NewsMark Schmidt on Law Journal TV
January 15, 2007
Mark Schmidt Appeared on Law Journal TV to discuss Workers' Compensation Issues Read More...Law Firm Donates To KIDS CHANCE Inc.
December 10, 2006
Schmidt, Kirifides, Pearson & Koutcher donate to KIDS' CHANCE, Inc. Read More... Fridkin Joins Schmidt, Kirifides, Pearson & Koutcher as Partner
May 1, 2007
New partnership expands law firm’s service offerings and adds office locations Read More... Mark Schmidt Appeared on Law Journal TV’s Workers’ Compensation Program On Monday, May 14, 2007
May 11, 2007
Guests provided insight on Workers’ Compensation: The Judge, Mediation & Settlement. Read More... Main Line Times Reports on Mark Fridkin
May 6, 2007
Mark Fridkin, Esq., has joined the firm as a partner. Read More... Contact Us
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Workers’ Compensation
FAQs
Workers’ Compensation laws are state-enacted statutes that
provide for a no-fault, employer-funded system of insurance. Under
such laws, employees who are injured on the job or develop an illness
as a result of their work may be awarded benefits which include
compensation for lost wages and medical bills related to their work
injury. While this system of compensation sounds simple in theory,
it is actually quite complicated and difficult for workers and lawyers
who do not concentrate their practices on Workers' Compensation
to navigate. The following are some commonly asked questions about
the Workers’ Compensation system. Keep in mind that these
are just general guidelines. Every case has unique facts and circumstances
that could require a different answer. For information specific
to your claim, please call Schmidt, Kirifides, Pearson & Koutcher,
P.C.:
Q: What is Workers’ Compensation?
Q. Who is covered under the Workers’ Compensation
Act?
Q. When must my employer start providing coverage
for me?
Q. Are all on-the-job injuries covered?
Q. If I am entitled to benefits by law, why do I
need an attorney?
Q. What makes Schmidt, Kirifides, Pearson &
Koutcher a good choice to handle Workers’ Compensation claim?
Q. How do I make a claim for Workers’ Compensation
benefits?
Q. How can my employer respond to my claim for benefits?
Q. Are there time limits that apply to Workers’
Compensation claims?
Q. What kinds of benefits are available and how
are they calculated?
Q. How do I know how much my case is worth?
Q. How long will it take to resolve my case?
Q. Can I get money for pain and suffering?
Q. Can I settle my claim instead of going to court?
Q. Can I ever sue my employer if I am injured at
work?
Q. Can I apply for benefits in addition to those
provided by the Workers’ Compensation Act?
Q. Can I get another job?
Q. Can I see my own doctor about my injury or illness?
Q. What if my doctor and the insurance company’s
doctor disagree?
Q. What does it cost to hire a Workers’ Compensation
attorney?
Q. How will my attorney be paid?
Q. Can my employer fire me for making a Workers’
Compensation claim?
Q. Where can I go for further information about
Workers’ Compensation?
Q: What is Workers’ Compensation?
Pennsylvania’s Workers’ Compensation Act requires nearly
all employers to provide Workers’ Compensation insurance for
their employees. The insurance provides full medical, total and partial
disability, permanent disfigurement and physical rehabilitation benefits
to injured employees, provided their Workers’ Compensation claims
are approved. In the event that a worker is killed on the job, death
benefits are payable to the worker’s surviving spouse and dependents.
Workers’ Compensation is also known as workers’ comp,
workman’s compensation, workman’s or workmen’s comp,
and workmen’s compensation.
Q. Who is covered under the Workers’
Compensation Act?
Almost all Pennsylvania workers, including those who work seasonally
or part-time, are covered by the Act. Even non-profits and employers
with only one employee must have Workers’ Compensation insurance,
or provide it themselves. However, other compensation laws cover federal
employees, railroad workers, longshoremen, shipyard workers and certain
other employees. Those who may not be covered at all include certain
volunteers, some agricultural laborers, domestics and certain agricultural
workers.
Q. When must my employer start providing coverage
for me?
Your coverage begins on the day you are hired. You do not need to
be at your job for a certain period of time in order to receive benefits.
Q. Are all on-the-job injuries covered?
Workers' Compensation covers most workplace injuries and illnesses.
This is true even if an employer or other employee's carelessness
caused the injury. There are limits, however. Coverage is not provided
in the event that an injury is caused by intoxication or illegal drug
use. Coverage may also be denied if an injury is self-inflicted, suffered
while the worker was committing a crime, or if the worker violated
company policy.
You should know that your injury need not be caused by an accident
to be covered. Often, workers receive compensation for injuries that
accumulate over a long period of time, such as carpal tunnel syndrome
or back pain. Diseases that develop gradually as a result of work
conditions also fall within the Act. These might include heart or
lung conditions or stress-related illnesses. You might also be entitled
to benefits if your work aggravates a pre-existing condition.
Q. If I am entitled to benefits by law, why
do I need an attorney?
Even though the law requires your employer to provide Workers' Compensation
insurance for your protection, your employer or your employer's insurer
may not automatically start paying benefits to you if you are injured
or become ill as a result of your job. Under the Workers' Compensation
Act, you must take certain steps to begin the claims process and follow
particular procedures and prove particular facts along the way. If
you do not meet the Act's requirements, you could forfeit some or
all of the benefits to which you are entitled. A skilled Workers'
Compensation attorney, such as the partners at Schmidt, Kirifides,
Pearson & Koutcher, can help ensure that you secure the maximum benefits
available without delay. Keep in mind, too, that your employer and
the employer's insurance company will have experienced lawyers working
for them. You should, too. Because time is of the essence in these
matters, do not delay in contacting an attorney if you think you have
a claim. Waiting to do so could result in delayed or forfeited benefits.
Q. What makes Schmidt, Kirifides, Pearson &
Koutcher a good choice to handle Workers' Compensation claim?
The lawyers at Schmidt, Kirifides, Pearson & Koutcher are experienced
attorneys who have spent more than a decade handling Workers' Compensation
matters for claimants like you. Workers' Compensation is all we do.
We care about you and your family and strive to help you obtain all
that is owed to you under the law. And we pride ourselves on superior
service to our clients. When you choose Schmidt Kirifides Pearson
& Koutcher, you do so knowing that you will receive personalized,
courteous attention from your lawyer. And you will deal only with
your attorney because our lawyers attend to each matter themselves.
We are passionate about our work and set out not to meet, but to exceed,
our clients' expectations.
We will help you decide whether you have a valid claim and, if so,
determine what steps you must take to obtain benefits. In addition,
it is common for insurers or employers to initially deny a Workers'
Compensation claim. In the event your claim is denied, we can handle
the appeals it will take to get you the benefits that you are owed.
Finally, one of our competent Workers' Compensation lawyers can determine
whether you may bring suit against any third parties that contributed
to your injury or illness.
Q. How do I make a claim for Workers' Compensation
benefits?
Your first call should be to your Workers' Compensation attorney,
who can help you take the correct steps to increase the likelihood
that you will receive benefits. These steps include:
(1) Promptly reporting any injury or work-related
illness to your employer or supervisor. Telling a co-worker is not
sufficient. When you tell your employer or supervisor about your injury
or illness, you must be sure to specify the date and place of injury.
If possible, the notice you provide should be in writing.
(2) Filing a claim petition if your employer or the
employer's insurance carrier denies coverage for your injury or illness.
Your petition will then be assigned to a Workers' Compensation judge.
(3) If, after hearing evidence and testimony, the
judge denies your claim, there are multiple levels of appeal that
your lawyer can help you navigate.
It is important not to give up if your claim is initially denied.
This is a common occurrence and you are not without recourse. A skilled
attorney can help you pursue your claim with the goal of securing
all of the benefits to which you are entitled.
Q. How can my employer respond to my claim
for benefits?
Within 21 days of receiving notice of your claim, your employer (or
your employer's insurance company) must respond with a Temporary Notice
of Compensation Payable, Notice of Compensation Payable or Notice
of Compensation Denial. A letter from the insurance company or employer,
or the filing of only an incident report, is not a legally recognized
response.
(1) A Notice of Compensation Payable means your claim
has been accepted and wage loss and medical benefits will begin. You
might still need a lawyer to ensure the description of injury and
benefit rate are correct.
(2) A Notice of Compensation Denial means your claim
has been denied. Immediately contact an attorney to discuss your options.
(3) A Temporary Notice of Compensation Payable sometimes
results in a false sense of security. Your employer can file this
notice if the employer is unsure about accepting your claim. Under
this notice, your employer can provide benefits for up to 90 days
without legally accepting your claim. If your employer issues a Temporary
Notice, you should consult with an attorney.
Q. Are there time limits that apply to Workers'
Compensation claims?
Yes. You must inform your employer within 120 days of your injury
or disability. While this seems like plenty of time, in reality it
is crucial to report any injury or work-related illness to your employer
or supervisor right away. You must tell your employer that you were
injured while working, giving them the date, location and nature of
the injury. If your employer or insurer denies your request for Workers'
Compensation benefits, you have three years from the date of injury
to file a Claim Petition.
In the case of occupational illness or disease, the injury or disability must occur
within 300 weeks from the date of your last employment in an occupation in which you
were exposed to a hazard. A petition must be filed within three years of the date of
injury or disability.
If your benefits were suspended and your condition changes or worsens and you again
become disabled, you can file a petition to have benefits reinstated. The petition can be
filed up to 500 weeks after the suspension.
If you do not take action within these time frames, you could forfeit your right to benefits.
Q. What kinds of benefits are available and
how are they calculated?
The Workers' Compensation Act provides for several kinds of benefits.
Depending on your individual situation, you may qualify for lost wages,
specific loss benefits, medical care and/or death benefits.
(1) Lost Wages: Payments for lost wages are available
to employees who are unable to work due to a "total" or "partial"
disability. They are also payable to workers who, due to a temporary
disability, are earning or are capable of earning less than they were
making pre-injury. Wage loss benefits typically total two-thirds of
your average weekly wage, subject to a weekly maximum.
(2) Specific Loss Benefits: These are payable to
workers who permanently lose the use of a limb or appendage; their
sight or hearing; or who have suffered a serious and permanent disfigurement
of the head, face or neck.
(3) Medical Benefits: Covered claims will include
payment for reasonable and necessary surgical and medical treatments
that are provided by a physician or other healthcare provider. If
they are deemed necessary, medical supplies, hospital treatment and
services, orthopedic appliances and prostheses will also be covered.
Employees may not be charged the difference between a healthcare provider's
fee and the amount paid by the employer or insurance carrier.
Q. How do I know how much my case is worth?
Each case is different because each depends on the facts and circumstances
of a worker's injury or illness. It is possible to have 10 people
who have suffered the same injury, and yet have each case be worth
a different amount. Some of the factors that will affect your case
are: the way your injury occurred, the insurance company involved,
your age, whether you have been offered other jobs and other medical
conditions unrelated to your work injury.
The variable nature of Workers' Compensation claims is just one of
the reasons why it is important to secure the services of a knowledgeable,
experienced firm like Schmidt Kirifides Pearson & Koutcher. Our lawyers
know how to evaluate cases. If your attorney feels you have a valid
claim, he can explain how the various factors might affect it and
what its worth might be.
Q. How long will it take to resolve my case?
Typically, it takes about a year for a Workers' Compensation claim
to go through the court system, although there are instances when
a settlement or agreement is reached before the case ends, and other
times when the litigation takes longer. Each case is different.
Q. Can I get money for pain and suffering?
No. Workers' Compensation benefits are not available for pain and
suffering. The Workers' Compensation system is very different from
the civil court system that handles personal injury cases and the
like, which is where damages for pain and suffering are recoverable.
There are, however, instances in which someone other than your employer
or co-worker is responsible for causing your injuries. In such cases,
you can pursue monetary damages including those for pain and suffering.
An experienced Workers' Compensation attorney can help you determine
whether you have such a case.
Q. Can I settle my claim instead of going to
court?
Yes. You can resolve your Workers' Compensation claim by settlement
- called a Compromise and Release - but only if both sides agree to
the terms. If both sides do not agree on the amount or other terms
there is no settlement. Your employer's insurer cannot force you to
take less than you are willing to take; and you cannot force the insurance
company to give more than it is willing to give. Even if all sides
agree, a Workers' Compensation judge must still approve the settlement
after making sure that you understand the legal significance of it.
Q. Can I ever sue my employer if I am injured
at work?
Typically, you cannot sue your employer for a work-related injury
or illness. The Workers' Compensation system is meant to provide employees
who are disabled by work-related injury or disease with fixed monetary
awards. It is intended to protect employees by guaranteeing benefits
for accepted claims, and also to safeguard employers from lawsuits.
However, there are some limited situations when you may sue the employer
in court. If you think you have such a case, it is important to contact
an attorney for assistance with your dispute.
Q. Can I apply for benefits in addition to
those provided by the Workers' Compensation Act?
Yes. You are permitted to apply for other sources of income such as
Social Security, unemployment or public assistance while your case
is proceeding. However, you must remember that Workers' Compensation
is a "wage loss" system. You may not "double dip." That is, you cannot
receive benefits from two different sources. This means that at the
conclusion of your claim, the insurance company might be able to deduct
what you received in other benefits from your Workers' Compensation
claim. Or you might have to return money to the agency from which
you received those benefits.
Q. Can I get another job?
You are permitted to return to work if you are physically capable
of doing so. Even though your injury may leave you unable to perform
your regular job, you may be capable of performing a lighter-duty
job. If that is the case, the insurance company might offer jobs it
thinks you can handle. Or you might learn of job openings or opportunities
on your own. Bear in mind, though, that the Workers' Compensation
system will pay benefits based only on the wages you lose. If you
return to work at the same salary you were earning at the time of
your injury, you will not be losing any wages and you will therefore
receive only medical benefits. If you return to work at a lower salary,
Workers' Compensation may pay you a reduced benefit depending on the
amount of your current earnings, and will continue to pay the medical
bills related to your work injury.
Q. Can I see my own doctor about my injury
or illness?
Whether you can see your own physician depends on your employer. If
your employer has posted a list of six or more physicians, and you
have signed an acknowledgement form indicating that you are aware
of the list, then you must choose one of those physicians for your
initial treatment. For 90 days thereafter, you must continue to treat
with one of the healthcare providers on the employer's list. You are
entitled to a second opinion in the event that invasive surgery is
recommended, however. After 90 days, or in the case of workplaces
with no list, or where you have not signed an acknowledgement form,
you may see your own physician for treatment. You will have to notify
your employer of the provider you choose.
After you begin receiving benefits, your employer or the employer's
insurer is entitled to ask you to see their doctor for an examination.
If you refuse, a Workers' Compensation judge may order you to comply
with the request. Failure to comply with the order could result in
suspended benefits.
Q. What if my doctor and the insurance company's
doctor disagree?
If the insurance company doctor feels that you have fully or partially
recovered from your work injury, but your own doctor believes that
you are still disabled and unable to return to work, the insurance
company may file a petition to challenge your benefits. A Workers'
Compensation judge will hear each doctor's medical opinion and render
a decision based on their testimony.
Q. What does it cost to hire a Workers' Compensation
attorney?
At Schmidt, Kirifides, Pearson & Koutcher, your lawyer's fee will
be based on the benefits we obtain or maintain for you. If we do not
secure or maintain benefits for you, we will not get paid.
Q. How will my attorney be paid?
How and when your lawyer gets paid depends on what type of case you
have. If the insurer has denied your claim, we will fight your entire
case. If we do not obtain benefits for you, there is no fee for our
service. If an award is made in your favor, the judge will order the
attorney's fee. In exact compliance with the judge's order, the insurance
company will pay your benefits to you in one check, and issue a separate
check to us for our attorney's fee. We may receive counsel fees for
as long as you receive benefits.
If, on the other hand, the insurance company has paid you benefits, and the insurer then files a petition to reduce or eliminate those benefits, we will appear on your behalf and submit relevant documents to the judge. The judge will then make a preliminary decision on whether you are to continue receiving benefits while the case proceeds. The judge may also issue an award of attorney's fees at that time. If so, the insurance company will issue the appropriate benefits to you in one check, and the attorney's fee to us in a separate check.
Finally, if there is a settlement, the insurance company will also issue two separate checks. One check will be issued to you for your share of the settlement. The other will be issued to us for attorney's fees.
In most cases, the attorney's fee is deducted from the client's benefits.
In some cases, the attorney's fee may be paid by the insurance company
directly and will not be taken out of the client's benefits. This
is what we request in all cases, but you should be aware that such
an award is extremely rare.
Q. Can my employer fire me for making a Workers'
Compensation claim?
Maybe. It is unlawful for your employer to fire you just for seeking
Workers' Compensation benefits. In addition, it is unlawful for your
employer to harass or otherwise discriminate against you for doing
so. However, an employer is permitted to fill a vacant position and
may not have an opening when you recover from your injury. The rights
and duties of the employee and employer may be covered by a written
company policy, contract, collective bargaining agreement or even
by Labor Laws separate from the Pennsylvania Workers' Compensation
Act.
Q. Where can I go for further information about
Workers' Compensation?
Pennsylvania's Department of Labor and Industry provides online information
for individuals. Click
here.
The Workers' Compensation Appeal Board also maintains a Web site.
Click
here.
You may also ask your supervisor, union or your employer's Workers' Compensation insurance carrier for additional information.
Finally, Pennsylvania offers a Workers' Compensation helpline. The e-mail address is
ra-li-bwc-helpline@state.pa.us. Or, call toll-free inside Pennsylvania: 800.482.2383 (800.362.4228 for hearing impaired callers). Local calls and those made outside of Pennsylvania should dial 717.772.4447 (717.772.4991 for hearing impaired callers).
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