Author Archives: Karl Voigt IV, Esq.

Can I receive a lump sum settlement from workers’ comp and can I sue anyone else?

by Karl Voigt

Karl just answered this Pennsylvania workers’ compensation question on Avvo.com:

“I was hurt at work 2 weeks ago, the company doctor put me on light duty and i lost a week of work now im on full duty and my employer says they gave away my position. i have a surgeon and my private doctor telling me that i need surgery asap and they told me not to go back to work until i have the surgery and im healed. i was told i am not getting workers comp and i have not returned to work.
I work for a hiring agency and was contracted to work at a water treatment plant through them. my paychecks come from the agency. Also i went to the comp doctor 3 times they told me that i didnt have a hernia at all and that i pulled a muscle, 4th time i went they tell me i do have a hernia and that i dont need surgery”

The other answers are correct – we don’t know enough of the facts in your case. However, some general answers can point you in the right direction.

First and foremost, nearly any case can settle. The big questions are “when?” and “for how much?”. As a general rule I think that settlement should only come after two prerequisites are met. Namely, an injured worker’s medical condition must be plateaued; it may be unwise to settle the case when one is facing imminent surgery. Second, an injured worker should have a plan as to what happens after the settlement. Reeducation? Move on to a different job? Collect Social Security disability? Once these conditions are met, that is the time to seriously contemplate settling your case for a lump sum.

As far as being able to sue anyone else, certainly your employer enjoys immunity from civil lawsuit. Which means immunity from any assessment of damages for pain and suffering. Sometimes, however, other parties are more responsible for your injury. As an example, a worker could be injured in a motor vehicle accident. If it happened while working, clearly it should be covered by Workers’ Compensation. However, that individual may also have the right to sue the person who hit him. However, any recovery could be reduced because of the concept of subrogation. If the Workers’ Compensation insurance company paid any benefits, they may be entitled to reimbursement from the proceeds of the personal injury award.

If all of this seems complex, you’re right. I will echo the other answers here and strongly suggest that you meet with a certified Workers’ Compensation specialist. Good luck!

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Should I Get a Lawyer for My Workers’ Compensation Claim?

Karl answered this Pennsylvania workers’ compensation question on Avvo.com:

“Should I get a lawyer for my workers compensation claim? I separated my ac joint in my right shoulder in may of 2013. As a result I have a brachial plexus injury to the nerves in my shoulder. I have been out on workers comp for a year now and my symptoms have not changed they have tried medication and many different nerve blocks and still have the pain and numbness. My WC has not discussed settlement or anything and I dont know if I should get a lawyer or just wait to see what happens. Any advice would be greatly appreciated. Thank you.”

 

It’s not very likely that any lawyer will tell you that you don’t need a lawyer. On the upside, while you should most definitely be consulting with one, you may not have to pay one immediately. There are plenty of attorneys here on Avvo who can help you. Look for one who is a specialist in workers’ compensation.

As far as the specifics of your case, brachial plexitis is a pretty serious injury and often requires years of treatment. It is at the very least prudent to have a lawyer on hand just in case you ever have to hire one. Namely, it will be most helpful for you if you have a lawyer who becomes familiar with the specifics of your case, including your medical treatment. That lawyer will be able to provide direction in your case, and prepare a defense well in advance if the insurance company ever tries to attack your benefits.

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Travel Expenses for WC medical treatment

by Karl Voigt

Karl answered this Pennsylvania workers’ compensation question on Avvo.com:

“I had surgery performed by an out of state provider. Can my travel and OOP costs be reimbursed by WC carrier?”

There is a compelling argument that the carrier should reimburse your costs. Until about 1992, workers’ compensation carriers would regularly have to reimburse Pennsylvania claimants for all travel expenses incurred treating their work injury. Unfortunately, following the issuance of an appellate case, Helen Mining Co. V. WCAB, 616 A.2d 759, the law changed. The courts can now only award travel expenses in cases where the requisite medical treatment is not available in your locale. If you can indeed prove that it was absolutely necessary to travel out-of-state for treatment, there is a good chance that your expenses should be reimbursed.

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Governor Approves Minor Changes to PA Workers’ Compensation Act for Maritime Workers

by Karl Voigt

Governor Corbett today has signed a new bill, promoted by legislators in Pennsylvania maritime regions, that makes some minor changes to the Workers’ Compensation Act.

House Bill 2081 changes workers’ compensation coverage for any person engaged in maritime employment, such as longshoremen, ship repairmen, shipbuilders, ship-breakers, pleasure boat captains, stevedores, vessel repairers, harbor pilots, bridge builders and harbor workers. Prior to this legislation, maritime employers were required to maintain insurance on their employees both under state and federal policies. These policies were often redundant, as benefits were almost always paid under the federal program. However, now, only the federal coverage must be maintained by employers.

Legislators from districts surrounding the Delaware River and Lake Erie supported the legislation  so as to save employers money and therefore encourage new hiring. It is hoped that the changes will save maritime employers money by not have to “double insure” their employees.

The text of the law can be found at:

http://www.legis.state.pa.us/cfdocs/billinfo/billinfo.cfm?syear=2013&sind=0&body=H&type=B&bn=2081

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Settling Your Workers’ Compensation Case

by Karl Voigt

Many of our clients have expressed an interest in settling their workers’ compensation case for a lump sum. And, statistically, most long-term workers’ compensation cases in Pennsylvania do indeed eventually settle for a lump sum. Sometimes a settlement is warranted. When it is, it’s important to know all about the process.

Historically, with our clients who have a long-term workers’ compensation cases, we don’t rush to settlement. Before we seriously discuss settling a case for a lump sum — which stops one’s weekly benefits — we like the assurance of our client’s medical status having plateaued. For example, it would be unwise to settle a case where an injured worker is facing a serious, injury-related surgery in the near future. Therefore, it is far better to settle after any major medical procedures are in the past. Once a client’s medical condition has plateaued, we want to make sure that they have a plan for what happens next. Do they plan on living off of the income generated by the lump sum? Are they going back to school? Have they applied for Social Security disability?

Once these conditions are met, it is usually the injured worker that places the initial demand to settle. Naturally, in some cases, the carrier has already put out an offer; most often, that offer is far too low and was made simply to initiate negotiations. Then the negotiations commence, usually between Claimant’s counsel and Insurer’s counsel or the adjuster. Nevertheless, the negotiation process can take as little as several days or weeks. Sometimes, however, months or even years. Patience is important during the process; we prefer a very methodical and deliberate approach to the process — this is the rest of your life we’re talking about.

Of course, there are two portions of your case generally that can be settled: wage loss and medical. That is to say, you can settle both, or simply settle the wage loss portion and preserve the insurer’s obligation to pay for any future work-related medical treatment. Is also possible to put a time limit on the latter portion. Namely, negotiations can result in an agreement that the carrier will pay medical bills for, say, two or three years following the settlement date.

There is absolutely no requirement that your case be settled. Particularly with cases involving very serious and worsening disability, it may be best for a case not to settle. If your attorney is confident that your benefits will continue without much challenge from the insurer, you can continue to receive weekly checks. However, due to inflation, you will find that the value of those weekly checks reduces over time. The cost of food and utilities goes up overtime. Rent increases over time. Unfortunately, there is no concomitant rise of Worker’s Compensation wage loss benefits.

Of course, the risk that the carrier will file future petitions against the injured worker is always there. However, we remain our clients’ lawyers and are also always there for our clients.

There are two primary factors in evaluating a case’s settlement value: degree of disability and amount of earnings loss. We generally say that assuming the same disability, the injured worker he used to make $50,000 a year settles for more than one who made $20,000 a year. On the other hand, assuming similar income, the worker who now uses a wheelchair to get around settles for more than the one who uses a cane. These are, of course, not the only factors in valuing the case, but they are the major determining factors.

Of course, if the worker was subject to an impairment rating evaluation and, as a result, is now limited to receipt of no more than 500 weeks of continued benefits, the insurer’s exposure to pay future wage loss is now limited.

If your case is in litigation, it will likely be subject to mandatory mediation. Since 2007 it has been mandatory that any cases entering litigation must engage in a mediation with a mediating Judge other than the presiding judge.

There is certainly no obligation to settle your case during the mediation; only your attendance at the mediation is mandatory. During that mediation, the mediating judge will sit down with you, your lawyer, and the insurers lawyer to determine if the parties can come to a “meeting of the minds”.

Once a settlement is reached, it must be approved by a judge, which means there is no check issued immediately, but rather only after a hearing is conducted. The injured worker will have to testify that he or she’s understands the agreement and, of course wishes for it to be approved. If the judge approves, and order will be issued by mail hopefully just several days later. Technically, the carrier has 30 days to comply with that order, although most do within 2 to 3 weeks. Naturally, as of the hearing, any and all weekly workers’ compensation wage loss checks cease.

As you can tell, the settlement process is full of potential pitfalls. When it’s time, however, it’s important that things be done methodically and comprehensively.

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What Are My Rights at an Insurance Medical Examination (IME)?

Karl answered this Pennsylvania workers’ compensation question on Avvo.com:

“What Are My Rights at an Insurance Medical Examination (IME)?”
Sometimes, the insurer gets to choose what doctor examines you. The carrier is allowed to have you examined for an insurance medical examination (IME) twice a year. The IME doctor is hired not to treat you but to express an opinion as to your current condition. The doctor may agree or disagree with your own doctor’s opinions. The insurance company can use their doctor’s opinion for a variety of measures, including trying to terminate your wage loss and medical benefits or trying to reduce your benefits by identifying jobs that you can do with a new employer.

The carrier is responsible for your travel there. That means you can request transportation, or ask in advance to be reimbursed for your own travel mileage.

When you arrive, you have the right to be seen on time. The doctor will conduct an interview and physical examination. No agents of the carrier should be present during either. Under no circumstances should you allow for any invasive testing. You should not do anything during the examination that causes a marked increase in pain. You should document your symptoms before hand and whether they change immediately following the examination.

Technically, the Act actually allows you to bring a doctor of your choosing to the IME. However, this is generally at your own cost and therefore it is a section of the Act rarely used

Always remember, however, that your own doctor calls the shots. If their doctor’s opinion leads to job shopping, or a job offer from your own employer it’s important to let your lawyer know immediately, so that you can get the best advice.

See Karl’s answer here:

http://www.avvo.com/legal-answers/workers-compensation-1633143.html?answered=true

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Can a Nurse Case Manager Talk to My Doctor?

Karl answered this Pennsylvania workers’ compensation question on Avvo.com:

“Can a IC’s Nurse Case manager talk to the Dr. after my appointment without my permission?”

No. As has already been pointed out, one of the first “red flags” that we see in WC cases is the involvement of a nurse case manager. He or she is simply not your friend, but an employee of the insurance carrier whose job it is to control your medical costs and the direction of your case. Customarily, we send out a letter addressed directly to the nurse revoking and rescinding any express or implied permission to speak with your doctors. Your doctors get a copy of the letter as well. Good luck!

See Karl’s answer here:

http://www.avvo.com/legal-answers/-pennsylvania-worker-s-comp-case–can-a-ic-s-nurse-1605795.html#answer_3514957blog

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Can Someone Tell Me What Does “NCP” Mean in a WC case?

Karl answered this Pennsylvania workers’ compensation question on Avvo.com:

Can someone tell me what does ncp meaning in wc injury case????

An NCP is a Notice of Compensation Payable. If you have received one, it’s good news. Without issuing this document, the carrier is not bound to pay any benefits associated with your work injury. If you got one, the carrier is now “on the hook” to pay your medical bills and wage loss benefits.

There are a few forms of NCP. A Notice of Temporary Compensation Payable is — obviously — like an NCP except it can be withdrawn by the carrier without it going to court. A medical-only NCP is an acceptance by the carrier to pay work-related medical bills, but not wage loss.

Even if you received an NCP, it is still important to verify that your average weekly wage, compensation rate and injury description are correct. If you question any of these, you should consult an attorney immediately to discuss options to correct it.

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Bureau of Workers’ Compensation Announces Statewide Average Weekly Wage for 2014

by Karl Voigt

The Bureau of Workers’ Compensation has announced the statewide average weekly wage for 2014. This directly affects workers who are injured in 2014. Generally, workers’ compensation is paid at 66 2/3% of an injured worker’s average weekly wage, up to a maximum as defined by the statewide average weekly wage. Section 105.1 of the Pennsylvania Workers’ Compensation Act requires the Bureau to calculate and publish the statewide average weekly wage so that statewide maximum compensation rates can be calculated. The statewide average weekly wage for injuries occurring on and after Jan. 1, 2014, is $932.00 per week. This represents a s 1.6 percent increase from last year.

As a result, the maximum weekly benefit an injured worker can now collect is $932.00. Therefore, any injured worker who earns more than $1,398.00 a week will be limited to this figure, no matter how much more they earn. Anyone whose preinjury earnings are between $1,398.00 and $699.01 a week will receive 66 2/3% in workers’ compensation. Anyone who earns between $699.00 and $517.78 a week will receive $466.00, which is half of the statewide average weekly wage. Anyone who earns $517.77 or less will receive 90% of their preinjury wage.

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Despite Teething Problems, Workers’ Compensation Automation and Integration System is Functional

by Karl Voigt

Despite Teething Problems, Workers’ Compensation Automation and Integration System is Functional

The Bureau of Workers’ Compensation’s  Workers’ Compensation Automation and Integration System (WCAIS) is now available online. Injured workers can access some portions of their claim online from their home computer.

If your case is in litigation, you may be able to access copies of assignments, hearing notices, exhibits, as well as transcripts. You may also have limited access to actually change your information online. As an example, an injured worker may change his or her address online through WCAIS. However, this will only make the change available to the Commonwealth; it will not change your address with the insurance company.

Injured workers can simply enter in some of their claim information to begin the registration process. They can then initiate access to their file by visiting: http://www.wcais.pa.gov

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