Workers Compensation is legislated under two separate Acts. The Workers Compensation Act was adopted in 1915. Originally, it was known as the Workmens Compensation Act. It has been amended many times since its original enactment. Occupational diseases are governed by the Occupational Disease Act of 1939. The administration of both Acts is under the supervision of the Pennsylvania Department of Labor and Industry which has extensive rule and regulation making powers.
At its simplest, an employee injured in the course and scope of his employment is entitled to receive payment of wage loss benefits and payment of medical expenses. When an injury occurs, the employer is required to report the injury to the Workers Compensation Bureau. The employer can accept liability and file the appropriate document which will result in payments beginning to the injured employee and payments of medical expenses paid directly to the medical providers. In this situation, an injured employee rarely requires consultation with counsel.
However, when an alleged employer fails to accept responsibility for the injury, the employee is required to file a Claim Petition. At this point, even the most sophisticated layman will find himself or herself trapped in a maze that cannot be navigated without the help of counsel knowledgeable in the interpretation of the Statues as amended and the case law that has developed over many years.
Examples of hurdles that may be encountered are: distinction of employee versus independent contractor, was the injured individual within the course and scope of employment when the injury occurred, and did the injury occur while on or off the premises.
Most injuries which occur on premises are compensable, while many off premises are not. In a case recently handled by our firm, we were able to extend the definition of on premises to an unusual situation.
In summary of that case, a worker parked her car in a garage off the employer’s campus at a reduced rate as an employee benefit. The employer provided shuttles from the garage to the employer’s campus. The employee parked her vehicle at the garage and slipped on sidewalk ice as she prepared to board the employer-provided vehicle. After being denied benefits by the Workers’ Compensation Judge, the Board on appeal reversed the decision and benefits were granted.
The Board reversed the WCJ and concluded that the claimant sustained her injuries on the extended premises of the employer and her injuries were compensable. The Board found that the employer posted “drop off and pick up” areas where
employees were required to board and disembark from the company-provided shuttle. The Board found the claimant’s injury was caused by the operation of the Defendant employer’s shuttle bus at that location. In short, the Board found that the shuttle pickup
and disembark area was an extension of the employer’s property and the employee was injured as a result of the condition of the extended premises. The lesson to be learned is that consultation with counsel should always be had in cases where an injury occurs when going to or leaving employment.
The Workers Compensation Law is extremely complex and issues arise constantly over the benefits owed to claimants who are injured in their employment. Some of those issues are:
- Compensation for Specific Loss such as:
- Disfigurement and determining the amount of compensation
- Benefits in respect to fatal injuries, accruing to the employee’s
- (a)thumb, fingers and hand;
- (b)forearm and arm;
- (c)lower leg or leg
- (d)toes and foot
surviving spouse and children, parents and brothers and sisters.
Settlement of Claims
By Section 449 of the Act, settlements for the first time were sanctioned, and as amended in 2006, the settlement approval process was streamlined. This procedure is known as a Compromise and Release Agreement (C & R) and in the proper case, will provide a lump sum payment to the claimant. It is also used in disputed cases to obtain a final resolution.
In summary, counsel should be consulted immediately in the event the employer disputes an injury claim. Counsel is also desirable in all cases when a Compromise & Release Agreement has been offered or suggested by the employer or its carrier.
If you have a Workers Compensation issue, you can’t afford to make the wrong decision in choosing a lawyer. Contact us today for your free no obligation evaluation.
Update Regarding Workers’ Compensation Act
Protz V. Workers Compensation Appeal Board (Derry Area School Board)
On June 20, 2017, the Pennsylvania Supreme Court found Section 306(a.2) of the Pennsylvania Workers Compensation Act to be unconstitutional. This Section allowed employers to demand that claimants undergo an impairment-rating evaluation (IRE) to determine the claimant’s “degree of impairment” due to the claimant’s compensable injury.
In almost every case, the degree of impairment found was less than 50%, which permitted the employer or its insurance carrier to change total disability benefits to partial disability benefits, limiting disability payments to 500 weeks.
With the decision in Protz, an injured claimant can continue receiving total disability benefits for as long as the work-related disability prevents a claimant from returning to work regardless of the degree of impairment.
Employees who, in the past, have had their benefits limited by IRE findings or have otherwise entered into settlements influenced by IRE evaluations or the expected results of an IRE Evaluation should have our firm review your case for possible re-opening.
The Heart and Lung Act
It should be recognized at the outset, that The Heart and Lung Act is somewhat of a misnomer as it applies to injuries sustained by certain public servants engaged in hazardous occupations. It would include, but is not limited to, the State Police Force, Enforcement Officers and Investigators of the Pennsylvania Board of Probation and Parole, Department of Corrections Employees, Special Agents at the Office of Attorney General, and many other officers engaged in hazardous occupations at State, County and Local Municipalities.
The Heart and Lung Act provides for what is essentially a salary continuation during temporary disability without the deduction of taxes.
While Heart and Lung benefits and Workers’ Compensation are separate programs, benefits can be received concurrently and upon happening of an injury in the course of employment, a claim should be made for both The Heart and Lung Act Benefits as well as Workers’ Compensation Benefits.
Heart and Lung Act Benefits are paid only during the period of temporary disability, and should that temporary disability become permanent, The Heart and Lung Benefits will cease; however, Workers’ Compensation Benefits will continue.
Pittsburgh Automobile Accidents Lawyers
Hundreds of people get injured or killed in car accidents each year. These accidents will likely leave a lasting effect on the lives of people and their families for years to come.
THINGS YOU SHOULD KNOW ABOUT AUTOMOBILE INSURANCE IN PENNSYLVANIA
AUTOMOBILE INSURANCE IN PENNSYLVANIA
First and Foremost:
“Limited Tort” Option:
Pennsylvania has adopted the “Limited Tort” Option. This Option limits your right and the right of members of your household to seek financial compensation for injuries caused by other drivers. Under the Limited Tort form of insurance your recovery for injuries sustained by yourself or other household members is severely limited. Although you may seek recovery for all medical and other out-of-pocket expenses, you may not sue for pain and suffering or other non-monetary damages with some exceptions. You or other members of your household may only sue for pain and suffering if your injuries fall within the definition of “Serious Injury” as set forth in the policy. The definition of “Serious Injury” has been narrowly interpreted and would exclude, in most instances, injuries such a broken arm, broken leg, “whiplash injury”, rib fractures and other injuries that would not leave a person permanently impaired.
While the “Limited Tort” Option is slightly less expensive then the “Full Tort” Option, you must clearly be aware that you are giving up some of your rights to sue in exchange for a relatively low premium reduction.
“Full Tort” Option:
An insured in Pennsylvania also has the option of choosing “Full Tort”, which if chosen, you and other members of your household maintain an unrestricted right to seek “full” financial compensation for injuries caused by other drivers. Under this form of insurance, you and your household members may seek recovery for all medical and other out-of-pocket expenses and may also seek financial compensation for pain and suffering and other non-monetary damages as a result of injuries caused by other drivers.
While the annual premium for “Full Tort” is higher than for “Limited Tort”, this option should be seriously considered when purchasing or renewing an insurance policy.
In many instances, while the pain, suffering an inconvenience caused by injuries such as a broken arm or leg, whiplash or other bodily fractures are not considered “serious injury” under Limited Tort, the pain and suffering and inconvenience associated with such injuries can be quite substantial. In many or most cases involving injuries in an automobile accident, the recovery available under this Option far exceeds any savings realized in selecting Limited Tort. Carefully consider this Option when purchasing or renewing your insurance policy.
UNDERSTANDING OTHER AREAS OF YOUR
AUTOMOBILE INSURANCE COVERAGE
Pennsylvania, as well as many other states, mandates that an automobile owner purchase auto insurance for at least a State-mandated minimum. In Pennsylvania this minimum is $15,000 for injury to one person and $30,000 for all injuries caused by an incident. A basic auto insurance policy is comprised of six basic types of coverage, some of which are required by State law, while others are optional. The various types are:
- Bodily Injury Liability;
- Property Damage Liability;
- Personal Injury Protection (PIP);
- Uninsured/Underinsured Motorist;
- Collision; and
Liability coverage is required in Pennsylvania and in most states. If you are at fault in an accident, your liability insurance will cover the cost of bodily injury and property damage caused to others involved in the accident, as well as the cost of your legal bills associated with the accident. It is extremely important to consider the amount of coverage you are able to afford, keeping in mind that if the injuries and property damages caused by you exceed the amount of the coverage you purchased, the injured parties may sue you for the difference between the total damages incurred and the amount your insurance company pays.
Property Damage Liability Coverage falls within the Liability Coverage which you are required to purchase. While Property Damage Liability Coverage usually repairs damage to the other driver’s vehicle, it can also cover damages to things such as lamp poles, fences, buildings, or anything else that you may have struck.
As Liability insurance is the foundation of most auto insurance policies, careful attention must be paid to be sure that you have enough coverage to avoid a short-fall in coverage which would put your savings, investments and other property in jeopardy of being lost. In short, consider being safe rather than sorry.
PERSONAL INJURY PROTECTION (PIP)
Personal Injury Protection (PIP) is required coverage in Pennsylvania. Personal Injury Protection will pay your medical bills to the extent of your coverage when injury occurs as a result of an accident while you are driving your car, someone else’s car (with their permission), and the injuries you or your family members incur as pedestrians. Additionally, PIP may cover other expenses that are related to injury in addition to medical, which include lost wages, child care and funeral costs. Ordinarily, if you have a good health insurance plan, there may be little need to buy more than the minimum required. However, there are exceptions to this general rule. PIP Coverage is relatively inexpensive and a rather small premium purchases substantial coverage in the event of injury and lost wages. When your automobile insurance carrier pays your expenses and lost wages, they are not entitled to recover the payments made to you should you make recovery against another driver who was responsible for your accident. On the other hand, if your medical bills have been paid by your Health Insurance Company, the amounts paid on your behalf may have to be paid to that health insurance company or disability insurance company that made payments on your behalf. Primary examples of payments made which must be reimbursed include payments made by Medicare, Medicaid, Public Assistance Benefits, and payments made by Health Insurance Companies through employer provided health insurance (ERISA). The right of these health care providers to recover is often times referred to as a subrogation interest.
This concept is best understood with an example: You are injured in an automobile accident and the sum of $50,000, the amount of your coverage, was paid to your healthcare providers under your PIP Coverage. You then seek recovery against the driver who was at fault and are awarded a settlement or a verdict in the amount of $100,000. In this example, the entire settlement or verdict is awarded to you with no responsibility to make any payment whatsoever to your auto insurance company for what it may have paid.
However, let’s assume the same injuries and a recovery of $100,000 with medical bills of $50,000. You have purchased PIP coverage of $10,000. Your medical bills of $50,000 were paid by your automobile insurance carrier to the extent of your $10,000 coverage. The balance was then paid by Medicare or your company-provided health insurance (ERISA).
In this example, you have no responsibility to repay your automobile carrier the sum of $10,000 it expended. The sum of $40,000 must, however, be reimbursed to Medicare or your ERISA health benefit provider before you are entitled to receive any monies as a result of your injuries. Therefore, you will only receive $60,000 of the $100,000 recovery made with the sum of $40,000 being paid to Medicare or ERISA health care in reimbursement.
The amount of PIP coverage you purchase should be carefully considered in light of the foregoing examples.
UNINSURED/UNDERINSURED MOTORIST COVERAGE
Like Personal Injury Protection (PIP), Uninsured/Underinsured Motorist Coverage protects you and your family when injured in an automobile accident which was not your fault. When seen in this light it is easily recognizable that this form of coverage is extremely important. While Liability Insurance Coverage is mandated by State law at a minimum amount, please recognize that many individuals drive vehicles without the required insurance or with only the minimum $15,000 coverage. In the event that an accident causing injury to you is caused by an uninsured motorist, unless you have uninsured motorist Coverage, you cannot make any recovery for your injuries except through your own uninsured motorist Coverage. Of course, you retain your right to sue the party at fault, however, if they were driving without insurance, it is very unlikely that they would have any assets with which to provide compensation to you. Uninsured Motorist Coverage also comes in to play if you are struck and injured by a hit and run driver.
Underinsured Motorist Coverage (UIM) often comes in to play in Pennsylvania accidents as the Commonwealth of Pennsylvania only requires a driver to carry $15,000 in liability insurance. In today’s economy and with the cost of medical care, the $15,000 required Liability Coverage is quickly exhausted. In such an event an injured insured who was not at fault can turn to his own insurance carrier to cover the difference in damages between the $15,000 provided by the underinsured driver and the amount of coverage you carry with your own insurance company. As an example, if you sustain injuries for which you are entitled to $100,000 in compensation , you would be entitled to receive $15,000 from the at-fault driver’s insurance company and the balance of $85,000 from your own insurance company if your Underinsured Coverage was $100,000.
It should be obvious that Uninsured and Underinsured Coverage is extremely important to you and your family and high coverage limits should be considered. Be reminded, however, that uninsured and Underinsured Motorist Coverage can only be purchased in an amount equal to the Liability Insurance Coverage that you purchase for your vehicle. From a cost standpoint, carrying high Liability Coverage and equal amounts in Uninsured and Underinsured Coverage is a wise financial choice. Remember that the Liability Coverage of your policy is very reasonable and limits can be raised to a higher level without a substantial increase in your premiums.
Collision Coverage will pay to repair your vehicle if you cause an automobile accident. This coverage typically covers the actual cash value of your car, which is not the same as the car’s replacement cost. Collision Coverage is normally the most expensive component of auto insurance. The cost of Collision Coverage can be reduced by choosing a higher deductible, which is the amount you will pay out-of-pocket before your insurance company is required to make additional payment to you. As Collision Coverage is very expensive, you should carefully consider if the purchase of Collision Coverage, which is not required by Pennsylvania, is the right choice for you. Remember that should substantial damage occur to your older model auto, the insurance company may well conclude that it will “total” your car. If the cost of repairs exceed a certain percentage of the car’s worth, you will only be paid the actual cash value of your car and not its replacement cost. If you have an automobile which has an actual cash value of $1,000 and a deductible of $250, the most that you can expect to recover from your insurance company is $750. Your yearly premium costs in this situation could exceed the amount that you could recover.
Comprehensive Coverage will pay for damages to your car that were not caused by an auto accident, such as theft, fire, vandalism, natural disaster or hitting a deer. Comprehensive Coverage also comes with a deductible and your insurance company will only pay up to the amount the car was worth at the time the car was damaged. Comprehensive Coverage is not a required coverage under Pennsylvania law.
While Collision and Comprehensive Coverage are not required under Pennsylvania law, when you finance a car, your lender may require that your purchase Collision and Comprehensive Coverage as part of the loan agreement. Please remember that if your car is financed you will be required to pay the total amount you owe to the finance company notwithstanding that you may no longer have use of the vehicle.
The above information is not intended to be exhaustive with regard to automobile insurance coverage in Pennsylvania. However, if it provides some answers to questions regarding your insurance coverage, it has served its purpose. In conclusion, please know that insurance companies will charge different premiums for the same coverage. It is important to determine exactly what coverages you would like to purchase and in what amounts and then check the premium being charged by a number of insurance companies to be sure that you receive the coverage you desire at the best possible cost.
If you have sustained any injuries in a car accident, truck accident, bike crash or any other type of automobile crash, please contact us today We will evaluate your case and provide you with a Free Consultation. We will not charge you any fee unless there is a monetary recovery for you.
We shall investigate your accident from the start to determine the party at fault. If need be, we shall consult with an accident reconstructionist to determine liability. After determining liability we shall focus on your damages and make sure you receive the maximum possible recovery for your claim. Medical bills, lost salary or wages, property damage and pain and mental suffering generally account for your damages.
We represent clients that have experienced all kinds of automobile-related accidents. These include:
- Car Accidents
- Motorcycle Accidents
- Pedestrian Accidents
- Bicycle Accidents
- Bus Accidents
- Boating Accidents
- Truck Accidents
- Train Accidents
- Vehicle-Related Wrongful Death
Our Pittsburgh Car Accident Lawyers will obtain all necessary information in the form of medical records and billings to prepare your claim properly so you can focus on your rehabilitation. Our Pennsylvania Accident attorneys will manage your case and work diligently with you. We will guide you throughout the process from the pre-litigation settlement discussions to mediation or arbitration, and throughout trial if necessary.
Soon after sustaining an injury you should get in touch with a Car Accident Lawyer in Pittsburgh who can protect your rights. For professional representation you can depend on Eddy DeLuca Gravina & Townsend for any type of motor vehicle accident.
Our expert Car Accident Attorneys provide representation to car accident victims all over the State of Pennsylvania.