Workers’ Compensation Benefits for an Occupational Disease

Under Pennsylvania workers’ compensation laws, if you are injured on the job, you have a right to pursue benefits for lost wages, medical expenses, rehabilitation and even retraining. Those benefits, however, are not available only to people who suffered a sudden injury in a workplace accident. You can also recover workers’ compensation benefits if you contract an illness because of conditions related to your job.

What Types of Occupational Disease are Covered by Workers’ Compensation?

Workers’ compensation laws provide benefits for losses associated with a wide range of illnesses, provided you can demonstrate that your work environment caused or contributed to your disease. The illnesses for which benefits are available include:

• Cancer stemming from exposure to toxic chemicals, silicates or other substances
• Lung disease, such as asbestosis, Mesothelioma or black lung
• Skin conditions, from rash to eczema or psoriasis
• Respiratory conditions caused by breathing in dust or particulates

The symptoms of many occupational diseases can often look like other, more benign, conditions, such as a cold. You may find yourself sniffling, or have a cough or phlegm in your throat. If the symptoms don’t go away or start to get worse, you want to see your doctor as soon as possible. If your doctor confirms that your condition is related to your work, you will want to determine whether you can address the problem by making changes at work, or whether you can no longer work at all in the environment that caused your illness. If you can wear protective gear and still do your job, you won’t likely be able to obtain workers’ compensation benefits. However, if you are not able to continue working, you can seek workers’ compensation benefits from your employer. You may also be able to pursue damages from the manufacturer or distributor of a toxic substance.

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At Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP, we have protected the rights of individuals throughout Delaware County since 1980. We offer a free initial consultation. To schedule an appointment, call us at 610-565-4055 or 302-594-4535 or contact us online.

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Dealing with a Workers’ Compensation Claim Denial

When you are injured at work, your first course of action is typically to file a claim for workers’ compensation (after you have received medical care). If you are like many people, though, you may be surprised to have your seemingly legitimate claim denied. You have options, though, but you will need an experienced lawyer to guide you through the process.

Why Was Your Claim Denied?

The first thing you need to do is determine why your claim was rejected. For far too many people, the reason for denial was a failure to file the application within the required time period. Even though you may still be receiving medical attention and may not know the full extent of your injuries, you must still file your request for benefits within the period of time stated in the workers’ compensation laws, usually 30 days.

Another frequent occurrence—your employer disputes the claim. This can happen for a variety of reasons, including:

• Your employer’s assertion that the injury was not work-related
• Your employer’s belief that your injury is not as serious as you claim it is
• Your employer may claim that the type of injury is not covered by workers’ compensation (mental distress, for example)

The Appeals Process

Though the appeals process is different in every state, there are certain steps that you should always take. First, if you don’t have an attorney, now is the time to hire one. Your attorney may opt to contact your employer or the workers’ compensation insurance provider directly, to determine if there was a mistake in the paperwork or other technical problems with your claim that can easily be resolved.

If you are unable to resolve the matter by discussing it directly with your employer or the insurer, you will likely have to appeal your denial to an administrative law judge. A hearing will be set, and attorneys for both sides will present evidence regarding the claim. There are generally additional levels of appeal, should your claim be denied by the administrative law judge. Some states even allow you to file an action if court, if your administrative remedies are exhausted.

Contact Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP

At Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP, we have fought for the rights of individuals throughout Delaware County since 1980. We offer a free initial consultation. To schedule an appointment, call us at 610-565-4055 or 302-594-4535 or contact us online.

Understanding the Benefits Available in a Workers’ Compensation Claim

If you have been hurt on the job, your primary (and often sole) source of financial recovery will be through a workers’ compensation claim. State workers’ compensation laws represent a compromise between the rights of injured workers and the needs of employers. Under workers’ compensation laws, an injured worker is typically entitled to a specific payout, based on the type of injury sustained. The advantage to the worker is that he or she won’t have to engage in a lengthy legal process, with the costs associated, before receiving compensation. For the employer, the workers’ compensation system eliminates the possibility of a large jury verdict, and allows the employer to manage the cost of workplace injury through an insurance policy.

The Types of Benefits Available through a Workers’ Compensation Claim

Workers’ compensation provides remuneration for:

• A disability that prevents you from working—The disability may be temporary or permanent, or it may be partial or total. Most workers who receive workers’ compensation benefits have what is categorized as a temporary total disability. This means that their disability keeps them from working at all, but that the disability will only last for a limited period of time. Customarily, the benefit received for a disability is 2/3rds of your pre-injury wage.
• Medical expenses—Workers’ compensation benefits generally pay for hospital and other medical care, including doctor visits, prescription drugs and surgical procedures. Wheelchairs and other special needs may also be covered.
• Rehabilitation expenses—Workers’ compensation typically pays for physical therapy, as well as care and training that may be necessary to regain lost skills.
• Death—State workers’ compensation generally offer a death benefit to surviving family members to cover loss of financial support.

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At Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP, we offer experienced and knowledgeable legal counsel to individuals in Pennsylvania. To set up an appointment for a free initial consultation, call us at 610-565-4055 or 302-594-4535 or contact us online.

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Your Options When Your Pennsylvania Workers’ Compensation Claim is Rejected

You’ve been hurt on the job and you’ve followed all the appropriate steps to secure benefits under Pennsylvania’s workers’ compensation laws. You’ve notified your employer in a timely manner. You’ve been examined by a company-approved doctor. You’ve provided medical documentation of your condition. But your employer’s workers’ compensation insurance carrier has denied your claim. Now what do you do?
Workers’ compensation benefits are far from automatic, even when your injury appears to be undeniably work-related. Employers and their insurers will deny legitimate claims for a variety of reasons:

• There may unintentionally be inaccurate information in the accident report
• Your employer may allege that the injury occurred outside of work
• Your employer may question the legitimacy or the severity of your injury
• Your application for benefits may have been filed after the deadline
• Your employer may accuse you of participating in illegal activity at work

Your Right to Appeal the Denial of a Workers’ Compensation Claim

Under Pennsylvania law, when your initial workers’ compensation claim is denied, you can submit a “Claim Petition” with the Pennsylvania Bureau of Workers’ Compensation. Your case will be heard by an administrative law judge at the Bureau, and the judge may grant or reject your appeal.

If the judge denies your appeal, you can file an appeal of that decision, but you must do so within 20 days of the date the opinion is issued. The Workers’ Compensation Appeals Board will then review your case and issue their own written opinion. If that decision is not in your favor, you can seek redress through the Pennsylvania Commonwealth Court, but must file your appeal within 30 days of the Appeals Board decision.

Contact Our Office

At Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP, we have protected the rights of individuals throughout Delaware since 1980. We offer a free initial consultation. To schedule an appointment, call us at 610-565-4055 or 302-594-4535 or contact us online.

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How Do You Determine How Much You Are Entitled To in a Worker’s Compensation Claim?

In Pennsylvania, workers’ compensation benefits are determined by a formula based on your average weekly wage (AWW). In most instances, you will receive a monetary payment equal to approximately 2/3rd of the weekly amount you were earning before you were injured. There is a cap, however, on the amount of benefits that can be paid out, so if you were a highly compensated worker, it’s likely that your benefits will be less than 2/3rd of your former pay. Additionally, if you receive less than the average worker in Pennsylvania, you may be entitled to up to 90% of your former earnings.

Workers’ compensation benefits typically do not kick in until you have been unable to work for at least seven days. Pennsylvania has a seven working day waiting period, which offsets your benefits if you are disabled for 14 days or less. For example, if you miss 13 days, you will receive benefits for only 6 days (13-7). However, if your injury keeps you away from work for more than 14 days, you get benefits from the first day you were unable to work.

Workers’ compensation benefits are not taxable, so the amount you receive will typically be comparable to your after tax income.

In addition to financial compensation, you are entitled to have certain medical expenses covered under a workers’ compensation claim. Generally, medical facilities and medical caregivers are paid according to a fee schedule administered by the Bureau of Workers’ Compensation.

Contact Our Office

At Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP, we have protected the rights of individuals throughout Delaware since 1980. We offer a free initial consultation. To schedule an appointment, call us at 610-565-4055 or 302-594-4535 or contact us online.

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Potential Pitfalls When Seeking Workers’ Compensation in Pennsylvania

When you have been hurt at work, you have a right to pursue financial compensation for the time you are away from your job. You can obtain the forms and try to handle the claim by yourself, but there are a number of potential stumbling blocks. Here are just a few:

You Must Meet All Statutory Deadlines

Under the workers’ compensation laws, you must notify your employer of your injury within a certain period of time, and you must file a claim petition by a certain date. There may be other deadlines you have to meet throughout the process. If you miss one, even unintentionally, you may lose your right to benefits.

You Must Provide Adequate Documentary Evidence to Support Your Claim

Your injury may seem obvious to you, but you will need to submit medical proof of your injury, as well as documentation that the injury was work-related. You can get treatment from a doctor of your own choosing, but will also have to undergo an examination by a company-approved physician.

Your Employer or the Workers’ Compensation Insurance Carrier May Use A Variety of Strategies to Delay, Diminish or Deny Your Claim

Don’t be surprised if your claim is initially denied. Many legitimate claims are initially rejected, for a variety of reasons. Your employer pays insurance premiums based, in part, on the number of claims the insurer has to pay, so your employer has a vested interest in denying your claim. In addition, the workers’ compensation insurance carrier maximizes profit by paying out as little as possible in claims. So they will also look for ways to reject your claim.

Contact Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP

At Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP, we have fought for the rights of individuals throughout Delaware since 1980. We offer a free initial consultation. To schedule an appointment, call us at 610-565-4055 or 302-594-4535 or contact us online.

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Protecting Your Wealth in Pennsylvania

Many of us face a significant amount of stress in our daily jobs—quotas, deadlines, concerns over safety and health. Sometimes, the weight of those concerns can be overpowering. When your work environment leads to depression, a numbness so severe that you can’t work, can you file a claim for workers’ compensation benefits? The answer—yes, but it’s difficult and you need good legal counsel.

Pennsylvania workers’ compensation laws recognize occupational illness as a compensable injury, and certain mental conditions fall under the category of occupational illness. Typically, workplace mental disorders fall into three categories:

• Mental-physical disability claims—With these types of claims, a mental or emotional event manifests in a physical injury. A stressed worker may suffer a stroke, or an employee witnessing an accident may have a physical reaction, such as a heart attack
• Physical-mental disability claims—Here, a physical injury has mental consequences. A worker may lose a finger or suffer a neck or back injury and may develop PTSD or depression as a result
• Mental-mental disability claims—In these situations, an emotional or mental event causes further mental or emotional trauma. For example, a witness to an accident may experience depression, anxiety or other mental conditions

Compensation for Depression Caused by Work-Related Events

In Pennsylvania, most workers’ compensation claims based on depression are categorized as a mental-mental disability claim. Workers’ compensation insurers rarely approve these types of claims, customarily only when it can be clearly shown that the injured worker was subjected to “abnormal working conditions.” For some workers, such as law enforcement officers or EMTs, the definition of “abnormal working conditions” may be significantly higher than it is for most other occupations.

A smaller number of work-related depression claims are approved as physical-mental disability claims. To succeed, you must be able to convince a workers’ compensation judge that your depression stems from a work-related physical injury.

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At Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP, we offer experienced and knowledgeable legal counsel to individuals in Pennsylvania and Delaware. To set up an appointment for a free initial consultation, call us at 610-565-4055 or 302-594-4535 or contact us online.

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Claiming Worker’s Compensation for Depression or Anxiety

Stress, anxiety, depression, or other mental illnesses, even when caused by work, are not compensable in most states. However, mental illness that accompanies a work-related physical injury is compensable in most states. For example, a nurse who develops depression related to his or her work in an emergency room typically would not be entitled to workers’ compensation, but a nurse who is attacked and then physically injured by a patient – and as a result develops anxiety – could legitimately receive workers’ compensation benefits for the physical, as well as the mental injury.

Distinguishing Post – Injury Depression

A recent study by Abay Asfaw, Ph.D., and Kerry Souza, Ph.D., of the Centers for Disease Control and Prevention focused more narrowly on what should be compensable psychological harm in the form of depression. The Journal of Occupational and Environmental Medicine published Asfaw’s and Souza’s findings in an article titled “Incidence of Depression After Occupational Injury.”

Distinguishing post-injury depression from the variety that is “original” compensable harm, such as the type that can result from a hostile work environment, is important. This distinction must be made because of the different factors, and different treatments, related to depressions that stem from circumstances related to someone’s work and distress related to compensable physical harm.

One spoiler regarding the researchers’ findings is that “injured workers were more likely than non-injured workers to suffer from depression during the study period. Consequently, additional costs are incurred for treating injured workers’ depression; these costs were not covered by the workers’ compensation system.” Another spoiler is that “the occupational health community, employers, and others may reasonably anticipate that injured workers may need mental health services.”

Collateral damage from a compensable incident often extends well beyond physical harm that stems from the initial injury. The psychological effects of even short-term disabilities, pursuing workers’ compensation benefits, and anxiety regarding an ability to return to work can be severe. For employers, providing mental health services for injured workers is a costly hidden expense of occupational injuries and illnesses.

Hidden Costs of Compensable Harm

The researchers concluded that the estimated $67 billion price tag for treating occupational injuries and illnesses excludes “costs that are indirect or more difficult to quantify, such as the effects on a worker’s (daily) activities or family life.” The study determined as well that “these costs are usually borne by private medical insurance or by the workers themselves, as workers’ compensation … frequently does not cover such treatment. This underestimates the true costs of occupational injuries or illnesses.”

Findings specifically related to depression included that most workers’ compensation systems do not acknowledge that condition as being work related “although depression has been linked to a preceding occupational injury and has been found to be a factor influencing workers’ success in returning to work.”

From ‘Depression: The Hidden Cost of Compensable Work Injuries’

Bibliography: Depression: The Hidden Cost of Compensable Work Injuries. (2013). [Blog] LexisNexis® Legal Newsroom Workers Compensation Law. Available at: http://www.lexisnexis.com/legalnewsroom/workers-compensation/b/mental-injuries/archive/2013/01/25/depression-the-hidden-cost-of-compensable-work-injuries.aspx [Accessed Jun. 2014].

Contact Delaware County, Pennsylvania and Delaware State Attorneys Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP Today

Many workers’ compensation claims are initially denied. It is always a wise decision to seek counsel from an experienced workers’ compensation lawyer. For an appointment, contact Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP online or call our office at 610-565-4055 or 302-594-4535.

Workplace Bullying – An Unfortunate Side Effect of Filing a Workers’ Compensation Claim

The Workers’ Compensation system, in a perfect scenario, should fairly compensate workers who are injured on the job. Unfortunately, due to the fact that worker’s compensation was created by and for employers in order to minimize lawsuits filed against them, this is not always the case.

To an injured worker who has to file a claim, and initiate a seemingly endless barrage of bureaucracy, the process can seem overwhelming and unending. Also, many workers’ compensation claims are often initially denied.

Bullying of a Workers’ Compensation Claimant

Lawsuits in courtrooms are public knowledge, with any potential harassment or retaliations being on record. In workers’ compensation claims, however, cases remain private, with employer misdeeds buried in secrecy, along with any further psychological damage caused to the claimant.

Also, although workers’ compensation recognizes some physical-psychological claims, these stress related damages are extremely difficult, if not impossible, to receive compensation for.

Surveillance of Workers’ Comp Claimants

Surveillance of injured workers connotes distrust. Employers have gone so far as to videotape and follow workers, accusing them of lying about severity, or faking their injuries altogether. Regardless of physician testimony and subsequent surgeries for said injuries, this employer ‘proof’ can cause irreparable damage to a person’s case.

Other methods of employer harassment can include:

• Denial of valid claims
• Issuing disability checks late
• Intentional refusal to purchase insurance for employees
• Making examples of employees who have filed claims

Workers’ Compensation Lawyers Serving Pennsylvania & Delaware

Contact Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP online or call our office at 610-565-4055 or 302-594-4535 today for a free initial consultation to discuss your workers’ compensation case.

If you’re injured on the job, and directly or indirectly threatened that there will be consequences if you file a workers compensation claim, you are in a difficult situation.

The first thing to find out is whether your employer has workers compensation insurance. Most employers are legally obligated to carry that insurance. Failing to carry workers compensation insurance is a criminal offense.

An employer violating the law can face fines up to $2500 and/or one year in prison for each day that the employer does not have coverage for employees. Each day that an employer does not carry workers’ compensation insurance constitutes a separate offense. Generally this offense is a misdemeanor, but if a court finds that the failure to comply with workers’ compensation requirements is intentional, the employer may face felony charges.

An employer failing to carry workman’s comp insurance exposes the company to significant civil liability. Although employers are generally shielded from personal injury claims from their employees, this is the case only if the company has workers’ compensation insurance.

If an employee is injured on the job and the employer was negligent, the employee can sue the company in a personal injury action. If the injury is serious, the lawsuit may be much more costly for the company in the long run.
If the employer does have workers compensation insurance, but is making threats to avoid a claim to save money, the employee has some options.

If a claim is filed, and you are fired as a result, state law could help. If the claim is filed and you’re retaliated against, but in ways short of being fired, state and federal law may help.

Thirty-seven states have statutes that make it illegal to retaliate against an employee for filing a workers compensation claim. Pennsylvania is not one of them. Over the years, judges have created a “common law” claim for retaliation if the employee is fired due to his or her claim. Shick v. Shirey, 716 A.2d 1231 (Pa. 1998).

The common law cause of action exists for at will employees only. Harper v. Am. Red Cross Blood Servs., 153 F.Supp.2d. 719 (E.D.Pa. 2001). The issue of whether the Pennsylvania common law cause of action extends to mere discrimination versus a complete discharge of an employee in retaliation for filing a workers’ compensation claim does not seem to have been litigated in Pennsylvania.

If you file a workers compensation claim and are retaliated against, filing a complaint with the federal Occupational Safety and Health Administration (OSHA) may be an option. The agency, which enforces the Federal Railroad Safety Act (FRSA), along with other federal workplace safety laws, early last year rendered a decision that Norfolk Southern Railway Co. was responsible for $1.1 million in compensatory and punitive damages following a pair of whistleblower complaints that workers were retaliated against for filing workplace injury claims. The company is appealing the decision.

Since August 2007, when OSHA was given authority over FRSA whistleblower complaints, the agency has received more than 1200 such complaints. Sixty percent of them involve allegations that an employer retaliated after an employee reported a workplace injury.

You may fear repercussions if you file a claim, but if an injury turns out to be serious or difficult to treat, you don’t want to be responsible for the medical bills. If you wait a long time to file a claim, the insurance company may claim the injury was not work related and deny the claim.

If you find yourself in this situation, contact our office. We represent workers injured on the job. We can talk about your injury, your employer and your situation. After we discuss your options, you can take the course of action that’s right for you.