Martz&Gailey

General Questions | Automobile | Motorcycle | Worker's Compensation | Social Security Disability | Wrongful Death

The ten questions most frequently asked by our clients about Workers' Compensation:

Question: Do I need a lawyer to represent me if my benefits are being paid?

Answer: Though many lawyers will take on a claim in which there are no present problems (and begin to charge fees), we believe that our involvement is appropriate only if the workers' compensation insurance company is failing to pay benefits, threatening to terminate or suspend benefits, or asking you to sign papers which cause you concern. In those cases, we will review the situation, advise you candidly as to whether or not you need our current active involvement and, if appropriate, become directly involved to represent your interests. If we do not think you need immediate assistance, we will advise you of that and will not charge you a fee. You should not hesitate to call us if you have any questions.

Question: How are my wage payments calculated?

Answer: In most cases, your benefits will amount to 2/3 (66 2/3%) of your average weekly wage. Your average weekly wage is calculated based upon your past four (4) quarters of earnings. If you were an extremely high wage earner, you will be subject to a maximum benefit "cap" which is set by law, and if you earned less than a certain amount, you will either receive a statutory minimum or ninety (90%) of your weekly earnings.

Question: If my injury happened because of my employer's unsafe workplace or negligence of a co-employee, can I sue my employer?

Answer: By law the only remedy you have against your employer is your claim for workers' compensation benefits. Even if the work injury was your employer's fault, you cannot sue your employer or get additional damages. Instead, your only remedy against your employer is through the workers' compensation system. However, if the work injury was caused by the fault or negligence of someone other than your employer or a co-employee, then you can file suit and pursue a personal injury claim against that other person or company in addition to your workers' comp claim.

Question: Since my work injury, I have had considerable pain, suffering and loss of usual activities. Can I receive compensation for these damages from my employer or workers' compensation insurance company?

Answer: No. The workers' compensation system limits payments to medical expenses and earnings loss only, as well as specific loss benefits if you lose a body part or lose total use of a body part such as a finger or hand because of a work injury. The law simply does not allow for pain and suffering damages as part of your workers' compensation claim.

Question: Can a workers' compensation claim be settled for a lump sum?

Answer: Yes. It is common to enter into what is known as a Compromise and Release Settlement Agreement with your employer and the workers' compensation insurer, which is a lump sum settlement of benefits. In appropriate cases, medical benefits may be retained into the future even though the wage claim is settled in a lump sum. In virtually every case the involvement of a lawyer in the negotiation of such a lump sum settlement is advisable.

Question: Can I select my own physician or do I have to go to the "company doctor"?

Answer: It depends. The employer has a right to insist that you go to a list of "panel physicians" if the employer has complied with certain requirements, such as posting a list of six (6) of these physicians at the workplace. If your employer complies with the technical requirements then you may be required to treat with a panel physician for ninety (90) days before the employer/workers' compensation insurance company must to pay for medical treatment by a non-panel physician.

Question: Do I have to pay taxes on my workers' compensation wage or medical benefits?

Answer: No.

Question: Do I have a time limit to provide notice of my on-the-job injury to my employer?

Answer: Yes. You must give at least oral notice to a supervisor or someone in management within twenty one (21) days of the work injury to be entitled to benefits going back to the date of injury. If you do not give notice within twenty one (21) days of the injury, then you have 120 days after a work injury to report it to your employer. In that situation, your entitlement to workers' compensation benefits does not begin until you give proper notice of the work injury to your employer.

Question: Can I continue to receive workers' compensation benefits for my entire lifetime?

Answer: Generally not. There are specific, fairly long term limitations on the period of time you can receive workers' compensation wage loss benefits, normally a maximum of 604 weeks. In certain rare cases involving very severe impairments, this may extend for a lifetime. There is no time limitation regarding payment of medical expenses related to a work injury.

Question: Once my workers' compensation benefits are started, can the insurance company stop them for any reason?

Answer: If benefits are paid pursuant to a Notice of Temporary Compensation Payable, the insurance company has up to ninety (90) days during which time the carrier can stop payment and issue a denial of your claim for any reason. After that time has passed the insurer can stop payment only in certain specific instances.

The above is only a brief summary of the law and your rights and obligations under Pennsylvania Workers' Compensation Law. If you have a workers' compensation claim you should call us for more information and advice or if you have any questions or problems regarding your claim and we will assist you.