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Sustaining an injury or illness at work can leave a worker unable to do their job for an extended period. In some cases, a work-related injury can be life-altering. Workplace injuries affect a wide range of workers across many different industries. Workers who have been injured on the job rely on workers’ compensation benefits to help cover the cost of medical expenses and carry them through periods of disability.
If you are employed in Pennsylvania and sustain an injury or illness related to work, chances are you qualify for workers’ compensation benefits. Under the Pennsylvania Workers’ Compensation Act, nearly all workers are entitled to benefits after suffering an injury at work. The Workers’ Compensation Act provides medical expense coverage and wage loss compensation for those totally or partially disabled from injury.
If you suffer a work-related injury that leaves you disabled and totally or partially unable to do your job, ideally you will want to start receiving workers’ compensation benefits as soon after the injury occurs as possible. Beyond that, you will, of course, want those benefits to continue for the entire length of time takes you to recover. However, your employer or your employer’s workers’ compensation insurance company may petition to suspend — or stop — your benefits before you are physically able to return to the job you had before the injury.
Suffering a serious injury at work can potentially be devastating, and losing important benefits will only add to the stress of an already trying situation. Here we will talk about Pennsylvania’s workers’ compensation benefits and why they might get suspended, as well as the steps you can take to resolve issues and disputes related to a suspension of benefits.
About the PA Workers’ Compensation Act
Pennsylvania enacted its Workers’ Compensation Act in 1915 as a way to protect workers from the ramifications of sustaining an injury at work. Today, the provisions of the Workers’ Compensation Act are carried out by the:
Department of Labor and Industry’s Bureau of Workers’ Compensation
In addition to medical expenses and wage loss benefits, workers’ compensation benefits also include death benefits for dependent survivors in cases of work-related death, as well as specific loss benefits. You may be entitled to receive a specific loss award if, for example, you experience the loss of an arm or leg, hearing loss or another permanent disability or disfigurement.
Workers’ compensation benefits are paid out by private insurance companies or, in some cases, the State Workers’ Insurance Fund. Most workers in Pennsylvania are covered under the Workers’ Compensation Act, including seasonal and part-time employees. Some categories of employees are not covered under the act, including volunteers, agricultural laborers, domestics, casual employees and employees who have been granted a religious exemption from the act. Certain employees, such as federal civilian employees, railroad workers, longshoremen, shipyard and harbor workers, may be covered by other compensation laws.
You may not be able to receive benefits if the injury or death is self-inflicted or intentional, or if the injury happened while you were intoxicated or acting in violation of the law.
If an injury leaves you completely unable to work, you may be entitled to receive wage loss benefits for the entire period you are unable to do the job. Wage loss benefits amount to approximately two-thirds of your weekly wage. Those who are left partially disabled — meaning their injury has caused their wages to be lower than they were before the injury — may receive partial benefits for a maximum of 500 weeks.
When you sustain a job-related injury, you should report the injury as soon as possible, as the failure to do so could result in the delay or denial of benefits. If you are prompt in reporting your injury, you should receive your first wage loss compensation check within 21 days of your absence from the workplace, provided you miss more than seven days of work and the workers’ compensation insurance company accepted your claim.
What Is a Suspension of PA Workers’ Compensation Benefits?
A suspension of workers’ comp benefits is when wage loss benefits stop. If you have suffered an injury or illness at work, ideally you will receive weekly wage loss payments for the entirety of your time out of work. Unfortunately, some employers or insurance companies might try to suspend your benefits before you have fully recovered. For several reasons, you may lose your eligibility for weekly wage loss benefits, despite still suffering from a work-related illness or injury — and still being unable to work.
Under a suspension of benefits, the workers’ compensation insurance carrier can still pay medical bills despite the termination of wage loss benefits. There are many ways in which an employer or insurance carrier may petition for a workers’ compensation suspension of benefits. A workers’ compensation judge may order the suspension of benefits due to a change in your economic circumstances, your 500 weeks of partial disability benefits may have expired or you may have signed a supplemental agreement to stop the payments if they are no longer necessary.
If you are an injured worker whose wage loss benefits have stopped, there are several possible causes for the suspension of your workers’ compensation benefits. If any of these apply to your situation, and you feel you are entitled to continue receiving benefits, be sure to take additional steps as soon as possible to resolve the issue with your employer and have the suspension of your benefits lifted.
The insurance company denied your claim. An employer or workers’ compensation insurance carrier may issue temporary wage loss compensation for up to 90 days, even if the employer or insurer doesn’t accept your claim. If your claim gets denied, your temporary benefits may stop after the 90-day period.
You have returned to work. Wage-loss benefits may stop if your employer or insurance company has evidence that you have reentered the workforce and are earning the same as or more than you were earning before your work injury. When you return to work, there is a 20-day trial period. You may file a challenge to the return-to-work suspension within 20 days. If this challenge is successful, your workers’ compensation benefits will be automatically reinstated.
You have become disabled from a condition not related to work. If you were already unable to do your job due to a work injury and are then diagnosed with an unrelated illness or condition that leaves you totally disabled, your wage loss payments may stop.
You have failed to follow procedure. For example, you may have failed to complete paperwork from the workers’ compensation insurance company, or perhaps you did not participate in an insurance medical exam — or IME — ordered by the insurance company. If you are receiving benefits, it is imperative you provide the insurance carrier with information that may be relevant to determining the amount of your compensation. These details can include information about income from another employer or from self-employment, or details about your physical condition.
A workers’ compensation judge determines you have earning potential. Insurance carriers can file a notice of ability to return to work based on jobs that might be available to you without having to prove such a job exists or has been offered to you. If your employer or insurer has evidence that employment is available within your area and within the realm of any medical restrictions, your benefits may get suspended.
You have refused reasonable medical treatment. In this case, the insurance carrier would need to file a petition, and a workers’ compensation judge would then have to rule that the medical treatment in question would reasonably lead to you being able to return to work. In this situation, your reason for refusing treatment must be based on facts, rather than your opinion.
You have been incarcerated. If you are convicted of and incarcerated for a crime, you will no longer be eligible to receive workers’ compensation benefits.
You have voluntarily withdrawn from the workforce. Workers’ compensation benefits can potentially be suspended if you indicate you have no intention of returning to the workforce. Perhaps you feel your injury, age or lack of certain skills are preventing you from being able to return to the workforce at all. Voicing this to your employer or their insurance carrier may provide reason enough for them to suspend your wage loss benefits.
What Is a Petition to Suspend Workers’ Compensation Benefits?
If your employer or their insurer wants to alter or stop your workers’ compensation benefits, they can file a petition to modify, suspend or terminate your benefits with the Bureau of Workers’ Compensation. Though they might sound similar, a petition to suspend workers’ compensation benefits is not the same as a petition to terminate benefits. Understanding the difference between these petitions is key to understanding why your employer or insurance carrier might be stopping your wage loss benefits.
Petition to Suspend Benefits
When an employer or insurance company files a petition to suspend workers’ compensation benefits, they do so with the knowledge that they will still bear some responsibility for compensating you. A petition to suspend benefits will suspend wage loss payments, but not medical bill payments. There may be several different reasons for this, as outlined above. However, you may still be recovering from your injury and possibly unable to return to work at the time your benefits get suspended.
Petition to Terminate Benefits
A petition to terminate benefits comes with a different goal in mind. When an employer or insurance company files a petition to terminate workers’ compensation benefits, they typically do so to terminate both wage loss payments and future medical bill coverage. An employer or insurer may file this petition if they feel you have fully recovered from the work injury and they have fulfilled their obligation to provide workers’ compensation benefits. The petition is usually based on information from your physician stating you are recovered and can return to work.
Petition to Modify Benefits
An employer or insurance company may file a petition to modify your workers’ compensation benefits to reduce the amount of compensation you receive in their weekly wage loss payments. A petition to modify benefits is usually filed based on information from your physician stating you are no longer disabled to the same extent you were before. Your physician may release you to a modified job they feel you are well enough to do.
What to Do If You Believe You Are Entitled to Workers’ Compensation Benefits?
If you have sustained an injury on the job and you are not receiving the benefits for which you are eligible, there are multiple ways to proceed.
Contact your employer or workers’ compensation insurance company. This step is the first one you should take if a problem arises. Remember, the insurance carrier has 21 days from the day you notified your employer of your injury to accept or deny your claim.
File a petition with the office of adjudication. If speaking with your employer or insurer doesn’t resolve your problem, file a petition with the Office of Adjudication with Pennsylvania’s Department of Labor and Industry. The Office of Adjudication is responsible for resolving disputes through petitioning workers’ compensation judges, who then decide each case based upon hearings.
Consider alternative dispute resolution. In alternative dispute resolution, a judge helps the employee and the employer or insurer resolve their dispute through mediation, a settlement conference or an informal conference. These options give the involved parties the opportunity to talk through the dispute.
Workers’ compensation litigation can be complex. If you find yourself in a legal dispute regarding your workers’ compensation benefits, it is likely a capable attorney will represent your employer or their insurance carrier. It would be beneficial for you to hire an attorney to represent you in any workers’ compensation proceedings.
For any questions about workers’ compensation benefits, the best way to get the answers you need is to get in touch with an experienced legal professional. At KBG Injury Law, we are familiar with the intricacies of PA workers’ compensation and exactly how the law applies to your specific circumstances. Not only are we knowledgeable, but we’re also sensitive to your situation. Issues surrounding a work-related injury are about more than finances. We recognize an injury or illness sustained on the job may have forever changed your life.
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