Frequently Asked Questions about Workers' Comp Cases | Merwine, Hanyon & Kaspszyk, Attorneys at Law

With a few exceptions, nearly every worker in Pennsylvania is covered by the Workers' Compensation Act. Employers are legally required to provide Workers' Compensation coverage for all of their employees, including seasonal and part-time workers.

No matter how many employees a business has, or what type of business it is--non-profit or unincorporated businesses, for example, they must comply with the Act's requirements.

Generally, the only workers not covered by the law are volunteer workers, agricultural laborers, casual employees, domestics and employees who have been granted a personal religious exemption from the Act.

Why do I need an attorney?

Workers' Compensation litigation is complex and you can be sure that your employer or your employer's insurance company will be represented by an experienced attorney.

You may represent yourself in Workers' Compensation proceedings, but a non-attorney cannot represent you.

What kind of benefits are available?

There are many types of Workers' Compensation benefits. For example:

Payments For Lost Wages--Wage benefits are available if you are totally disabled and unable to work or partially disabled and receiving wages less than your pre-injury earnings.

Death Benefits--When injuries result in death, surviving dependents may be entitled to benefits.

Specific Loss Benefits--Permanent loss of the use of all or part of a thumb, finger, hand, arm, leg, foot, toe, sight, hearing, or in the event of a serious and permanent disfigurement on your head, face or neck, you may be entitled to a specific loss award.

Medical Care--In the event of a work-related illness or injury, you are entitled, if covered under the Act, to the payment of related reasonable surgical and medical services rendered by a physician or other health care provider.

Medicine, supplies, hospital treatment and services, orthopedic appliances, and prostheses are also covered for as long as they are needed. However, specific rules concerning the choice of medical professionals must be followed to ensure that these benefits remain available to you.

Even in cases involving no loss of work time, health care costs for a work-related injury or illness are payable under the act.

Is there a time limit for Workers' Compensation claims?

Generally, employers must be notified no later than 120 days after the injury for compensation to be allowed.

If a request for Workers' Compensation benefits is denied by an employer or an employer's insurance carrier, the injured worker has three years from the date of injury to file a Claim Petition.

In occupational disease cases, such as asbestos poisoning, the injury or disability must occur within 300 weeks from the date of last employment in an occupation in which there was exposure to a hazard, and a petition must be filed no later than three years from the date of injury/disability.

Failure to file a petition on a timely basis may result in forfeiture of your right to benefits. If your benefits were terminated, you may file a Petition to Reinstate WC benefits within three years after the date of your most recent WC check.

If your benefits were suspended, you may file a petition to have benefits reinstated. This petition must be filed within 500 weeks from the date of suspension.

It is important to know that payment of medical benefits by your employer does not mean that your claim has been accepted or reopened.

I received a notice from my employer that my Workers Comp benefits are being terminated. Are my benefits going to stop?

No, not immediately. Neither your employer nor the insurance company has the right to stop your benefits without you signing something or without a Judge’s approval.

In order to terminate your Workers’ Compensation benefits, your employer or the insurance company must file a Petition. Once the Petition is assigned to a Judge, a Hearing will be held. At that hearing the Insurance Company’s lawyer will ask the Judge to stop your checks while the case is proceeding through the system.

With our assistance, 99 times out of a 100, we will be able to keep your benefits going while the case proceeds. After the case is fully litigated in 9 to 12 months, the Judge will decide whether or not to stop your Workers’ Compensation benefits.

I cannot work due to an injury I suffered on the job. How much will my benefits be?

Workers’ Compensation benefits depend directly upon your wages. Benefits are calculated based upon the average wage you earn on a weekly basis. For an injury occurring after January 1, 2010, if you earned less than $469.43 per week, your Workers’ Compensation benefits will be 90% of your Average Weekly Wage.

If you earned between $469.44 and $633.75 per week, your Workers’ Compensation benefits will be $422.50. If you earned between $633.76 and $1,267.50 per week, your Workers’ Compensation benefits will be two-thirds of your Average Weekly Wage.

Finally, if you earned $1,267.51 per week or above, your Workers’ Compensation benefits will be $845.00 per week.

My employer denied my claim for workers’ compensation benefits. I think I am entitled to benefits because I can’t work. Do I need an attorney to get benefits or can I file a Claim Petition on my own?

Yes, you can file a Claim Petition on your own, however, the Workers’ Compensation system is difficult to navigate without an attorney. You will be required to pay for and take testimony from your treating doctor, which can cost thousands of dollars. You will also be required to participate in hearings, etc. without assistance if you do not hire an attorney.

Meanwhile, you can be sure that your employer or its insurance company will be represented by at least one high experienced attorney.

While you can proceed on your own, we do not recommend that you try. We are trained to litigate these matters and a high degree of expertise is necessary to successfully litigate a Workers’ Compensation case.

Since I am not working due to my work injury, I have no money. How can I hire an attorney if I have no money?

Attorney’s fees in Workers’ Compensation cases are based on a percentage of your compensation rate. If we are successful at obtaining benefits for you, or keeping those benefits going, our fee will be set by the presiding Judge in the case. Generally the fee is 20 percent of your weekly compensation checks or settlement amount. Only a Judge can approve our fee.

If we do not win your case for you, you will pay nothing.

I’ve been receiving benefits for my back injury for a couple of years and then last month my benefits were stopped out of the blue. Is my Employer allowed to do this?

No, absolutely not. Your employer and its insurance company are required to keep paying you until you sign something closing your case or a Judge says so. If neither of these things has happened, call us immediately so that we can seek to have your benefits reinstated as soon as possible.

I suffered a work injury. Do I have to be treated by the company's doctor?

Yes. The law requires you be treated by the company's doctor for 90 days. After 90 days, you can choose a different physician if you want.

If my employer is based in New Jersey and I was injured while working in Pennsylvania, can I recover workers’ compensation benefits in Pennsylvania?

Possibly. This will depend on where you begin and end your work day. If you begin and end your work day in Pennsylvania, you will likely be eligible for Pennsylvania Workers’ Compensation.

Can I recover workers’ compensation benefits if my injury did not occur on my employer’s premises?

Yes. As long you begin and end your work day in Pennsylvania, even if you were not injured on site, your employer can still be held liable for your injuries.

Can I recover workers’ compensation benefits even if my work injury is my own fault?

Generally, yes. There are exclusions at times, but provided you did not directly violate an instruction from your employer, you should still be eligible for Workers’ Compensation.

Can I recover workers’ compensation benefits if my work injury is caused by a co-worker or a third party?

Generally, yes. There are exclusions at times. For instance, if you get in a fight with a co-worker who causes you injuries, you likely will be unable to collect Workers’ Compensation. However, if you were simply carrying out your work duties and a third party caused your injuries, you should still be eligible for Workers’ Compensation.

Can I sue my co-worker if he or she caused my injury?

Possibly. This will depend on whether your co-worker’s actions were accidental or intentional and how the injury occurred. For instance, if your co- worker accidentally hit you with his car while you were performing work duties, you may be able to sue him.

However, if your co-worker mopped the floor on which you slipped, there will likely be no right to sue him. A potential claim against a co-worker will also depend on whether there is any insurance coverage. Our attorneys will advise you if any such claim exists.

I have been receiving workers’ compensation benefits for an injury I suffered at work last year. If I return to work, will that affect my weekly benefits?

Yes. If you return to work your benefits will be either modified or stopped. If you return to work earning greater than or the same as your Average Weekly Wage, your benefits will stop. If you return to work, but are earning less than your Average Weekly Wage, you are entitled to 2/3 of the difference between your actual wages and your Average Weekly Wage.

I received unemployment compensation after my work injury. Now the employer is seeking a credit against my workers’ compensation benefits. Are they allowed to do this?

Yes. Your employer is entitled to a credit for any unemployment received. If unemployment pays you less than Workers’ Compensation would pay for an accepted injury, your employer must make up the difference.

The employer said I am not entitled to workers’ compensation benefits anymore since I started receiving my pension. Is that correct?

It depends on how much you are receiving. Your employer is entitled to a credit against Workers’ Compensation for any pension benefits received. If your pension benefit is higher than your Workers’ Compensation payout, then your Workers’ Compensation benefits will stop. However, timing is very important and in some situations your employer is not entitled to an offset.

Every case is different. We will address the specifics of your case with you.

Can I apply for and receive Social Security (Old Age) benefits if I am receiving workers’ compensation benefits?

It depends on the situation. If you got hurt after you started collecting, then an offset may apply. If you “retired” after the injury, you may be barred from receiving Workers’ Compensation. Every case is different. We will address the specifics of your case with you.

Can the employer offset my workers’ compensation benefits by the amount of long or short-term disability benefits I receive?

Yes, depending on who funded the disability program. If you paid for these benefits on your own, then, more than likely, no offset will likely apply. If your employer funded the benefits, then an offset may apply. Every case is different. We will address the specifics of your case with you.

The workers’ compensation insurance company will not pay for or approve the prescriptions needed for my work injury and I cannot afford to pay for them myself, what do I do?

Call MHK immediately. A Petition will likely have to be filed on your behalf to force your employer to pay for these necessary medical expenses.