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How Long Am I Covered Under the Heart and Lung Act?

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How long am I covered under the Heart and Lung Act?

How Long Am I Covered Under the Heart and Lung Act?

First responders, such as law enforcement officers and firefighters, face higher risks in their daily jobs than the average worker. In light of that fact, the Pennsylvania legislature created a program in 1935 that allows police, firefighters and several other categories of Pennsylvania employees to receive 100% of their regular salary while they are temporarily off-duty because of an injury, as well as payment of medical expenses. Legislators amended the law in 2006 to include sheriffs and deputy sheriffs.

Although this law is commonly known as Pennsylvania’s Heart and Lung Act, the official name of the statute is Enforcement Officer Disability Benefits Law. The difference in wording is important.

Under Pennsylvania’s law, a first responder injured while performing his or her duties is eligible for benefits. So if a police officer trips and hurts him or herself while chasing a suspect, he/she would qualify for benefits. In other states, such as Virginia, first responders only qualify for the program if they suffer injuries or diseases concerning the heart or lungs.

The individual’s salary is the basis for the benefits, which exclude overtime or any other income from a second job. The Act does not cover death benefits. Because this law can be complicated, here is a guide to understanding the PA Heart and Lung Act.

Who Qualifies for the Program?

The Heart and Lung Act covers a broad range of Pennsylvania employees who work as first responders or in law enforcement.

  • All city, county, borough, township or town police officers
  • All firefighters
  • State police
  • Sheriffs
  • Deputy sheriffs
  • Parole agents
  • Liquor control board investigators and enforcement officers
  • Psychiatric security aides who work for the Department of Public Welfare or the Department of Corrections
  • Correction employees whose primary duties involve taking care of inmates
  • Drug enforcement agents
  • Special agents who work for the office of the attorney general
  • Members of the Delaware River Port Authority Police

When Does the Heart and Lung Act Cover Me?

Assuming you are a Pennsylvania employee and you work in one of the above categories, if you become injured while performing an official duty, you may be eligible for compensation under the Heart and Lung Act in Pennsylvania.

When does the Heart and Lung Act cover me?

To qualify, you must be performing an official duty when you are injured. For instance, if a firefighter parks her car in the fire department’s parking lot and slips and falls on her way into work, the Heart and Lung Law would not cover that injury (although the workers’ compensation laws likely would). On the other hand, if an alarm sounds and a firefighter gets injured while climbing into the fire engine, he would be eligible for the Heart and Lung Act.

How Do I Receive Benefits?

If you are injured while on duty, you should file an injury report. You will normally do so using a prepared form, often the same one used to report job-related injuries for a workers’ compensation claim.

Your employer may also ask you to file a statement showing how your injury relates to the performance of your duties, the temporary nature of the injury and why you think it would prevent you from carrying out the essential responsibilities of your job.

Your employer reviews the statement, conducts an investigation and then issues a written report.

You will continue to get benefits as long as:

  • Your injury is temporary.
  • The injury prevents you from performing the essential duties of your job.
  • Your employer cannot or is unwilling to restructure your work duties to accommodate your limitations.
  • You continue to meet the eligibility requirements of the Pennsylvania Heart and Lung Act.

If the administrator responsible for reviewing the report determines you are eligible for benefits, you receive them beginning on the first workday after your injury occurred or you received a diagnosis of an illness.

If the administrator decides you are not eligible, they should explain the employer’s position denying you benefits in the report. The same report should also notify you of your appeal rights.

Can My Employer Use My Sick Leave When I Receive Heart and Lung Act Benefits?

No. The Heart and Lung Act explicitly states an employer may not use an employee’s sick leave to account for any time off while they are injured.

Do I Continue to Receive Regular Health Benefits and Accrued Vacation Pay When I Have an On-Duty Injury or Illness?

The Heart and Lung Act does not specifically stipulate that an injured employee would continue to receive regular health benefits, or that they would accrue vacation pay while off-duty because of an injury. However, it may fall under the collective bargaining agreement between your union and the authority for which you work.

When do my Heart and Lung Act benefits end?

When Do My Heart and Lung Act Benefits End?

Terminating Heart and Lung benefits happens when an administrative proceeding determines you are not eligible for benefits or that your eligibility period has ended — for example, by accepting disability retirement. If your employer can show you are no longer disabled or, on the other hand, that your injury is of indefinite duration and therefore may be permanent, you may also find your benefits terminated.

Before getting off compensation for the Heart and Lung Act, however, you receive a due process hearing. Your employer will send you a letter detailing why they believe you are no longer eligible for benefits. You will then have a chance to respond to these allegations.

What Is a Due Process Hearing?

If your employer has denied your initial claim to be covered under the Heart and Lung Act, or if they believe you may no longer qualify to receive benefits, you are entitled to a due process hearing.  The employer arranges this hearing under their guidelines, and it must conform to specific legal procedures.

Very often, however, you will receive scant guidance on how these proceedings will take place, other than notification of the time and place. Unfortunately, there can be substantial differences in how these proceedings get carried out, depending on which employer holds them.

Often, a three-member panel composed of employer’s representatives conducts the proceedings. These representatives consider the arguments made by both sides, as well as the opinion of a doctor.

Your rights during the proceeding include:

  • The burden of proof is on the employer to prove that you are not eligible to receive Heart and Lung Act benefits or that you no longer qualify to receive them.
  • You have the right to legal representation, and to cross-examine witnesses, submit evidence and address the panel.

Once the hearing ends, the three-person panel renders a decision in writing.

The employer will attempt to prove one of the following points:

  • Your illness or injury was not a result of your official duties.
  • Your employer will try to pressure the treating physician into saying your illness or injury is not the result of your employment. Often, the employer sends you to a handpicked physician in the hopes the doctor will say your injury did not result from your official duties.
  • Your employer will argue that you are no longer injured and can return to work.
  • Your employer will argue that your injury is permanent, and thus you are ineligible to receive any further Heart and Lung Act benefits, although you could still qualify to receive workers’ compensation benefits.
  • Your employer does not need to show that your injury may be permanent, but that it may be of “indefinite duration.”

Employers will do this, even to law enforcement officers and first responders, because paying Heart and Lung Act benefits can be costly. Therefore, employers and their insurance carriers will do everything possible to either prove that you are not eligible to receive these benefits, or that they should stop.

Will I Automatically Be Ineligible for Heart and Lung Benefits If I Am Not Represented at a Due Process Hearing?

No, but your chances improve if you have representation from competent legal counsel. A due process hearing for the Heart and Lung Act does tend to stack in favor of the employer. Indeed, the panel that will determine benefits often consists of the employer’s representatives. Since the rules on holding a due process hearing change from employer to employer, it’s hard for an injured worker to know exactly what they need to do during the hearing to prove their case.

Working with a competent attorney who understands the Heart and Lung Act, as well as the workers’ compensation system, will give an injured worker the best chance of proving they deserve to continue to receive benefits.

Can I Restore Terminated Heart and Lung Act Benefits?

Yes, but it is difficult. If the panel determines you are not or are no longer eligible for Heart and Lung Act benefits, you may appeal. This process, however, is often cumbersome. It frequently requires an attorney to spend a substantial amount of time to prepare an appeal. Often, a panel might not render a decision on an appeal for several months.

Is it possible to lose Heart and Lung benefits without a due process hearing?

Is It Possible to Lose Heart and Lung Benefits Without a Due Process Hearing?

Yes. There are some circumstances under which an employer may end your benefits without a due process hearing:

  • If you suffer a separate injury that totally disables you, apart from your work injury
  • If you accept or become eligible for Social Security benefits or a disability pension

You must speak to an attorney before you accept a disability retirement. Accepting disability could have a severe impact on your eligibility for workers’ compensation benefits.

Should I Hire a Union Lawyer or a Personal Lawyer to Represent Me?

While union lawyers may be extremely well-versed in labor law, they are likely unfamiliar with workers’ compensation litigation and its connection to the Heart and Lung Act. Or, your union might work with a legal firm that gives them a reduced fee for representing the union on all legal matters. In this case, the lawyer assigned to represent you may not be familiar with the crucial issues at stake.

All lawyers have ethical reasons to competently represent their clients. If you want your best chance of winning, however, work with a lawyer who is familiar with the Heart and Lung Act, workers’ compensation law and the various ways employers will try to convince you to accept early retirement or a disability pension to avoid paying benefits.

For instance, if you accept a disability pension or you retire before you explore benefits available for permanent disability through workers’ compensation, it could cost you a lot of money.

Contact the Attorneys at KBG Injury Law for Help With Heart and Lung Act Benefits or If You Face a Due Process Hearing

If you feel you are not getting the Pennsylvania Heart and Lung Act benefits you deserve, or if you are facing a hearing and may be losing your benefits, contact KBG Injury Law for a consultation. The attorneys at KBG Injury Law have helped thousands of injured workers and plaintiffs secure benefits for their injuries.

At KBG Injury Law, our attorneys have extensive experience in working with cases involving Heart and Lung Act benefits, as well as workers’ compensation. They can help provide you with the expertise and guidance needed at a due process hearing and also help you decide if you should proceed with a workers’ compensation claim.

If you would like to speak with one of our experienced and knowledgeable attorneys, call us at 800-509-1011, or visit our contact us page to let us know how we can help you. A member of our team will get back to you as soon as possible.

Contact KBG Injury Law for a free consultation from one of our experienced lawyers.

During this challenging time, our attorneys are advocating more than ever. While our physical offices are closed, we are all working remotely to ensure you still get the Results You Deserve. To all of our current clients, you can connect with us the same way you always do via email, phone, fax or text. To all of our prospective clients, the best way to get in touch with us is by using our contact form or by calling (800) 509-1011

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