Author Archives: Karl Voigt IV, Esq.

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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New PA Supreme Court Case May Change the Landscape of Vocational Litigation

by Karl Voigt

A November 21, 2013 opinion from the Pennsylvania Supreme Court may have just changed the game in job availability litigation. Since 1996, workers’ compensation insurers have been able to try to reduce an injured worker’s wage loss benefits by alleging that they can return to hypothetical jobs. In an opinion published in Phoenixville Hospital v. WCAB (Shoap, Aplt) – No. 32 EAP 2011, the Supreme Court may have made that task far more difficult for carriers.

In post-1996 litigation, a carrier had to show that hypothetical jobs were available to the Claimant. The Claimant in Shoap was advised of hypothetical jobs and applied for those jobs. Because so much time had lapsed between the vocational counselor’s identification of the jobs and the notice to the Claimant, the jobs were no longer vacant. The Supreme Court did not allow for the reduction of her benefits

The Shoap case in essence maintains that the jobs must be open long enough for the injured worker to apply. In short, because most job identifications are that stale, carriers will likely have a very difficulty time meeting their burden of proof.

The text of the Court’s opinion can be found at:

http://www.pacourts.us/assets/opinions/Supreme/out/J-26-2012mo%20-%201016273591814727.pdf?cb=1

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Injured Workers': time to enroll for ObamaCare

by Karl Voigt

Injured workers can now enroll in health care coverage in the Affordable Care Act insurance exchanges also known as Obamacare. Coverage begins in 2014, but you must sign up by December 15 if you want coverage to begin January 1.

Many injured workers are left uninsured after they are unable to return to work at their regular jobs. This can happen to those who have been out for a few years, or even just a few months. If they can qualify for Social Security Disability, they can secure Medicare coverage. If not, there are few alternatives for health insurance. The Affordable Care Act allows for coverage intended to be affordable.

Start the process at healthcare.gov, the federal online Obamacare portal. You’ll have to set up an account and provide information like your name, address, age, number of people in your family, household income and whether you have access to insurance elsewhere.

The process includes an application for a federal subsidy that will pay all or part of your premium. You can learn instantly if you qualify for the subsidy. If you do, you’ll be able to shop for and apply for insurance coverage right away.

 

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Workers’ Compensation Automation and Integration System (WCAIS) is Open for Business

by Karl Voigt

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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I got a Workers’ Compensation Verification Form in the mail. What is this?

by Karl Voigt

Some clients have asked us what to do with a Workers’ Compensation Verification Form they have received in the mail.

First of all, if you are an injured worker and are receiving benefits, the Workers’ Compensation carrier has the right to send you verification forms twice a year. They are in essence forms to document your receipt of wages or other benefits that might effect your Workers’ Compensation benefits. You must complete the forms and return them signed to the carrier. Otherwise, your benefits may be suspended until the forms are received.

There are essentially three forms that the carrier can send you to question your income. These forms will ask if you are earning wages, pension, unemployment, severance or Social Security Old Age benefits.

There is one trick to these forms: two of the forms are very, very similar. Namely, the LIBC-760 and LIBC-750 (a code found in the lower left of the form) are nearly identical. However, an important distinction must be made. If you fail to return the LIBC-760, your wage loss benefit checks can be suspended until you do. Failure to return the LIBC-750 does not allow the carrier to stop your checks. This distinction is critical because the forms are so similar; you could return only one form thinking you were sent doubles. If the one you returned was the LIBC-750 and not the LIBC-760, your benefits are in jeopardy.

We recommend that you return your forms via USPS certified mail, with a return receipt, so you can prove that you sent the forms back. Naturally, we would like a copy of the completed forms for our files.

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A New Assault on Injured Workers

by Karl Voigt

The Pennsylvania legislature is once again scheming against injured workers, this time in an effort to deny their right to choose their doctors.

As any reader of this blog knows, people who are injured at work are subject to a “captive period” where they have to treat with the employer’s choice of physicians. However, this only lasts a temporary period of 90 days. When the period is over, they are free to choose their own physicians.

However, if the legislature is successful in its efforts, this new law would require treating with company doctors not for 90 days, but for the lifetime of the injury. An employer could force an injured worker to treat with one Coordinated Care Organization (CCO) until death.

Anyone familiar with the care given by a CCO may shudder at this prospect. It is not unusual for the physicians at a CCO — particularly those selected by the employer – to be very sympathetic not to their patient but to the employer.

Naturally, we urge our readers to contact their representatives and let them know their opposition to this proposed legislation.

To read the text of House Bill 1636, go to http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=HTM&sessYr=2013&sessInd=0&billBody=H&billTyp=B&billNbr=1636&pn=2251

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Workers’ Perspectives on Settlements and Hearings

by Karl Voigt
A recent study of injured workers lends some insight into the merits and hazards of settling a workers’ compensation case. While the study was conducted in Minnesota and not Pennsylvania, there are some common elements. The study, titled “Workers’ Perspectives on
Settlements and Hearings” was authored by analyst Brian Zaidman. In short, the paper is based on conversations with injured workers some months after they settled their cases, hopefully lending some perspective to those workers contemplating the settlement of their own case.

One of the most common responses to the study was a complaint that the dispute resolution process took too long and, as a result, people felt that they were leveraged into settling their case. This is not an uncommon sentiment even in Pennsylvania where, if the parties are litigating a claim petition and the claimant is not getting paid, the prospect of a large lump sum becomes more appealing as time progresses and his debts accumulate.

Some other interesting responses arose. Namely, only half of workers who settled reported that they understood the benefits involved in their dispute. One third indicated that they had little or no understanding of their agreement. 29% said that, if they had a chance to do things over again, they would once again settle. 41% reported that, since settlement, their medical conditions had become worse.

At the very least, the study reveals that injured workers and their attorneys have to make and communicate informed decisions. Obviously, this is a study performed in Minnesota and not Pennsylvania, where workers’ compensation laws differ, but there are certainly things to learn and consider after reading the paper.

The text of the study is available at: http://www.dli.mn.gov/RS/Pdf/settlement_study.pdf

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Should I Collect Pension Benefits While on Workers’ Compensation?

by Karl Voigt

The laws surrounding the effect of collecting retirement benefits on Workers’ Compensation wage loss benefits has been evolving rapidly. The Pennsylvania Supreme Court has recently issued an important decision regarding interaction of these benefits. It has reversed the 2012 holding from the Commonwealth Court that created a presumption that an individual had withdrawn from the workforce simply by virtue of collecting retirement benefits. An injured worker who claims that he is retired from the workforce is considered to have withdrawn from the workforce and therefore is not eligible for Workers’ Compensation wage loss benefits.

Happily for Workers’ Compensation claimants approaching retirement age, the Pennsylvania Supreme Court has recently rejected this rule, opting to allow judges to consider a “totality of the circumstances” approach to determining whether a claimant has withdrawn from the workforce. The lower Court’s ruling would have allowed an insurer to stop wage loss benefits the moment an injured worker received pension benefits from an employer.

The Pennsylvania Supreme Court, in City of Pittsburgh v. WCAB (Robinson), ___ A.3d ___ (Pa. 2013) (filed March 25, 2013), rejected that rule, finding it unfair to allow a presumption of withdrawal simply from an injured worker’s application for pension. The Court reasoned that a judge must look at all of the evidence.

So an injured worker’s receipt of pension benefits, standing alone, is not enough to prove that he has withdrawn from the workforce. Howwver, an employer may still attempt to prove that an injured worker has withdrawn from the workforce. They can even use evidence of application for pension to support the allegation. However, the judge must consider the “totality of the circumstances”. Namely, if the injured worker continues to seek employment elsewhere or can show that she was forced into retirement because of the work injury, her Workers’ Compensation wage loss benefits should indeed continue.

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Subrogation and Workers’ Compensation

by Karl Voigt

Workers’ Compensation cases sometimes involve other insurers other than the Workers’ Compensation insurance company. As an example, a motor vehicle accident that injured a worker would bring in a second potentially responsible insurer: the auto insurer. Such cases are introduced to the concept of subrogation.

Subrogation is a legal doctrine that allows one insurer to seek reimbursement from the other. More specifically, where one insurer makes a payment on an obligation which, by law, is the primary responsibility of another insurer, the first insurer is then subrogated to the claims of the second.

Using our example, let’s assume a car owner is injured at work in a collision using his car and the collision insurer pays his medical bills. He then opens a Workers’ Compensation claim. In essence, the Workers’ Compensation insurer – the party more responsible for medical treatment for a work injury – would have to reimburse the collision insurer for the bills it paid.

Subrogation not only protects the rights of the insurance companies, but also ensures that a medical care provider is not paid twice for the same service. This would be considered an unjust enrichment under the law.

This concept can also apply to wage loss benefits. Assuming our injured worker is first paid for his wage loss by the collision insurer. Then, if he opens a Workers’ Compensation claim he would be eligible for payment for wage loss from the Workers’ Compensation insurer. To prevent “double dipping”, the collision insurer would have the right to reimbursement.

In the Workers’ Compensation specialty practice, we most often see an injured worker who also filed suit against a third-party who caused the motor vehicle accident. This litigation may take years and the injured worker might receive wage loss benefits from the Workers’ Compensation insurer during this period. If the motor vehicle case is settled, the Workers’ Compensation carrier might actually have the right to reimbursement from the civil award.

These cases can become extraordinarily complex, particularly if it is not a matter of simple reimbursement for monies paid. Namely, The injured worker may still be disabled from the accident and is therefore receiving Workers’ Compensation wage loss benefits. If this is the case, and the amount of the civil award exceeds the wage loss benefits paid to date, the Workers’ Compensation carrier may actually receive a credit for future benefits payable. The Workers’ Compensation carrier may actually have the right to file a special petition for the amount of future offset from Workers’ Compensation wage loss to be determined by the Workers’ Compensation judge.

The concept of subrogation is an equitable principle designed to be fair to all parties involved. Unfortunately, one side effect is often very complex litigation. Naturally, when discussing your Workers’ Compensation case with your lawyer, it is critical to let her know if you have or are considering a civil case.

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Two Prince Law Attorneys Become Certified as Workers’ Compensation Specialists

by Karl Voigt

Two Prince Law Office attorneys — Thomas Beveridge and Karl Voigt — have been certified as specialists in the practice of workers’ compensation law by the Pennsylvania Bar Association Workers’ Compensation Law Section.

Both lawyers successfully completed the certification process by submitting a variety of documents showing that at least 50 percent of their legal practice is in the specialty field of workers’ compensation, that they have practiced in the field for more than five years, and that they actively participate in Mandatory Continuing Legal Education in workers’ compensation law and related fields. Both lawyers also passed the challenging certification examination that focuses on workers’ compensation law and rules and leading case law.

In 2012, the Pennsylvania Supreme Court approved the PBA Workers’ Compensation Law Section as the first bar association entity in Pennsylvania to certify lawyers in the area of workers’ compensation law.

Because of their successful completion of the certification process, they will be permitted to use the following language when communicating about their certification to clients and to the public: “Certified as a specialist in the practice of workers’ compensation law by the Pennsylvania Bar Association’s Section on Workers’ Compensation Law as authorized by the Pennsylvania Supreme Court.”

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