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What is your PA Workers’ Compensation Case Really Worth?

Settlements in workers’ compensation cases are fairly limited despite what you might hear. Why? Because, in a Pennsylvania  workers’ compensation case, you are generally only entitled to wage loss benefits based on  66 2/3% of your gross weekly pay, and the payment of your work related medical bills. You are NOT entitled to pain and suffering damages in a workers’ compensation case the way you are in a personal injury case.  Those damages significantly increase settlements in personal injury cases. This is why six figure settlements in workers’ compensation cases are the exception, rather than the norm. Workers’ compensation cases are typically valued for settlement at between 2 to 5 years of additional weekly wage loss benefits payable to the injured worker, unless the case involves a catastrophic injury where the injured worker is confined to a wheelchair or the bed. There are exceptions to every rule and settlements in workers’ compensation cases are no different. But, for the most part, cases in workers’ compensation are valued using this 2 to 5-year range. Why this range? Because the accepted belief is that most work injuries should resolve enough during this period to allow the injured worker to return to work in some capacity, or if not, the Employer should be able, through litigation, to reduce or change the status of an injured workers’ entitlement to compensation during this period. Remember, workers’ compensation is not meant to be a long term benefit, which explains why the word “ temporary “ appears before the two types of wage loss benefits that are available under the PA Workers’ Compensation Act. Temporary TOTAL disability benefits are given to injured workers’ who can’t work at all because of their injury, and temporary PARTIAL disability benefits are benefits that are given to those workers who can work despite their injury but at a wage loss.

Since the change in the law in 1996, you can now settle your right to medical benefits in addition to your wage loss benefits or, in other words, you can now settle your entire claim. In fact, most Employers insist that the entire claim be resolved before they will even consider settling. Therefore, before you decide to have your attorney approach the Employer about settling your case you need to make sure that you are at maximum medical improvement (MMI), which simply means that you’ve improved all that you are going to from your work injury. Only your doctor can tell you when you have reached MMI. If you settle before you reach MMI, you need to understand that neither your Employer or their workers’ compensation insurance carrier will be responsible for the payment of your work related medical bills after a full and final settlement of your case.

There are other factors that impact the value of a workers’ compensation case. They include offsets/credits that might be taken against your weekly wage loss benefit because you received unemployment compensation; Social Security Retirement (SSR) benefits; pension/severance benefits; short-term and long-term disability (STD/LTD) benefits, salary continuation, etc. Receipt of these benefits will reduce the overall settlement value of your case. Other factors that impact settlement values are the age of the claimant; the severity of the work injury; whether the injured worker has transferrable skills that might be used in some other kind of employment, the worker’s educational background, the physical nature of the worker’s pre-injury job, the evidence against the worker in pending litigation, and even the temperament of the Judge assigned to the case.

BUT, THE MOST IMPORTANT THING THAT AFFECTS THE SETTLEMENT VALUE OF A PA WORKERS’ COMPENSATION CASE IS THE BENEFIT RATE ITSELF. AS A GENERAL RULE, THE LOWER THE COMPENSATION RATE, THE LOWER THE SETTLEMENT VALUE OF THE CASE, REGARDLESS OF THE SEVERITY OF THE INJURY (AGAIN, UNLESS YOU’RE DEALING WITH A CATASTROPHIC INJURY).

There are other options for you to pursue if you settle your workers’ compensation case and you find that you can’t go back to work. You can apply for Social Security Disability (SSD) benefits if you can’t work in any capacity, not even a sit down job or light duty work, and if you’ve been out of work, or are expected to be out of work for at least 1 year. Social Security Disability, unlike workers compensation, is a more long- term benefit for those who simply can’t work because of a work injury, or some other disabling condition. The Social Security Administration will not only consider your disability from the standpoint of your work injury, but they will consider any condition, physical or mental, that you suffer from that disables you from work. If you’re already on SSD benefits at the time you’re ready to settle your workers’ compensation case, there are some rather technical things that must be done in order to resolve your right to future medical benefits. Therefore, you should seek the advice of an experienced lawyer to guide you through this process.

Settling your workers’ compensation case is an important decision and it should only be done when the circumstances are right for you. Let the attorneys at Banks Law guide you through this process. We will get you what you’re entitled to.

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Employer-Provided Long Term Disability Benefits – Appealing a Denied Claim

Many employers provide long term disability insurance policies for their employees. LTD insurance policies take effect when an employee can no longer work due to any illness or injury, and they pay monthly benefits until the employee can return to work. The monthly amount is usually between 50-70% of the employee’s monthly income.

Most employer-provided LTD insurance plans are governed by the Employment Retirement Income Security Act (ERISA), which favors insurance companies. Unlike most insurance policies, ERISA-governed policies are very difficult to challenge in court. If your claim for employer-provided LTD benefits is denied, you cannot file a lawsuit until you file an appeal to the LTD policy holder. You will have 180 days to file this appeal.

You should seek assistance from an experienced attorney to appeal a denial, as the appeal will need to address many issues depending on the policy, denial letter, and your disabling conditions. However, there are some things you can do to prepare your appeal:

  • Get a copy of the policy, which can be obtained from your employer’s human resources department or from the insurance company that denied the policy.
  • Get a copy of your job description, which can also be obtained from your HR department.
  • Continue treating with your doctors, and find out if they will support your appeal.
  • Educate yourself about Social Security Disability benefits, as many LTD policies will require you to file for SSD.
  • Collect any records that are relevant to your claim, such as:  letters to and from the insurance company; pay stubs; list of treating doctors; statements from your doctor(s); medical test results; medications list; etc.

The appeal needs to be carefully prepared in consideration of the policy provisions, your medical conditions, and your occupation. At Banks Law, our experienced attorneys will ensure that your appeal has the highest chance of success. Please give us a call is you have any questions regarding your long term disability benefits.

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Are You Suffering from an Occupational Disease?

An employer must pay damages for an occupational disease contracted by a worker during their employment. An occupational disease can be any sickness, illness or ailment brought about by work conditions and work-related activity. Occupational diseases can be caused by exposure to certain chemicals, gasses, fumes, metals, oils, radiation, and other harmful substances. Occupational diseases can also develop from abnormal work conditions.

Here are some conditions that have been found to be occupational diseases:

  • Lung cancer and lung disease
  • Asthma, bronchial infections, and other breathing disorders
  • Heart disease and other cardiovascular conditions
  • Infection and inflammation of the skin
  • Skin cancer
  • Fibromyalgia and other chronic pain syndromes
  • Mesothelioma and Asbestos Poisoning
  • Musculoskeletal Disorders
  • Hearing and vision impairments
  • Post-traumatic stress disorder, depression, and anxiety

There are certain cutoff dates for bringing a Workers’ Compensation claim for an occupational disease. You may be unaware that your health conditions were caused or aggravated by your work environment or working conditions. At Banks Law, our attorneys work with doctors on a regular basis, and can determine if you are suffering from an occupational disease. Please give us a call to speak to one of our specialized Workers’ Compensation attorneys.

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