Prince Law Offices, P.C.

by Karl Voigt

It’s all over the news. But what does the ObamaCare challenge means to workers’ compensation recipients?

It’s of particular interest to those workers’ compensation claimants who have been out of work for some time.  Many — even most — of them have had their health insurance policies canceled by their employers. This often leaves them with no health insurance coverage. Unfortunately, under workers’ compensation law, an employer is not obligated to keep health insurance going if an employee is out of work for an extended period. And that’s why we periodically address this topic here in our blog.

The Patient Protection and Affordable Care Act, popularized as “ObamaCare”, scheduled to roll out in 2014, will provide reduced cost health insurance coverage to those who can’t afford often prohibitively expensive private health insurance policies. This less expensive coverage will enable many of our clients to afford the security of knowing their medical bills will be paid.

One compromise of the law as it is written is that it requires every citizen to secure some sort of health insurance. This may be a critical component of the law: this individual mandate to have health insurance would help create a pool of both healthy and unhealthy individuals. That way, there would not simply be a pool of sick people all vying for healthcare dollars. It is this requirement that has bred a major challenge to the Act before the United States Supreme Court. In essence, opponents believe that it is unconstitutional for the government to force them to buy anything.

If this week’s arguments are any indicator, there is a chance that the Court will strike this provision down. It is also possible that the Court will strike down the entire Act. We will likely learn what the Court has to say in June. Stay tuned.

Ten Things You Need To Know If You Have a Work Injury:

1) You should report any injury immediately to your supervisor or other person of authority. Don’t just shrug it off and assume it will go away. If you are a member of a Union, you should also advise your Union Representative.

2) You must report your work injury within 120 days of the date that you were injured, or you could be forever barred from filing a claim.

3) If you report your injury within 21 days of the date of injury, and you lose more than 14 days from work, you will be entitled to wage loss benefits starting from the date of the injury.

4) After you report an injury, your employer or its workers’ compensation carrier, has 21 days to either accept your injury as work-related, issue a denial or place you on temporary benefits while further investigating your claim.

5) If your employer pays the medical bills for treatment of your injury, this alone does not mean that you have an open Workers’ Compensation claim.

6) If your employer wants to control what doctor you treat with, it must post a list of designated medical providers for you to choose from if you are injured at work. Your employer must also have you sign a form when you start your employment, and again after you are injured, that acknowledges that you were provided with this list of doctors. If these requirements are not met, then you can treat with any doctor of your own choice. You also have an absolute right to choose which provider on the list that you want to see. Your employer cannot require you to see one specific provider on its list.

7) As a general rule, Workers’ Compensation benefits are paid at the rate of approximately 2/3 of what you were earning on average per week before your injury. If you have more than one job at the time of your injury, the wages from all of your jobs are considered when determining your workers’ compensation benefit rate.

8) An employee cannot sue an employer for “pain and suffering”.

9) An employee who contracts a disease through employment is also entitled to Workers’ Compensation benefits.

10) An employee who aggravates a preexisting condition at work may be entitled to Workers’ Compensation benefits if the aggravation causes a wage loss or requires medical care.

by Karl Voigt

A Lehigh Valley man was recently awarded workers’ compensation benefits for a stroke that was related to his employment. Namely, he worked in Victaulic’s “hot room” for decades. In part due to his constant exposure to this unusual heat, his doctors concluded that he had suffered a work-related stroke.

Because the Judge found in his favor, he will receive weekly wage loss benefits as long as he remains disabled, plus payment of injury-related medical bills. Because the stroke left him partially paralyzed, that may be for the rest of his life

Our attorneys have secured benefits for work-related strokes in the past, but it is a very difficult burden of proof to meet. It is not unusual for an employer to defend such a case by pointing the finger of blame somewhere else. They will blame a “pre-existing condition” or a history of smoking, rather than concede that it is work-related. Such was the case here; Victaulic fought the case by arguing — unsuccessfully — that his high blood pressure was the cause. However, the Judge found that this condition — which was controlled by medication — was less the cause than the oppressive heat of their foundry. Anyone who has worked in a foundry will be far too familiar with the desert-like temperatures workers endure.

You can read the Morning Call article here: