Types of Workers’ Compensation Benefits
Workers’ Compensation is one of the most powerful workers’ rights laws on the books. Pennsylvania requires employers to carry a form of insurance that will protect employees if they are hurt on the job. In the state of Pennsylvania, the Pennsylvania Workers’ Compensation Act outlines benefits that must be provided.
A business may create a self-paid insurance plan that pays benefits through the company directly after an injury or death. Most businesses, however, use an insurance company to manage Workers’ Compensation. The insurance company provides a blanket policy to the business, and anyone who is hurt has their claim processed by that provider.
Benefits are provided to those injured on the job. Families are also allowed death benefits if someone is killed on the job or dies as a result of injuries sustained on the job. Although a traditional insurance claim should pay for these benefits, employers, insurance companies, and even other lawyers might attempt to deny or curtail the victim’s coverage. A Philadelphia Workers’ Compensation lawyer can help the victim or their family fight for the coverage that should have been provided the moment an injury occurred.
Which Types of Workers’ Compensation Benefits are Available?
Workers’ Compensation is broken up into four types of coverage, including:
- Temporary total disability: An injury that leaves an employee unable to perform any job functions on a temporary basis.
- Temporary partial disability: This benefit is payable until a worker recovers to full work capacity after a work-related illness or injury.
- Permanent total disability: An injury that leaves the employee unable to return to employment.
- Permanent partial disability: An injury that did not improve, affecting one’s work performance.
Workers’ Compensation is paid based on a determination of the level of disability provided by the attending physician. These determinations may also be made when the insurer or employer orders a medical exam. Speak to a Workers’ Compensation lawyer for assistance when it unclear how benefits should have been paid.
Can Workers’ Compensation Pay My Medical Bills?
Injured workers must report these accidents or injuries to a supervisor as soon as possible. In Pennsylvania, the victim has 21 days to report an injury to receive benefits retroactive to the date of the injury. At the maximum, the employee must report their injury within 120 days to receive any benefits. If the injured party or their family must file a claim to receive benefits that should have been paid, they have three years from the date of the injury to file a claim. A Workers’ Compensation lawyer should review the case long before the statute of limitations is due to expire.
When workers are injured, they will visit a doctor who has been approved through the insurance provider. A poster or flyer in the office should provide a list of approved doctors, which new employees should note. Injured employees will go to one of those doctors, note that a Workers’ Compensation claim has been filed, and allow the doctor to bill the insurance company. Injured workers are not requested to make coinsurance payments when they visit a doctor, specialist, or facility.
Medical bills generated by the doctor’s office all go to the insurance company, and they are paid so long as the claim has been approved. In extreme cases, the employee might go to the doctor the same day only to discover that their claim has been denied a few days later. At this point, a lawyer will need to get involved.
Can Workers’ Compensation Pay for Future Medical Care?
Workers’ Compensation, in theory, should pay for future medical care. For example, the injured employee may need the following:
- Physical therapy
- A cast
- Medication that lasts longer than the original injury
- Surgical procedures to correct damage caused by the injury or accident
Although the insurance company should continue to pay for treatment or medication that directly manages a workers’ injuries, the employer or insurance company might try to curtail these expenses by asking employees to come back to work. Some insurance providers go so far as attempting to prove that the employee has fully recovered.
Common tactics include a utilization review where the employer or insurance provider can determine if the coverage received by the employee far surpasses the scope of their injuries. The employer or insurance company might request an independent medical examination (IME) through a third-party doctor to show that the employee is healed, or the insurance company might cut off the employee entirely. Injured employees should speak to a Workers’ Compensation lawyer if benefits are not provided as expected. For example, a lawyer can help injured workers and their families schedule the IME with a truly impartial doctor.
Does Workers’ Compensation Pay My Salary?
Workers’ Compensation insurance pays the worker’s salary at a particular rate depending on their job and wages. The average weekly rate is calculated based on the work that was performed prior to the accident. Most people will receive two-thirds of their average weekly rate until they recovered and can go back to work.
Someone who was working more than one job at the time of the accident should report all their income, owing to a rule that accounts for concurrent employment. The injured worker might receive more money every week if they were working multiple jobs, but they cannot receive that money if they do not report all their income. Lost wages are calculated as follows:
- Wage-loss benefits are calculated at two-thirds of the worker’s salary
- Temporary total disability benefits may be reviewed via a medical exam, but they convert to permanent total disability benefits once a permanent disability has been verified by a doctor
Workers’ Compensation can be confusing for new managers and payroll auditors. The insurance company pays the worker’s salary while they are recovering, and workers should expect to receive checks in the mail or a request for direct deposit information. If the worker is not receiving their salary or the payments suddenly stop, they should reach out to a Workers’ Compensation lawyer for help.
Can I Receive Benefits for Specific Losses?
Specific loss benefits go above and beyond traditional benefits, as they provide for loss of limbs, loss of function, or loss of senses. Someone who has been hurt on the job could be impacted for the rest of their life as a result of severe injuries such as these, and they require special benefits that will help them recover, move on, and even obtain gainful employment. Specific loss benefits can be paid for the following injuries:
- Lost fingers or toes
- Lost eyes or ears
- Loss of hearing, sight, smell, or taste
Because these injuries are quite severe, the payments are determined based on a schedule used only for the worst injuries. The worker has already had their average weekly wage determined so that they can receive their lost wage benefits. A specific loss payment is determined based on a certain number of weeks calculated for each injury.
Disfigurement is also covered under specific loss benefits because the worker may need several surgeries, constant medical care, and their quality of life will change. Disfigurement is painful, and it may result in the loss of limbs or a loss of functional movement. Although someone who has been disabled or disfigured on the job might be able to return to work at some point, they must still be compensated for the severity of their injuries.
Because the insurance company may not make an appropriate offer, a Workers’ Compensation lawyer should be retained to determine the proper amount of compensation for each lost limb or sense. A negotiation between the two parties can take place without input from the worker because their focus should be on their recovery. Although Workers’ Compensation has paid for treatment and rehabilitation, the lasting effects of these severe injuries deserve unique levels of compensation.
Can Workers’ Compensation Pay for Vocational Rehabilitation?
Vocational rehabilitation is offered to employees who cannot return to their regular jobs after an accident. The accident might have left the employee incapable of doing their job, and they need to be returned to a job that pays at or near what they were making before the accident. For example, a mechanic who no longer has the fine motor skills to deal with all the internal parts of an engine, transmission, or exhaust system might be trained as a vehicle painter, inspection technician, or designer. The goal of the program is to help these injured employees get back to work as quickly as possible.
Although vocational rehabilitation is not necessary for everyone, it should be considered when the worker has been badly injured. Businesses and insurance companies often believe that vocational rehabilitation means the worker can be reassigned to a menial job. Those jobs often do not pay the appropriate rate, and the worker will not be fulfilled.
Before accepting a reassignment, an injured worker should speak to a Workers’ Compensation lawyer who can petition for the proper vocational rehabilitation training. Most training occurs in a similar industry, or the employee might even train in a new field, change departments, or move on to a new company that can utilize their skills.
What If I am Deemed Partially Disabled?
When an employee has received temporary partial disability benefits for 104 weeks, they can be assessed in an Impairment Rating Evaluation (IRE). This evaluation is used to determine the percentage of the worker’s disability. When the injured employee has less than 50 percent body impairment, they will be covered under total partial disability benefits.
At this point, the worker can go into vocational rehabilitation as described above. Vocational rehabilitation is meant to put the employee in a job that allows them to earn wages comparable with what they earned before the injury. If the employee and their vocational therapist cannot find an appropriate job with the appropriate pay rate, they will receive two-thirds of the pay difference through Workers’ Compensation.
Are My Mental Injuries Recognized by the State of Pennsylvania?
Mental injuries are compensable under the Pennsylvania Workers’ Compensation Act, but they fall into a few different categories. This coverage is often the most confusing because some workers do not know they are eligible for this compensation. The three main categories of mental injury are as follows:
Physical-mental: A physical injury suffered at work can cause a psychological issue that is difficult to overcome. For example, the worker might have been injured using a certain type of machine. They would understandably feel uncomfortable using that machine again, and they might experience such intense anxiety that they cannot even approach that machine. Therapy is the best treatment for such a condition, and vocational rehabilitation may be necessary if the worker can no longer use the equipment needed for the job.
Mental-physical: A job that creates a high level of mental turmoil can cause physical problems in the future. Someone who is experiencing anxiety in the office or fearing for their job might begin to develop ulcers, suffer from high blood pressure, suffer from a heart attack, or experience severe migraines. The employee must be treated for their physical issues, but they also need counseling that will help them overcome the stress and anxiety that was created by their job.
Mental-mental: Mental injuries are not always recognized under state Workers’ Compensation laws. In Pennsylvania, mental injuries are recognized and covered. A mental-mental injury involves anything that starts as a mental issue and continues as a mental issue.
If a worker is subjected to extreme trauma when they are trapped inside their store during a robbery, they will feel extreme anxiety just going back to work. If these workers see the signs of another robbery or criminal act, they might suffer from a panic attack or feel extreme anxiety that prevents them from doing their job.
These workers might also take these anxieties home. Depression can make it difficult for the worker to engage in the normal activities of life. Such an employee needs mental health care, and that care should be paid for through the company’s Workers’ Compensation insurance.
When the employer or insurance company does not recognize mental injuries, a Workers’ Compensation can note that the worker is covered under Pennsylvania law, and they can help the worker receive the appropriate care. In most cases, the worker simply requests the coverage that should have been provided when the mental injury occurred.
Am I Eligible for Mental Injury Benefits?
Workers may not know they are eligible for coverage because they believe their mental injuries do not rise to the level of a Workers’ Compensation claim. Covered mental injuries include these issues:
Harassment: Harassment on the job is illegal when it is sexual in nature or targets a protected group. Someone who is consistently bullied at work cannot leave those interactions at work. These employees might feel extreme anxiety when they must come to work, or they might begin to experience symptoms of depression. A claim for mental injury should be filed along with documentation the employee has collected of the harassment they experienced.
Customer service interactions: Although most people would say that dealing with customers is part of the job, some workers have truly terrifying or unnerving encounters with customers. For example, someone who works overnight at a gas station might have been threatened by a customer who came into the store. That customer might make the worker feel so afraid that they cannot return to work.
When customer service interactions go above and beyond normal retail banter, the worker can file a claim for mental injury. These cases must be reported as soon as possible because the employee might also need to be reassigned, along with receiving the treatment they need for their anxiety or depression.
Excessive workloads: Excessive workloads can cause anxiety or depression because the worker believes they can never keep up. The anxiety and depression that these workers feel could cause physical health issues and reduced performance. These employees often work for managers or owners who have unreasonably high expectations, and those expectations make the workload that much worse.
Unhealthy shift work: Studies have shown that shift work can cause a change in sleep patterns, health issues, and chronic fatigue. Employees who are scheduled to work strange hours often believe that they are missing out on family events.
Additionally, these workers often feel much less satisfied with their jobs. When someone is unhappy in their work but believes have few options, they could feel anxious or depressed. Extreme symptoms should be reported so that the worker can receive the care they need.
Consistent job insecurity: Consistent job insecurity can take a toll on anyone who is afraid of losing their livelihood. Someone in this state will feel anxious or depressed all the time because they may believe they are stuck with their current employer with no other option but to hold on to an unsatisfying job. In fact, long-term studies of workers who suffered from job insecurity found that it is just as bad for someone’s mental health as being unemployed.
How Do I Receive Workers’ Compensation Coverage?
Injured workers must report any accidents or injuries as soon as possible. The manager or supervisor who takes the report will send that information to the insurance carrier or insurance department within the company. A claim will be filed, and the worker will begin receiving benefits. The claims process might take a few days to complete, and it helps to remain in contact with the manager who filed the report or the employer’s insurance department. If there has not been any movement on the claim, a lawyer should be retained to ascertain the nature of the situation. Some insurance companies move slowly, but some businesses do not report claims properly.
If the insurance company suddenly decides that the injury should not be covered, a lawyer should get involved. The injured worker should not complain to the insurance company; an official letter from an attorney will be taken seriously. Insurance companies have a team of lawyers to protect their interests, and injured workers should have a Workers’ Compensation lawyer on their side.
It is important to remember that exempt executives, railroad workers, longshoremen, defense contractors, sailors, domestic workers, volunteers, independent contractors, and those with religious exemptions cannot file a Workers’ Compensation claim.
Are Additional Benefits Available to Me?
Additional benefits are available if the injured employee can no longer obtain gainful employment. The employee may need to file a claim for Social Security Disability benefits. Although these benefits are separate from the Workers’ Compensation process, they should be considered when it is obvious the injured worker cannot return to work.
A lump-sum settlement is also available if the injured worker or their attorney wishes to settle out of court. In short, the insurance company makes one payment to the injured worker in exchange for the worker promising not to litigate the case further.
Will Workers’ Compensation Pay Death Benefits?
Death benefits cover a range of options, which are handled by the insurance company. Death benefits are offered so long as the worker passes away within 300 weeks of the injury. Therefore, reporting the event is so important. There must be a clear record of the reported injury, and medical records must show that that injury is what killed the worker, regardless of how long the worker stayed alive. Families must continue to collect all their receipts and records over the next five years and 10 months in case the accident ultimately results in the death of their loved one.
Once the worker has died, a $3,000 death benefit is paid to help manage final expenses. Death benefits are also available for spouses, children, and dependent relatives. A spouse who receives death benefits will be paid 51 percent of the deceased worker’s average weekly wage until he or she remarries. Even upon a remarriage, the spouse will receive a final check for 104 weeks. When the spouse has children to raise, they receive 60 percent of the deceased worker’s wages. When there are two or more children involved, the spouse receives 67 percent of their spouse’s average weekly wage.
Relatives who qualify for benefits when no spouse or children are left behind include the following:
- Partially dependent parents, who will receive 32 percent of the worker’s average weekly wages
- Fully dependent parents, who will receive 52 percent of the worker’s average weekly wages
- Dependent brothers or sisters, who can receive between 22 and 32 percent of their deceased sibling’s average weekly wages
Children remain eligible for benefits until they turn 18. If they are enrolled in college, they can receive benefits until they are 23. A disabled child can receive benefits until their disability ends. Unfortunately, long-term benefits could stop at any time and with little to no notice. The family should contact a Workers’ Compensation lawyer for assistance with their case when there are gaps in benefits or stoppages. A lawyer can investigate why benefits were stopped and petition to have the benefits restarted.
When Should I Hire a Lawyer?
Injured workers and their families should hire a lawyer when they realize that their Workers’ Compensation benefits have not been handled properly. A Workers’ Compensation lawyer will help the family understand how benefits should be paid, calculate the benefits that should have been paid, and collect medical records that better explain how much the insurance company should have paid.
If benefits ever stop, the lawyer can contact the insurance company to determine what went wrong. Complaining to the insurance company does not help because the people who answer the phone likely do not know how to resume payment. Instead, a lawyer should contact the insurance company directly.
The injured worker should not sign anything without a lawyer present. The employer or insurance company might ask injured employees to sign a final receipt that will stop benefits without explanation. The employer or insurance company might also send documents through the mail to be signed and returned. The worker should ask a lawyer to read these documents first. Even phone calls should be forwarded to avoid confusion.
When a lawyer cannot negotiate a settlement or resumption of payments, they can take the case before an administrative law judge because the insurance company is not acting in good faith. The employer has been shielded from liability because they have Workers’ Compensation insurance, and they cannot be sued. If there might be an instance in which the employer is liable, the case should be reviewed with an attorney first.
Philadelphia Workers’ Compensation Lawyers at McCann Dillon Jaffe & Lamb, LLC Help Injured Workers Obtain the Benefits They Deserve
Reach out to the Philadelphia Workers’ Compensation lawyers at McCann Dillon Jaffe & Lamb, LLC for assistance with your benefits. You need to receive all the benefits described above, and a lawyer should assist you when your benefits have not been paid or even offered. We will review each case, let our clients know what can be done, and fight vigorously for every client’s right to compensation. Call us today at 215-569-8488 or contact us online for a free consultation. Located in Wilmington, Abington, and Media, Pennsylvania; Wilmington, Delaware; and Haddonfield, New Jersey, we serve clients throughout the surrounding areas.