discontinued. This includes reductions in salary as well. If the employee earns less than expected then the amount of disability benefits is not increased. The amount of the benefit is calculated considering the effect of the disability on employment so if the disabling condition doesn't change then the amount of the benefits generally shouldn't either.
Consult An Attorney About Changes To Your Employment StatusThe effect of returning to work, whether in your former position or to a new job, will vary from state to state. An employee who is being paid workers compensation for future lost earnings or who is totally disabled should use caution before making major changes in their employment status. These changes could affect their benefits. These individuals should also consider that they may have a duty to report changes in their employment to the company through which they obtained workers' compensation or to the insurer who is paying the benefits. An employee who fails to do this may find that they are responsible for reimbursing workers' compensation for any excessive payments made. The financial stakes in these cases can be high so a worker in this situation may want to consult an attorney before going back to work. An attorney may also be able to inform the employee of other options available to them such as applying for social security disability benefits.
How Do I Know If I Have A Workers' Comp Claim?
Most injuries which happen at work, regardless of who is at fault, will be covered under workers' compensation. Even injuries which happen away from the office or jobsite can be covered if you are furthering the business of your employer at the time of the injury. Injuries do not have to be associated with a specific incident, but can be the result of repetitive motion or cumulative trauma.
How Long Do I Have To Report My Injury?
It is a good idea to report any injury, no matter how small you think it is, right away to a supervisor. Saying something to your coworker is not the same as notice to your employer. If you delay giving notice of a work injury, you run the risk that when you do give notice later your employer will not believe you. The sooner you give notice, the sooner you can receive wage loss and medical benefits. Under the workers' compensation law, you will lose the right to make a claim if you do not give notice within 120 days of when you knew or should have known about the work injury.
Can I See My Own Doctor? What Is The "90 Day Rule"?
Many employers and their insurance companies will tell you that you must treat only with a "panel physician" within the first 90 days of a work injury. This is only true in certain limited circumstances, because the employer must comply with many elements of the workers' comp law in order to force an injured employee to choose a panel doctor. In truth, you can see any doctor you choose in the first 90 days, but if your employer complies with all aspects of the panel doctor law it will have no obligation to pay that doctor. After the 90 days is up, you can treat with whoever you want, and even get second opinions.
Will It Hurt My Employer If I Try To Get Workers' Comp?
Your employer has already paid the insurance company and bought the insurance which covers you. Presumably, your employer wants you to use the insurance which it already paid for. The workers' comp system is designed to make sure that injured workers get the treatment they need quickly and get back to work as soon as they can, and this benefits employers. If you delay your treatment by deciding not to file a claim, your employer may have to wait a lot longer to get a valued employee back.
Will I Lose My Job If I Make A Claim?
Most non-union Pennsylvania workers are "at-will employees," which means they can be fired at any time for any reason or no reason, as long as they are not being discriminated against. An employer can be subject to a wrongful termination lawsuit if it fires you for pursuing a workers' compensation claim. This does not mean that your employer must keep your job open for you forever, and it does not have to provide light duty for you. However, if you are fired after a work injury or not brought back to work if you are released to work modified duty, you may be entitled to wage loss benefits under workers' compensation.
To What Benefits Am I Entitled?
Workers' compensation in Pennsylvania provides for a wage loss benefit (typically 2/3 of your preinjury average weekly wage), and medical treatment which is reasonable, necessary, and causally related to the work injury. The calculation of the preinjury average weekly wage can be very complicated, and should always be double-checked by an experienced workers' compensation lawyer. Overtime and bonuses should be included in the calculations. Even if you are receiving wage loss benefits, you may be receiving the wrong amount. If you cannot earn your preinjury wages because of the work injury, you may be entitled to total or partial disability benefits.
Should I Settle My Claim?
Settlements of workers' comp claims are common in Pennsylvania. They are achieved by a Compromise and Release, where usually the insurance company pays the injured worker a lump sum of money in exchange for the worker giving up all of his or her rights under the law. The negotiation of these settlements is best left to experienced workers' compensation attorneys who can draw on years of experience to determine the worth of a claim and get the most value for the case. Not all cases should be settled, and not all cases must be settled for a full release of both wage loss and medical benefits. Each person's case is unique and should be evaluated individually.
Do I Need To See A Lawyer? What Will I Have To Pay?
You are not required to hire an attorney to go through the workers' compensation system, but most people who try to handle cases on their own realize quickly that they are in over their heads. Workers' compensation insurance companies will always be represented by lawyers, most of whom only practice workers' compensation law. Their mission is to reduce or eliminate your benefits. You will be wise to have a free consultation with an experienced workers' compensation lawyer who only represents injured workers. It costs you nothing to have your case evaluated, and having a lawyer involved in your claim from the beginning will maximize your ability to receive all of the benefits to which you are entitled.
How Does Returning To Work Affect My Workers' Compensation Disability Benefits?
If you are receiving benefits from workers' compensation for a disability, the effect of going back to work will depend on the type of benefit involved and the laws in your state. Although the details of each state's workers' compensation plans vary, there are characteristics that most plans share in common.
Is Your Disability Temporary Or Permanent?
There are two major categories of disability benefits: temporary and permanent. Temporary benefits are given when an employee needs to be away from work for a short period of time for medical attention or recovery. These benefits are intended to be temporary and expire when the employee returns to work.
Permanent disability benefits are given when the employee will never fully recover from their injury and therefore, their future earning potential is affected. The amount of the benefit reflects future lost wages (the difference between what the person would have earned and what they are able to earn with the disability). In cases where the employee is unable to do any work as a result of their injury, the individual would receive total disability benefits (these can be temporary or permanent depending on how long the disability prevents the person from working). This amount is generally calculated considering what the employee was able to earn before his or her injury.
Temporary Disability Benefits Will End
When a person returns to work, temporary disability benefits are terminated, since there is no need to compensate the person for lost wages since they are now able to work. In some states, the mere fact that the person returns to their former position would be enough to end the disability benefits, but other states require a letter from the doctor saying that an employee is able to return to full duty.
Total disability benefits are given when an employee is considered unable to do any work. Therefore, if the employee returns to work or finds a new job they will be unable to collect benefits. In general, if the person resumes working their benefits will terminate. Different states use different standards to determine when benefits will end. Some states will ask whether the person is capable of finding sustained gainful employment while other states will require that the person actually has an opportunity to perform a gainful and suitable occupation. The question is not just whether or not the person is capable of performing at a job but whether the person actually has a present opportunity for employment, such as a job offer.
Permanent Disability Benefits Will Likely Continue
Individuals who receive permanent disability benefits generally receive an amount that is based on their previous earnings and compensates them for future lost wages. The idea is that the employee may be able to find another job but they may not be able to earn the same wage. If an employee is receiving benefits and ends up finding a job that pays the same wage or more, their disability benefits will generally not terminate. In general, fluctuations in the amount that the employee earns will not cause his or her benefits to be reduced or discontinued. This includes reductions in salary as well. If the employee earns less than expected then the amount of disability benefits is not increased. The amount of the benefit is calculated considering the effect of the disability on employment so if the disabling condition doesn't change then the amount of the benefits generally shouldn't either.
Consult An Attorney About Changes To Your Employment StatusThe effect of returning to work, whether in your former position or to a new job, will vary from state to state. An employee who is being paid workers compensation for future lost earnings or who is totally disabled should use caution before making major changes in their employment status. These changes could affect their benefits. These individuals should also consider that they may have a duty to report changes in their employment to the company through which they obtained workers' compensation or to the insurer who is paying the benefits. An employee who fails to do this may find that they are responsible for reimbursing workers' compensation for any excessive payments made. The financial stakes in these cases can be high so a worker in this situation may want to consult an attorney before going back to work. An attorney may also be able to inform the employee of other options available to them such as applying for social security disability benefits.
How Do I Know If I Have A Workers' Comp Claim?
Most injuries which happen at work, regardless of who is at fault, will be covered under workers' compensation. Even injuries which happen away from the office or jobsite can be covered if you are furthering the business of your employer at the time of the injury. Injuries do not have to be associated with a specific incident, but can be the result of repetitive motion or cumulative trauma.
How Long Do I Have To Report My Injury?
It is a good idea to report any injury, no matter how small you think it is, right away to a supervisor. Saying something to your coworker is not the same as notice to your employer. If you delay giving notice of a work injury, you run the risk that when you do give notice later your employer will not believe you. The sooner you give notice, the sooner you can receive wage loss and medical benefits. Under the workers' compensation law, you will lose the right to make a claim if you do not give notice within 120 days of when you knew or should have known about the work injury.
Can I See My Own Doctor? What Is The "90 Day Rule"?
Many employers and their insurance companies will tell you that you must treat only with a "panel physician" within the first 90 days of a work injury. This is only true in certain limited circumstances, because the employer must comply with many elements of the workers' comp law in order to force an injured employee to choose a panel doctor. In truth, you can see any doctor you choose in the first 90 days, but if your employer complies with all aspects of the panel doctor law it will have no obligation to pay that doctor. After the 90 days is up, you can treat with whoever you want, and even get second opinions.
Will It Hurt My Employer If I Try To Get Workers' Comp?
Your employer has already paid the insurance company and bought the insurance which covers you. Presumably, your employer wants you to use the insurance which it already paid for. The workers' comp system is designed to make sure that injured workers get the treatment they need quickly and get back to work as soon as they can, and this benefits employers. If you delay your treatment by deciding not to file a claim, your employer may have to wait a lot longer to get a valued employee back.
Will I Lose My Job If I Make A Claim?
Most non-union Pennsylvania workers are "at-will employees," which means they can be fired at any time for any reason or no reason, as long as they are not being discriminated against. An employer can be subject to a wrongful termination lawsuit if it fires you for pursuing a workers' compensation claim. This does not mean that your employer must keep your job open for you forever, and it does not have to provide light duty for you. However, if you are fired after a work injury or not brought back to work if you are released to work modified duty, you may be entitled to wage loss benefits under workers' compensation.
To What Benefits Am I Entitled?
Workers' compensation in Pennsylvania provides for a wage loss benefit (typically 2/3 of your preinjury average weekly wage), and medical treatment which is reasonable, necessary, and causally related to the work injury. The calculation of the preinjury average weekly wage can be very complicated, and should always be double-checked by an experienced workers' compensation lawyer. Overtime and bonuses should be included in the calculations. Even if you are receiving wage loss benefits, you may be receiving the wrong amount. If you cannot earn your preinjury wages because of the work injury, you may be entitled to total or partial disability benefits.
Should I Settle My Claim?
Settlements of workers' comp claims are common in Pennsylvania. They are achieved by a Compromise and Release, where usually the insurance company pays the injured worker a lump sum of money in exchange for the worker giving up all of his or her rights under the law. The negotiation of these settlements is best left to experienced workers' compensation attorneys who can draw on years of experience to determine the worth of a claim and get the most value for the case. Not all cases should be settled, and not all cases must be settled for a full release of both wage loss and medical benefits. Each person's case is unique and should be evaluated individually.
Do I Need To See A Lawyer? What Will I Have To Pay?
You are not required to hire an attorney to go through the workers' compensation system, but most people who try to handle cases on their own realize quickly that they are in over their heads. Workers' compensation insurance companies will always be represented by lawyers, most of whom only practice workers' compensation law. Their mission is to reduce or eliminate your benefits. You will be wise to have a free consultation with an experienced workers' compensation lawyer who only represents injured workers. It costs you nothing to have your case evaluated, and having a lawyer involved in your claim from the beginning will maximize your ability to receive all of the benefits to which you are entitled.
WERE YOU GIVEN THIS FORM TO SIGN AT TIME OF EMPLOYMENT?
NOTIFICATION TO EMPLOYEES OF THEIR RIGHTS AND DUTIES UNDER SECTION 306 (f.1)(1)(i) OF THE PA. WORKERS’ COMPENSATION ACT The Pennsylvania Workers’ Compensation Act requires that employees be given written notification of their rights and duties under Sec. 306 (f.1)(1)(i) of the Act if a list of designated health care providers is established by the employer. Below are your rights and duties under Sec. 306 (f.1)(1)(i) and an acknowledgment signature line. This acknowledgment, signed by you, is to be returned to your employer. A brief summary: You have the right to seek emergency medical treatment from any provider; for post-emergency and other injuries, you must obtain treatment for work-related injuries and illnesses from a designated health care provider for 90 days. The penalty for not using a designated health care provider is that your employer is not liable for the medical bills incurred.
____________________________________________________________________________________________________ As an employee of the Commonwealth working at a location where a list of designated health care providers has been established and posted, you have: • The duty to obtain treatment for work-related injuries and illnesses from one or more of the designated health care providers for 90 days from the date of the first visit to a designated provider. • The right to seek emergency medical treatment from any provider, but subsequent non-emergency treatment shall be by a designated provider for the remainder of the 90-day period. • The right to have all reasonable medical supplies and treatment related to the injury paid for by your employer as long as treatment is obtained from a designated provider during the 90-day period. • The right, during this 90-day period, to switch from one designated health care provider to another designated provider. • The right to seek treatment from a provider if you are referred to that provider by a designated provider. • The right to an additional opinion from a provider of your choice when invasive surgery is prescribed by the designated provider. • The right to seek treatment or medical consultation from a non designated provider during the 90-day period, but the services shall be at your expense for the applicable 90 days. • The right to seek treatment from any health care provider after the 90-day period has ended. • The duty to notify your employer of treatment by a non designated provider (after the 90 day period) within 5 days of the first visit to that provider. The employer may not be required to pay for treatment rendered by a non designated provider prior to receiving this notification. I acknowledge that I have been informed of my rights and duties under Sec. 306 (f.1)(1)(i) and that I understand them to the extent that they are explained above. __________________
______ _____________________________________________ Print Name Employee Signature Date
WORKERS' COMPENSATION FAQS
HEALTH & SAFETY INFORMATION
Q. If I have multiple locations, how many safety committees are required and can they have a centralized committee; or is each location required to have its own committee?
A. An employer may have either a centralized committee or single committees. Ideally for a centralized committee, a representative from each location should be a committee member, but it is not necessary as long as there are measures in place to communicate safety concerns between all locations and safety committee members. If a single committee for each location is elected, then each committee must be approved and must meet all basic minimum requirements.
Q. What must I do to become certified?
A. An employer must meet the basic requirements and complete and submit an application for approval. Requirement information is available on our website at www.dli.pa.gov.
Q. Are safety committees required to meet every month after they are certified?
A. Yes. Safety committees must meet at least monthly, documenting a quorum of committee members present for a minimum of six months prior to signing, dating, and submitting their Initial Application for Certification. Upon certification, safety committees must document monthly meetings thereafter.
Q. My company has been bought by another person or company. Does the certification remain in effect? What name would I list on the Renewal Application?
A. Yes, you are still certified as long as the basic minimum requirements are being met. You would change the name of the company on the Renewal Affidavit and change workplace names as necessary. If you retain the same Federal Employer Identification Number (FEIN), that is all that is required. If you change the FEIN number as well as the company name, you must provide a detailed explanation as to why the FEIN was changed on the Renewal Affidavit.
Q. How is an organization selected for an on-site audit?
A. Each organization of the regulated community (insurers, self-insured employers, group funds and certified workplace safety committees) is assigned a record number. Record numbers are selected by the computer application. The record number is then matched with the “Master List,” which identifies the organization to be audited.
Q. How frequently should an organization expect to be audited?
A. On-site audits began in 1997, and currently less than 12 organizations have had a second on-site audit. The Health and Safety regulations allow for an organization to be audited at least once every two years.COMPLIANCE WITH THE WORKERS' COMPENSATION ACT
Q. Is a subcontractor required to carry workers’ compensation insurance if he/she is a sole proprietor?
A. Sole proprietors with no employees are not required to carry workers’ compensation insurance. However, detailed information must be provided to your insurer to prove that the individual is a true independent contractor. If your insurer determines that the sole proprietor is your employee, you will be charged for his/her payroll as per the appropriate classes on your policy. It is your responsibility to provide your insurer with all appropriate documentation to resolve their employment status.
Q. As owner of a trucking operation, must I show proof of workers’ compensation insurance if I use owner/operator drivers?
A. If an insured utilizes owner/operators and is part of a trucking operation, proof of workers’ compensation insurance coverage may be required. For those drivers deemed to be employees, your insurer will need proof of workers’ compensation insurance coverage. Otherwise, that part of the total remuneration that is wages will be included in the premium calculation. If payroll cannot be obtained, then 1/3 of the contract price will be considered payroll for premium calculation purposes.
Q. Do members of limited liability companies (LLC) have an obligation to ensure workers’ compensation liability on their members?
A. Section 301(a) of the Workers’ Compensation Act (Act), 77 P.S. Section 431, only requires employers to maintain workers’ compensation coverage of their employees. Section 104 of the Act, 77 P.S. Section 22, states that the “employee” as used in the Act is synonymous with servant and includes “[a]ll natural persons who perform services for another for a valuable consideration, exclusive of persons whose employment is casual in character and not in the regular course of the business of the employer…” To the extent that LLCs have no employees, i.e., its only workers are partners, it has no employees and, thus, no workers’ compensation liability. However, should a partner withdraw from the partnership and become an employee or the business adds a part-time or a full-time employee, it would then be required to insure its workers’ compensation liability.
Q. Do family members and minors have to be covered by workers’ compensation insurance?
A. Pennsylvania state law does require you to cover any employee, regardless of the number of hours worked per week or whether the person is your spouse or child. The Pennsylvania Workers’ Compensation Act can be viewed in its entirety on our website at www.dli.state.pa.us or can be obtained in hard copy from the State Bookstore of Pennsylvania, Commonwealth Keystone Building, Plaza Level, 400 North Street, Harrisburg, PA 17120, telephone number (717) 787-5109. You may want to look specifically at Sections 103, 104, 301 and 305(a).SELF-INSURING FOR WORKERS' COMPENSATION
Q. What are the requirements to be self-insured?
A. To be authorized by the Department of Labor and Industry’s Bureau of Workers’ Compensation to self-insure under the Workers’ Compensation Act (Act), an employer must first demonstrate that it has the financial ability to guaranty the payment of all benefits it may incur under the Act while it is approved as a self-insurer and that it has an adequate accident and illness prevention program. See question below for further explanation on financial ability. Additionally, an approved self-insurer must post security, such as a bond or letter of credit, covering its liability; must purchase excess insurance to protect it and its workers from losses resulting from a large claim or a catastrophic situation; and, must arrange for the proper adjusting and administration of its potential claims, either through in-house resources or the retention of an authorized claims services company.
Q. What factors does the Bureau of Workers’ Compensation consider in determining whether an applicant has the financial ability to self-insure?
A. In determining whether an applicant has the financial ability to self-insure, the Bureau first considers whether an applicant has the financial resources and capacity to liquidate easily the liability it could incur as a self-insurer, including the liability resulting from a catastrophe. The Bureau analyzes the applicant’s liquid assets, exposure to large losses, and excess insurance protection in making this determination. A successful applicant for self-insurance must also show that its current long-term financial condition and solvency indicates that it will be available and able to liquidate in the future the liability incurred as a self-insurer. The Bureau performs an analysis of an applicant’s audited financial statements and reviews other financial information in its consideration of an applicant’s financial health.
Q. How much security must a self-insured post with the Bureau of Workers’ Compensation?
A. The Bureau’s regulations require a private sector self-insurer to post security in the amount equal to or greater than the self-insurer’s outstanding liability for workers’ compensation plus a standard additive calculated by formula. The self-insurer’s amount of outstanding liability is calculated by the Bureau, generally using actuarial loss development techniques, or the outstanding liability is calculated by an independent actuary retained by the self-insurer.
Q. What annual special fund assessments do self-insurers pay and how much are they?
A. Self-insured employers must pay annual assessments for the maintenance of the Workmen’s Compensation Administration Fund, the Workmen’s Compensation Supersedeas Fund, the Subsequent Injury Fund, and the Self-Insurance Guaranty Fund. Assessments against a self-insurer are based on its pro rata share of all compensation paid by all self-insurers and insurers in the calendar year prior to a particular assessment multiplied against the amount needed to finance the operation of the special fund. While assessment rates vary each year depending on the amount needed to maintain the special funds and the amount of compensation paid, generally, total assessments against a self-insurer for all special funds have been averaging between 4 percent to 5 percent of the amount of compensation it paid in the prior year.
CLAIMS:
Q. How do I request my claims records?
A. Your request must be made in writing and either mailed or faxed to the Bureau of Workers’ Compensation. If you are representing the injured worker or are a party to the claim, you must specify your relationship in the request. Requests should be sent to:
Records Section, Claims Management Division
Bureau of Workers’ Compensation
1171 S. Cameron St., Room 109
Harrisburg, PA 17104-2501
Fax: 717-783-6365 or 717-783-6366
Q. How long does it take to get results to a request for records?
A. Processing usually takes about 7 to 10 days – depending upon the availability of records.
Q. I received a letter about a missing FEIN number. Can I give you the information over the telephone?
A. Yes, you can give this information by calling 717-787-3561.
Q. Why can’t I print a copy of the form I submitted over the Internet?
A. The form may be printed after it has been submitted using the print button provided on the screen. If you would like to print the form from the summary screen prior to submission, do a right click on your mouse to show the print command and left click on the print command to print. Note: The summary screen should only be used to review your data as you have filed your form at this point.
Q. How do you measure compliance with the 21-day filing requirements of the Workers’ Compensation Act?
A. The disability date or employer-notified date, whichever is later, is deducted from the file date to determine whether a particular filing is timely. The file date is the date the Bureau of Workers’ Compensation receives the form unless there is a legible, United States postal mark present on the envelope. In the case of a United States postal mark, the file date is the date of the postal mark.
Q.What is SWIF's written premium for 2015 and 2016?
A.2015 = $216,000,000
2016 = $187,000,000
Q.What is SWIF's Lost Cost Multiplier?
A. As of April 1, 2017: Commercial 3.187% and Coal 1.904%
Q.What is SWIF's calendar year loss ratio for the past three years?
A.2014 - 119.5%
2015 - 117.63%
2016 - 97.2%
(percentages are tentative pending SWIF's reserve estimate completion)
AS A WORKER.
QUESTIONS AND ANSWERS:
Q.What is a PPO?
A. A PPO is a Preferred Provider Organization, it is a list or “panel” of designated health care providers specializing in workers’ compensation by providing goal oriented medical treatment from board certified physicians that will facilitate a prompt recovery and a successful return to work.
Q.Why post a panel?
A.The Pennsylvania Workers’ Compensation Act gives employers the right to establish a panel of designated health care providers, when properly posted in the workplace and acknowledged by all employees, injured workers must seek treatment for their work related injuries with one of the designated providers for 90 days from the date of the first visit.
Q.Why is SWIF offering a panel of providers?
A.SWIF realizes that it’s vital that businesses take prudent steps in controlling their workers’ compensations costs.
Q.What are the benefits of posting a panel?
A.Reduced workers’ compensation medical and indemnity costs, a goal orientated treatment plan for your injured workers and improved treatment outcomes.
Q.How can I get my own panel from SWIF?
A.Contact Cathleen Fitzpatrick at 717-728-5502 ext. 1117 or by email at cfitzpatrick@hooverinc.com.
Q.Does SWIF have a Pharmacy Program?
A.Yes, administerd through KeyScripts.
Q.If I’m an injured worker how will I receive my prescription card?
A.Injured workers with compensable claims will automatically receive a pharmacy card listing the 4 closest pharmacies near your home.
Q.What are the benefits in using this service?
A.You will receive your prescriptions faster, pay nothing out of pocket, reduce unnecessary phone calls and become eligible for home delivery.
Q.How can I receive additional information on SWIF Pharmacy program?
A.Contact KeyScripts at 1-866-446-2848 with questions, or to locate the KeyScripts Network pharmacy nearest you.
Q.What is a Return to Work Program (RTW)?
A. A RTW program is a proactive approach in restoring injured workers back to their former lifestyle in the safest and most effective manner possible.
Q.Why implement a RTW Program?
A.Workplace injuries, illnesses and accidents are costly to the employer and the employees. Preventing injuries is the best way to protect workers while controlling workers compensation costs. Employers and workers need a way to manage injuries if they occur. An effective RTW program assists in assuring that the worker obtains medical care during the initial stages of recovery, and during the subsequent return to productive employment.
Q.What are the benefits of a RTW program?
A.For the Employer - Reduced staff turnover and training costs, reduced fraudulent claims, saves indemnity expenses, overtime costs, improve morale and employee relations.
For the Employee - Increase self-esteem, contributes to a faster recovery by keeping the injured worker mentally and physically conditioned, maintains social contact with fellow employees and reduces negative financial impact many injured employees experience.
Final Result - A Win-Win for everyone.Back to Top
UNDERWRITINGQHow does SWIF price Workers' Compensation coverage?
ASWIF assigns the appropriate classification code(s) and multiplies the rate by every $100 of payroll to produce the base premium. The base premium is then multiplied by any applicable Experience Modification or Premium Discount. The total is the Estimated Annual Premium.
Q.When does Minimum Premium apply?
A.The minimum premium applies whenever the actual premium is less than the minimum premium for the selected classification code(s).
Q.What is an Officer Exemption Form (LIBC 509 - Application for Executive Officer Exemption; LIBC 513 - Executive Officer Declaration), and when is it needed?
A.An Officer Exemption Form is a notice of rejection for Workers' Compensation coverage. When an Officer of a Corporation elects not to be covered by Workers' Compensation, they complete an "Application for Executive Officer Exemption Form" (LIBC 509) and an "Executive Officer Declaration Form" (LIBC 513). An Officer Exemption Form is only necessary for Corporations, since Sole Proprietors and Partners are automatically excluded from coverage. These Forms can be obtained from SWIF or the Bureau of Workers' Compensation, 1171 S. Cameron Street, Harrisburg, PA 17104-2501; telephone (717) 787-3567.
Q.Are employees covered while working in another state?
ASWIF does not provide Workers' Compensation Insurance coverage for states other than Pennsylvania. It does, however, afford coverage for Pennsylvania hired employees who are injured out-of-state pursuant to the Extraterritorial Provisions of the Workers' Compensation Act. Although it is a very fact specific area of the law, the general rule is that coverage will be afforded to an individual hired in Pennsylvania, but assigned to work out-of-state on a temporary basis. Any benefits paid will be made pursuant to Pennsylvania law and not the law of the state where the work injury occurred. This is a complex and difficult area of the law, where questions of coverage and compensability often turn on the facts surrounding the employee's hire and the insured's business presence out-of-state. Such questions often require the advice of an insurance broker or lawyer. Obviously, it is better that these questions be addressed before an injury occurs.Back to Top
SAFETYQHow do I establish a certified workplace safety committee and earn the 5 percent premium discount on my next policy renewal date?
A.See Certified Safety Committee Information under Resources.
Q.What Loss Control Services are available?
A.The services include, but are not limited to, on-site surveys, accident prevention training programs, and safety committee training. (See Loss Control Notice of Availability of Services)
Q.How do I get started?
A.Contact the Loss Control Manager at (570) 941-1653 to discuss your needs.
Q.What resources do you have to help me?
A.SWIF offers posters, and videos that can assist you in training your employees or raising their level of awareness about Workplace Safety. (See Available Safety Materials)
Q.Is there a cost to me for Loss Control Services and materials?
ANo. These services are included in your policy premium.Back to Top
CLAIMSQWhen, and to whom, do I report my injury?
A.Report any work related injury immediately to your employer. Your employer will then report your injury to SWIF.
Q.Who will contact me?
A.On all reported claims, you will be contacted by letter from SWIF assigning a # to your claim. If your injury causes you to lose work for 7 days, you will be contacted by a SWIF Investigator working from the district office serving your geographic location..
Q.What will my lost time benefits be?
A.Your benefits are based on your wages at the time of your injury.
Q.Will my medical bills be paid?
A.All medical bills falling under the Workers' Compensation Act and applying to your accepted claim will be honored.
Q.When will I receive payment of lost wage benefits?
A.After your lost time claim is investigated and accepted, you should expect to receive a check within ten (10) working days.
Q.What if I cannot do the job that I did before being injured?
A.SWIF offers several services to see that you receive the best medical care for your injuries and the best vocational opportunities for your return to the workforce.
What is a work injury?
A “work injury” is any injury, medical condition or disease that is caused by an individual’s job. The Pennsylvania Workers’ Compensation Act does not list specific injuries that are covered other than to specify that the injury must be work-related.
Who is eligible for workers' compensation?
If you work for a Pennsylvania company with three or more employees, you are covered by the Pennsylvania Workers’ Compensation Act for any work-related injury.
How do I file a workers' compensation claim?
If you’re injured on the job, you need to provide notice to your employer as soon as possible. It is important that you provide this notice in writing. If you have any questions about the Workers’ Compensation application process, we offer a free consultation to help you understand your options.
Is there a statute of limitations for reporting my accident?
Yes. Under the Pennsylvania Workers’ Compensation Act, a worker is required to provide notice to their employer that they have been injured on the job within twenty-one (21) days of the date of injury. Notice given after that time could result in a loss of benefits.
The absolute latest one can notify one’s employer of a workplace injury is one-hundred and twenty (120) days after the injury.In general, it’s best to inform your supervisor or boss as soon as you are hurt, even if you think you only suffered a minor injury that will go away without medical care.
When is my employer required to start paying my workers' compensation benefits?
Under the Pennsylvania Workers’ Compensation Act, an employer and its insurance company have twenty-one (21) days from when they are notified of a workplace injury to either agree that an injury is a “work injury” and pay benefits or to deny the claim.
Prior to receiving lost wages, there must be medical documentation confirming that you have the injuries you say you have and determining whether you can return to work and whether there are restrictions on your working abilities due to the accident.
Typically, insurance companies will mail checks to injured workers who qualify for Workers’ Compensation benefits every other week.
Do I need to see the company's doctor?
Under the Pennsylvania Workers’ Compensation Act, an injured worker only needs to treat with a “company doctor” for the first ninety (90) days from the first visit only if the employer:
- Provides a list of at least six designated health care providers
- Notifies an employee in writing of his or her rights and duties, and
- Obtains written acknowledgment from the employee that he or she has been informed of such rights.
Yes. It is possible to receive Social Security Disability, Unemployment or other benefits as a result of your work injury. However, in some cases, receiving Workers’ Compensation in addition to these other benefits can result in a reduced benefit amount for either Workers’ Compensation or for one of the other programs. Feel free to contact our attorneys to discuss potential benefit offsets.
How are workers’ compensation claims handled in Pennsylvania?
In Pennsylvania, workers’ compensation claims are governed by two separate laws, the Pennsylvania Workers’ Compensation Act and the Occupational Disease Act. Claims are processed through the Pennsylvania Bureau of Workers’ Compensation located in Harrisburg. These laws are enforced by special administrative judges, called workers’ compensation judges, who are located in each county, and appeals are handled by a deliberative body known as the Workers’ Compensation Appeal Board. Only rarely will your local Court of Common Pleas, which handles most civil matters, be involved in your case. As the rules, procedures, and practices in Workers’ Compensation differ than in civil court, a law firm that has the knowledge and experience in workers’ compensation law which features several lawyers who practice in this area is best suited to get you a good result.
What is my most important right?
Your right to have a lawyer is your most important right in successfully protecting your interests in your work injury claim. It is extremely difficult for a layperson to handle a workers’ compensation case. It is even difficult for attorneys who do not specialize in compensation law. This is because workers’ compensation as it has developed is a specialized practice where knowledge of specific rules, decisions, and practices which are important to protecting your rights. Most Workers’ Compensation Judges tell Claimants they should get an attorney at the first hearing. Indeed, an attorney is certainly necessary in most cases involving serious work injuries (those which will last over a year) because you will need a doctor to testify on your behalf “within a reasonable degree of medical certainty” at a medical expert deposition.
When should I give notice to my employer of my work injury?
You should give notice about your injury to your employer immediately as there are time limits which will effect your right to benefits. There are many and crucial advantages to giving notice as soon as possible and no disadvantages.
Will my employer retaliate against me for reporting my work injury?
It is against public policy for an employer to retaliate against you for reporting your own work injury or that of another injured worker. Most employers follow the law and will not terminate your employment for rights asserted pertaining to a work injury. Employers know they can be sued in civil court if they violate public policy by retaliating against you. If your employer retaliates against you for reporting a work injury, SEEK LEGAL COUNSEL.
What should I do if my employer refuses to recognize my work injury?
You will need in most circumstances to file a workers’ compensation claim. To do this, the basic rule is that you will need to file a Claim Petition within three years of the date of injury. But it is best to file it as soon as possible. This three-year period can be extended under certain circumstances. Sometimes the payment by your employer or its insurance company of wage loss or medical benefits can extend the three-year period. There are other rarer circumstances which must be analyzed on a case-by-case basis.
How much time does an employer’s insurance company have to pay my medical expenses?
An insurer must pay medical expenses within 30 days after receipt of the required bills and records from your healthcare provider. Often, insurance companies will not pay your bills without telling you. You only find out about the failure to pay because your healthcare provider tells you.
An insurance company that unilaterally stops payment of a claimant’s medical bills assumes the risk that it will be subject to a penalty for non-payment of bills. This penalty is within a workers’ compensation judge’s discretion but can be up to 50% of the outstanding amount of unpaid bills.
Do I need to respond to a Petition relating to my work injury filed by my employer or its insurance company?
Yes, it is essential that you respond promptly to a Petition filed by your employer or its insurance company. If you do not respond, eventually the employer will be granted the relief it requested in the Petition. It is essential to contact an attorney as soon as you receive a Petition.
There are many types of Petitions which can be filed against you which could effect your continuing right to wage loss benefits or medical treatment. The Bureau of Workers’ Compensation has developed specific forms which are to be used to answer the Petitions of your employer or its insurance company. Our attorneys have years of experience in handling the various types of Petitions employers file.
If your employer has filed a Termination, Modification or Suspension Petition against you, you will need at the first hearing to submit appropriate evidence, including medical evidence, on your behalf in a proceeding known as “Supersedeas.” This hearing is important for you to win as it will determine whether you will receive work loss benefits or not during the time you are fighting the employer’s Petition.
Can I receive workers’ compensation again where I was working “light duty” at my job and have been laid off?
Yes, it is quite possible that your employer is required to start on an ongoing basis your workers’ compensation benefits where you suffered a previous work injury, you have been laid off or terminated, and you were working with restrictions. Often the employer will not voluntarily fulfill its obligation to start your compensation again. You will be forced to file a “Reinstatement Petition” and litigate your entitlement to continued benefits.
At WusiA Reinstatement Petition,IS AN OPTION.
Do I have to follow up with job openings that the insurance company has sent me in the mail?
This is a good question, but has a complex answer. When you receive jobs in the mail, the insurance company is likely going to be trying to cut off or cut back your entitlements soon. If your work injury claim occurred before 1995, you will need to apply to each job in person or risk losing your benefits. Claims after 1995 are subject to Act 57 where there is no particular requirement that you follow up with jobs. However, it is still advisable that you do follow up with the proposed job openings.
In either case, it is advisable that you consult an established workers’ compensation firm once you receive a letter informing you of job openings. You will need in all probability to take actions concerning your rights either immediately or in the near future.
Am I eligible for a lump sum settlement of my workers’ compensation claim?
Yes, almost any Claimant is eligible for lump sum settlement. The amount of the settlement is dependent on the severity of your injury, how much you earned pre-injury in wages, what your doctor opines about your injury, and other factors.
A LEGAL GOAL IS to obtain for you the highest possible settlement.
Which doctor can I go to after I am injured?
One of the harsher aspects of workers’ compensation law is that under most circumstances you are required to go to a doctor on an employer-designated list for 90 days after your work injury. If you refuse to go to a doctor on the employer’s list, the employer does not have to pay for your medical treatment. The employer, however, remains liable for your expenses if it fails to give you written notice that treatment with a panel physician is required. This notice should be given to you at the time you begin work as well as after the work injury.
For cases that involve injuries that last over ninety days, you should consider seeking your own doctor to review your condition and treat you. Our experience has been that some doctors on the employer’s panel list tend not to treat your condition with the attention it deserves, while others give excellent care. As consistent treatment is one of the things that workers’ compensation judges look for in determining your case, it is important that you are comfortable with your doctor’s level of skill and interest.
Do I have a lawsuit outside of the workers’ compensation system?
This is a commonly asked question, and our attorneys are uniquely fit to answer in the specific factual context of your case. The answer depends on the unique facts of your case.
A person injured at work typically has as his sole and exclusive remedy the right to pursue his employer in a workers’ compensation claim. The major exception to this rule is if there are other(s) who may be liable for your injury besides your employer.
What are “litigation costs”?
“Litigation costs” is a term used to describe the cost of litigating each case by a Claimant. “Litigations costs” can be very expensive and may involve the expenditure of thousands of dollars. These costs include the cost for a doctor’s medical deposition and costs for deposition transcripts. A growing practice among many practitioners of work injury cases is to require their client to pay their own litigation costs as the case is ongoing. This places you in the awkward position of being charged for something at a time when you can least afford it.
THIS PRACTICE NORMALLY IS NOT FOLLOWED BY LEGAL COUNSEL.
MOST FIRMS will not pass EXPENSES on to clients who cannot afford to pay. We believe this practice is best suited to the interests of clients who usually live day-to-day on their paychecks.
HOW DO I KNOW IF I AM GETTING THE RIGHT AMOUNT OF BENEFITS?
Under the workers' compensation act, you are entitled to two-thirds of your pre-injury average weekly wage. This is subject to both a minimum and a maximum. Your average weekly wage is determined by analyzing your earnings during the year prior to your injury. Often, your employer or the insurance company will miscalculate your average weekly wage and you will be underpaid. An attorney will make sure that your benefits are properly calculated and he will get you the retroactive benefits you are entitled to, plus interest.
3. IF I HIRE A LAWYER, WON'T I LOSE 20% OF MY BENEFIT CHECK? NO! As long as the insurance company doesn't try to stop or reduce your benefits, there is no fee. When you hire an attorney during that time to monitor your case, it costs you nothing. Your attorney will advise you with regard to independent medical examinations and vocational interviews. If your check is late or your bills aren't being paid, your attorney will contact the insurance company on your behalf and make sure that those things are taken care of. The only time you will pay a 20% fee is if your attorney defeats a petition to reduce or cut off your benefits or if the attorney gets you benefits your are not currently receiving, either through settlement or a judge's award.
4. HOW LONG CAN I GET WORKERS' COMPENSATION BENEFITS?You can receive total disability benefits for the rest of your life. You can receive partial disability benefits for 500 weeks. You receive partial disability benefits if you return to work and earn less than you did per week before your injury. In addition, once you have received 104 weeks (two years) of total disability benefits, the insurance company can request that an impairment rating examination take place. A doctor selected by the Bureau of Workers Compensation will assess your "impairment rating". If that rating is less than 50%, then you will be deemed "partially disabled" and you will only be entitled to another 500 weeks of benefits. It is important that you have an attorney to advise you during this process so that he can help you avoid being labeled "partially disabled".
5. HOW IS A SETTLEMENT VALUED? Settlements are based on many factors. The extent of the injury, the type of work performed, the age and education of the claimant are some of the factors that go into calculating value. However, the most important factor is the pre-injury average weekly wage. This is the weekly amount of money that the insurance company calculated that you earned prior to your date of injury. If it was improperly calculated this could lead to your case being undervalued for settlement. An important factor that is not part of the calculation is pain and suffering. While workplace injuries are often highly traumatic and place great pressure on the injured worker and his family, the Pennsylvania Workers' Compensation Act does not provide for compensation for pain and suffering.
How Does Returning To Work Affect My Workers' Compensation Disability Benefits?
If you are receiving benefits from workers' compensation for a disability, the effect of going back to work will depend on the type of benefit involved and the laws in your state. Although the details of each state's workers' compensation plans vary, there are characteristics that most plans share in common.
Is Your Disability Temporary Or Permanent?
There are two major categories of disability benefits: temporary and permanent. Temporary benefits are given when an employee needs to be away from work for a short period of time for medical attention or recovery. These benefits are intended to be temporary and expire when the employee returns to work.
Permanent disability benefits are given when the employee will never fully recover from their injury and therefore, their future earning potential is affected. The amount of the benefit reflects future lost wages (the difference between what the person would have earned and what they are able to earn with the disability). In cases where the employee is unable to do any work as a result of their injury, the individual would receive total disability benefits (these can be temporary or permanent depending on how long the disability prevents the person from working). This amount is generally calculated considering what the employee was able to earn before his or her injury.
Temporary Disability Benefits Will End
When a person returns to work, temporary disability benefits are terminated, since there is no need to compensate the person for lost wages since they are now able to work. In some states, the mere fact that the person returns to their former position would be enough to end the disability benefits, but other states require a letter from the doctor saying that an employee is able to return to full duty.
Total disability benefits are given when an employee is considered unable to do any work. Therefore, if the employee returns to work or finds a new job they will be unable to collect benefits. In general, if the person resumes working their benefits will terminate. Different states use different standards to determine when benefits will end. Some states will ask whether the person is capable of finding sustained gainful employment while other states will require that the person actually has an opportunity to perform a gainful and suitable occupation. The question is not just whether or not the person is capable of performing at a job but whether the person actually has a present opportunity for employment, such as a job offer.
Permanent Disability Benefits Will Likely Continue
Individuals who receive permanent disability benefits generally receive an amount that is based on their previous earnings and compensates them for future lost wages. The idea is that the employee may be able to find another job but they may not be able to earn the same wage. If an employee is receiving benefits and ends up finding a job that pays the same wage or more, their disability benefits will generally not terminate. In general, fluctuations in the amount that the employee earns will not cause his or her benefits to be reduced or discontinued. This includes reductions in salary as well. If the employee earns less than expected then the amount of disability benefits is not increased. The amount of the benefit is calculated considering the effect of the disability on employment so if the disabling condition doesn't change then the amount of the benefits generally shouldn't either.
Consult An Attorney About Changes To Your Employment StatusThe effect of returning to work, whether in your former position or to a new job, will vary from state to state. An employee who is being paid workers compensation for future lost earnings or who is totally disabled should use caution before making major changes in their employment status. These changes could affect their benefits. These individuals should also consider that they may have a duty to report changes in their employment to the company through which they obtained workers' compensation or to the insurer who is paying the benefits. An employee who fails to do this may find that they are responsible for reimbursing workers' compensation for any excessive payments made. The financial stakes in these cases can be high so a worker in this situation may want to consult an attorney before going back to work. An attorney may also be able to inform the employee of other options available to them such as applying for social security disability benefits.
How Do I Know If I Have A Workers' Comp Claim?
Most injuries which happen at work, regardless of who is at fault, will be covered under workers' compensation. Even injuries which happen away from the office or jobsite can be covered if you are furthering the business of your employer at the time of the injury. Injuries do not have to be associated with a specific incident, but can be the result of repetitive motion or cumulative trauma.
How Long Do I Have To Report My Injury?
It is a good idea to report any injury, no matter how small you think it is, right away to a supervisor. Saying something to your coworker is not the same as notice to your employer. If you delay giving notice of a work injury, you run the risk that when you do give notice later your employer will not believe you. The sooner you give notice, the sooner you can receive wage loss and medical benefits. Under the workers' compensation law, you will lose the right to make a claim if you do not give notice within 120 days of when you knew or should have known about the work injury.
Can I See My Own Doctor? What Is The "90 Day Rule"?
Many employers and their insurance companies will tell you that you must treat only with a "panel physician" within the first 90 days of a work injury. This is only true in certain limited circumstances, because the employer must comply with many elements of the workers' comp law in order to force an injured employee to choose a panel doctor. In truth, you can see any doctor you choose in the first 90 days, but if your employer complies with all aspects of the panel doctor law it will have no obligation to pay that doctor. After the 90 days is up, you can treat with whoever you want, and even get second opinions.
Will It Hurt My Employer If I Try To Get Workers' Comp?
Your employer has already paid the insurance company and bought the insurance which covers you. Presumably, your employer wants you to use the insurance which it already paid for. The workers' comp system is designed to make sure that injured workers get the treatment they need quickly and get back to work as soon as they can, and this benefits employers. If you delay your treatment by deciding not to file a claim, your employer may have to wait a lot longer to get a valued employee back.
Will I Lose My Job If I Make A Claim?
Most non-union Pennsylvania workers are "at-will employees," which means they can be fired at any time for any reason or no reason, as long as they are not being discriminated against. An employer can be subject to a wrongful termination lawsuit if it fires you for pursuing a workers' compensation claim. This does not mean that your employer must keep your job open for you forever, and it does not have to provide light duty for you. However, if you are fired after a work injury or not brought back to work if you are released to work modified duty, you may be entitled to wage loss benefits under workers' compensation.
To What Benefits Am I Entitled?
Workers' compensation in Pennsylvania provides for a wage loss benefit (typically 2/3 of your preinjury average weekly wage), and medical treatment which is reasonable, necessary, and causally related to the work injury. The calculation of the preinjury average weekly wage can be very complicated, and should always be double-checked by an experienced workers' compensation lawyer. Overtime and bonuses should be included in the calculations. Even if you are receiving wage loss benefits, you may be receiving the wrong amount. If you cannot earn your preinjury wages because of the work injury, you may be entitled to total or partial disability benefits.
Should I Settle My Claim?
Settlements of workers' comp claims are common in Pennsylvania. They are achieved by a Compromise and Release, where usually the insurance company pays the injured worker a lump sum of money in exchange for the worker giving up all of his or her rights under the law. The negotiation of these settlements is best left to experienced workers' compensation attorneys who can draw on years of experience to determine the worth of a claim and get the most value for the case. Not all cases should be settled, and not all cases must be settled for a full release of both wage loss and medical benefits. Each person's case is unique and should be evaluated individually.
Do I Need To See A Lawyer? What Will I Have To Pay?
You are not required to hire an attorney to go through the workers' compensation system, but most people who try to handle cases on their own realize quickly that they are in over their heads. Workers' compensation insurance companies will always be represented by lawyers, most of whom only practice workers' compensation law. Their mission is to reduce or eliminate your benefits. You will be wise to have a free consultation with an experienced workers' compensation lawyer who only represents injured workers. It costs you nothing to have your case evaluated, and having a lawyer involved in your claim from the beginning will maximize your ability to receive all of the benefits to which you are entitled.
How Does Returning To Work Affect My Workers' Compensation Disability Benefits?
If you are receiving benefits from workers' compensation for a disability, the effect of going back to work will depend on the type of benefit involved and the laws in your state. Although the details of each state's workers' compensation plans vary, there are characteristics that most plans share in common.
Is Your Disability Temporary Or Permanent?
There are two major categories of disability benefits: temporary and permanent. Temporary benefits are given when an employee needs to be away from work for a short period of time for medical attention or recovery. These benefits are intended to be temporary and expire when the employee returns to work.
Permanent disability benefits are given when the employee will never fully recover from their injury and therefore, their future earning potential is affected. The amount of the benefit reflects future lost wages (the difference between what the person would have earned and what they are able to earn with the disability). In cases where the employee is unable to do any work as a result of their injury, the individual would receive total disability benefits (these can be temporary or permanent depending on how long the disability prevents the person from working). This amount is generally calculated considering what the employee was able to earn before his or her injury.
Temporary Disability Benefits Will End
When a person returns to work, temporary disability benefits are terminated, since there is no need to compensate the person for lost wages since they are now able to work. In some states, the mere fact that the person returns to their former position would be enough to end the disability benefits, but other states require a letter from the doctor saying that an employee is able to return to full duty.
Total disability benefits are given when an employee is considered unable to do any work. Therefore, if the employee returns to work or finds a new job they will be unable to collect benefits. In general, if the person resumes working their benefits will terminate. Different states use different standards to determine when benefits will end. Some states will ask whether the person is capable of finding sustained gainful employment while other states will require that the person actually has an opportunity to perform a gainful and suitable occupation. The question is not just whether or not the person is capable of performing at a job but whether the person actually has a present opportunity for employment, such as a job offer.
Permanent Disability Benefits Will Likely Continue
Individuals who receive permanent disability benefits generally receive an amount that is based on their previous earnings and compensates them for future lost wages. The idea is that the employee may be able to find another job but they may not be able to earn the same wage. If an employee is receiving benefits and ends up finding a job that pays the same wage or more, their disability benefits will generally not terminate. In general, fluctuations in the amount that the employee earns will not cause his or her benefits to be reduced or discontinued. This includes reductions in salary as well. If the employee earns less than expected then the amount of disability benefits is not increased. The amount of the benefit is calculated considering the effect of the disability on employment so if the disabling condition doesn't change then the amount of the benefits generally shouldn't either.
Consult An Attorney About Changes To Your Employment StatusThe effect of returning to work, whether in your former position or to a new job, will vary from state to state. An employee who is being paid workers compensation for future lost earnings or who is totally disabled should use caution before making major changes in their employment status. These changes could affect their benefits. These individuals should also consider that they may have a duty to report changes in their employment to the company through which they obtained workers' compensation or to the insurer who is paying the benefits. An employee who fails to do this may find that they are responsible for reimbursing workers' compensation for any excessive payments made. The financial stakes in these cases can be high so a worker in this situation may want to consult an attorney before going back to work. An attorney may also be able to inform the employee of other options available to them such as applying for social security disability benefits.
How Do I Know If I Have A Workers' Comp Claim?
Most injuries which happen at work, regardless of who is at fault, will be covered under workers' compensation. Even injuries which happen away from the office or jobsite can be covered if you are furthering the business of your employer at the time of the injury. Injuries do not have to be associated with a specific incident, but can be the result of repetitive motion or cumulative trauma.
How Long Do I Have To Report My Injury?
It is a good idea to report any injury, no matter how small you think it is, right away to a supervisor. Saying something to your coworker is not the same as notice to your employer. If you delay giving notice of a work injury, you run the risk that when you do give notice later your employer will not believe you. The sooner you give notice, the sooner you can receive wage loss and medical benefits. Under the workers' compensation law, you will lose the right to make a claim if you do not give notice within 120 days of when you knew or should have known about the work injury.
Can I See My Own Doctor? What Is The "90 Day Rule"?
Many employers and their insurance companies will tell you that you must treat only with a "panel physician" within the first 90 days of a work injury. This is only true in certain limited circumstances, because the employer must comply with many elements of the workers' comp law in order to force an injured employee to choose a panel doctor. In truth, you can see any doctor you choose in the first 90 days, but if your employer complies with all aspects of the panel doctor law it will have no obligation to pay that doctor. After the 90 days is up, you can treat with whoever you want, and even get second opinions.
Will It Hurt My Employer If I Try To Get Workers' Comp?
Your employer has already paid the insurance company and bought the insurance which covers you. Presumably, your employer wants you to use the insurance which it already paid for. The workers' comp system is designed to make sure that injured workers get the treatment they need quickly and get back to work as soon as they can, and this benefits employers. If you delay your treatment by deciding not to file a claim, your employer may have to wait a lot longer to get a valued employee back.
Will I Lose My Job If I Make A Claim?
Most non-union Pennsylvania workers are "at-will employees," which means they can be fired at any time for any reason or no reason, as long as they are not being discriminated against. An employer can be subject to a wrongful termination lawsuit if it fires you for pursuing a workers' compensation claim. This does not mean that your employer must keep your job open for you forever, and it does not have to provide light duty for you. However, if you are fired after a work injury or not brought back to work if you are released to work modified duty, you may be entitled to wage loss benefits under workers' compensation.
To What Benefits Am I Entitled?
Workers' compensation in Pennsylvania provides for a wage loss benefit (typically 2/3 of your preinjury average weekly wage), and medical treatment which is reasonable, necessary, and causally related to the work injury. The calculation of the preinjury average weekly wage can be very complicated, and should always be double-checked by an experienced workers' compensation lawyer. Overtime and bonuses should be included in the calculations. Even if you are receiving wage loss benefits, you may be receiving the wrong amount. If you cannot earn your preinjury wages because of the work injury, you may be entitled to total or partial disability benefits.
Should I Settle My Claim?
Settlements of workers' comp claims are common in Pennsylvania. They are achieved by a Compromise and Release, where usually the insurance company pays the injured worker a lump sum of money in exchange for the worker giving up all of his or her rights under the law. The negotiation of these settlements is best left to experienced workers' compensation attorneys who can draw on years of experience to determine the worth of a claim and get the most value for the case. Not all cases should be settled, and not all cases must be settled for a full release of both wage loss and medical benefits. Each person's case is unique and should be evaluated individually.
Do I Need To See A Lawyer? What Will I Have To Pay?
You are not required to hire an attorney to go through the workers' compensation system, but most people who try to handle cases on their own realize quickly that they are in over their heads. Workers' compensation insurance companies will always be represented by lawyers, most of whom only practice workers' compensation law. Their mission is to reduce or eliminate your benefits. You will be wise to have a free consultation with an experienced workers' compensation lawyer who only represents injured workers. It costs you nothing to have your case evaluated, and having a lawyer involved in your claim from the beginning will maximize your ability to receive all of the benefits to which you are entitled.
WERE YOU GIVEN THIS FORM TO SIGN AT TIME OF EMPLOYMENT?
NOTIFICATION TO EMPLOYEES OF THEIR RIGHTS AND DUTIES UNDER SECTION 306 (f.1)(1)(i) OF THE PA. WORKERS’ COMPENSATION ACT The Pennsylvania Workers’ Compensation Act requires that employees be given written notification of their rights and duties under Sec. 306 (f.1)(1)(i) of the Act if a list of designated health care providers is established by the employer. Below are your rights and duties under Sec. 306 (f.1)(1)(i) and an acknowledgment signature line. This acknowledgment, signed by you, is to be returned to your employer. A brief summary: You have the right to seek emergency medical treatment from any provider; for post-emergency and other injuries, you must obtain treatment for work-related injuries and illnesses from a designated health care provider for 90 days. The penalty for not using a designated health care provider is that your employer is not liable for the medical bills incurred.
____________________________________________________________________________________________________ As an employee of the Commonwealth working at a location where a list of designated health care providers has been established and posted, you have: • The duty to obtain treatment for work-related injuries and illnesses from one or more of the designated health care providers for 90 days from the date of the first visit to a designated provider. • The right to seek emergency medical treatment from any provider, but subsequent non-emergency treatment shall be by a designated provider for the remainder of the 90-day period. • The right to have all reasonable medical supplies and treatment related to the injury paid for by your employer as long as treatment is obtained from a designated provider during the 90-day period. • The right, during this 90-day period, to switch from one designated health care provider to another designated provider. • The right to seek treatment from a provider if you are referred to that provider by a designated provider. • The right to an additional opinion from a provider of your choice when invasive surgery is prescribed by the designated provider. • The right to seek treatment or medical consultation from a non designated provider during the 90-day period, but the services shall be at your expense for the applicable 90 days. • The right to seek treatment from any health care provider after the 90-day period has ended. • The duty to notify your employer of treatment by a non designated provider (after the 90 day period) within 5 days of the first visit to that provider. The employer may not be required to pay for treatment rendered by a non designated provider prior to receiving this notification. I acknowledge that I have been informed of my rights and duties under Sec. 306 (f.1)(1)(i) and that I understand them to the extent that they are explained above. __________________
______ _____________________________________________ Print Name Employee Signature Date
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