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Traumatic Servicemember’s Group Life Insurance (TSGLI)

The Traumatic Servicemember’s Group Life Insurance (“TSGLI”) program provides payment to service members who sustain serious injuries while both on and off duty that directly result from a traumatic event they sustained during service that causes them to suffer a qualifying loss. The U.S. Veterans Administration established the TSGLI program to provide financial assistance to service members and their families during the recovery period for serious injuries.

All service members are eligible for payment under the TSGLI program if, after, December 1, 2005, you were insured under the Servicemember’s Group Life Insurance (“SGLI”) and you: (1) experienced a traumatic event that (2) resulted in a traumatic injury which (3) is listed as a qualifying loss. TSGLI coverage is also provided retroactively for service members who suffered severe losses from traumatic injuries incurred between October 7, 2001, and November 30, 2005, and if the injury occurred during Operation Enduring Freedom or Operation Iraqi Freedom regardless of whether you had SGLI coverage at the time of injury.

Qualifying losses do not include mental impairments such as PTSD. Some examples of qualifying losses include: loss of sight, loss of speech, loss of hearing, burns, coma, facial reconstruction, amputations and paralysis. A qualifying loss can also include the loss of the ability to independently perform at least two of the following activities of daily living for, at least 15 days for traumatic brain injuries and at least 30 consecutive days for any other traumatic injury. Activities of daily living include the ability to bathe, maintain continence, dress, eat, use the toilet and transfer into or out of a bed or a chair.

If you are a service member who has suffered serious physical injuries resulting from a traumatic event sustained during your military service and you have suffered from one of the above qualifying losses within two years of the injury, please contact us right away for a free case consultation.

 

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Specific Loss In Pennsylvania: Limited Compensation, But Better Than Most States

The loss of a body part is a tragic and traumatic disruption to who you are as a person and your everyday life. I wish I could give my injured clients full use of their body and return them to their pre-injury condition, but as a lawyer all I can do is get them the medical treatment and monetary compensation that the law provides.

In Pennsylvania, there is good and bad news in this regard. When a worker is injured on the job, often times the only remedy is Workers’ Compensation. This means that instead of going before a jury to ask for damages for the loss of a limb, the amount of money an injured worker is entitled to is set by law. In the case of the total loss of a body part, the law provides that the compensation rate (which is based on the injured workers’ average weekly wage) is multiplied by a specific number of weeks of benefits. For example, a compensable loss of a hand will result in an award of 2/3 of the average weekly wage for 335 weeks (e.g. if you earned $800 per week, your compensation rate would be $533.33 and result in an award of $178,665.550).

This may seem like a small amount of money for the loss of a hand—it certainly does to me—but it turns out Pennsylvania has one of the highest maximum compensation rates of all the states. In the case of loss of a hand, only Nevada, the federal government, and Kentucky award more money. Similarly, in the case of the loss of a foot, only the federal government and Maryland award more money. If you are interested in further comparisons, check out this site. It allows users to compare each state’s compensation for different body parts. Please note, though, that it uses the maximum compensation rate in each state for its comparisons. This means these numbers should not be used to value your workers’ compensation claim since the amount that you are ultimately entitled to depends on your applicable compensation rate.

To determine the value of your workers’ compensation claim, you should consult with an experienced workers’ compensation lawyer. Even if you think an insurance company has offered the maximum compensation allowed for your injury under the law, it is worth talking to a reputable attorney to make sure you are receiving everything that you are entitled. This will give you peace of mind knowing that the insurance company did not take advantage of you. If you are being offered less than the law provides, your attorney will fight to get you what you deserve.

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Consultative Examinations (CE’s)

The majority of people that apply for Social Security Disability (“SSD”) or Supplemental Security Income (“SSI”) benefits will be scheduled to attend medical examinations known as Consultative Examinations or “CE” exams during the processing of their claim. The CE exam will be scheduled by the State Bureau of Disability Determination Services. If you have applied for SSD or SSI benefits based on physical limitations, you will be scheduled for a CE to evaluate your physical condition. If you have applied for benefits due to mental health impairments, you will be scheduled to attend a psychiatric or psychological CE. If you have made application for benefits due to both physical and mental limitations, you will be scheduled to attend both a physical and a mental CE.

The CE exam will be conducted by an independent doctor that is contracted by the Social Security Administration (“SSA”) to perform these types of exams. Currently, these cases are being scheduled by a company known as the IMA group. When is it time for a CE exam to be scheduled in your SSD or SSI case, you will receive a notice from IMA which will provide you with the date and time of your CE exam. It is very important that you show up to your CE exam on time on the day and time scheduled. If you fail to show up for your CE or show up late, the doctor will not be able to evaluate your conditions and SSA can close your case for non-compliance.

You should know that the CE is not for purposes of medical treatment, but rather to provide SSA with a brief overview of your disabling conditions and related limitations. You can expect both the physical and mental CE’s to be brief, usually lasting no more than 10-20 minutes. You should come to CE prepared to tell the doctor about the physical and mental conditions that you suffer from, along with any symptoms and limitations from your conditions that you feel keep you from being able to work full time.

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I don’t want to file for benefits because I don’t want to cause trouble at work.

The Pennsylvania Workers’ Compensation Act was adopted in 1915. Before the “Act,” injured workers had no ability to seek income for lost wages or for medical benefits from their Employer’s after suffering a work injury. Because those workers had no chance to support themselves or their families before the Act was established, most workers returned to their jobs despite suffering serious injuries. Often times the injuries worsened, making the worker incapable of doing anything, let alone being able to support their families.

The “Act” was implemented to provide workers the ability to seek medical care and lost wages for injuries sustained while working. Some injured workers do not take advantage of the benefits available to them for fear they will be seen by their Employer as troublemakers. A worker who continues to work despite suffering an injury may cause their injury to worsen because they are not capable of performing their job duties. Sometimes their injuries become permanent.

It is important that you speak with a knowledgeable Workers’ Compensation attorney to discuss what benefits are available to you. With proper medical care, a treatable injury will get better and not cause further wage loss. With an attorney’s help, some Employers will even agree to modify your job duties to accommodate your physical restrictions while you recover. Even if you feel you can push through the pain, it is important to discuss your options with an experienced attorney.

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How Long Do I Have To Treat With The Company Doctor?

The law requires you to treat with the company or panel doctor as they are called ONLY for the first 90 days following your work injury. BUT, this requirement is only effective if your employer does both of the following things. After your work injury (not only at the time of hire) they must give you a list of at least 6 company or panel doctors to choose from for medical treatment of your work injury. A posting in a central place where employees are likely to see the list is enough. AND, they must have you SIGN a 90 day notice advising you of your obligation to treat with the company doctor for the first 90 days following your work injury. It is not enough that the employer simply tells you about your 90 day obligation to treat with the company doctor. They must actually have you sign a notice telling you that you are required to treat with their doctor for the first 90 days. If your employer does not do BOTH of these things (they cannot just do one without the other) AFTER your work injury, then you NEVER have to treat with their doctor. You should be given a copy of the 90 day notice after you sign and date it.

Even if your employer gives you a list of company doctors to treat with and, has you sign the 90 day notice, you only have to treat with the company doctor for 90 days OR, until discharged, whichever comes first. So if you are discharged before the expiration of the 90 day period, you can immediately start treating with your own doctor.

You should speak with an experienced workers’ compensation lawyer if you have any questions regarding your medical treatment following a work injury. A lawyer can often times refer you to the right doctor to treat your specific injury.

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Can My Employer Fire Or Terminate Me While I’m Out Of Work Because Of A Work Injury?

Yes. Unfortunately, your employer can fire you or lay you off even though you are out of work because of a work injury. REASON? Most employees are “at will“ employees which means that they were not hired under a specific employment contract. “At Will” employees can be fired for ANY reason short of a constitutional violation such as being fired because of your religious beliefs or, because of your gender (male or female). You cannot stop your employer from letting you go even if at the time you are out of work because of a work injury. There is nothing in the Pa WC Act that prevents this from happening. But, an employer who does this puts themselves in a worse position, should you recover enough to be able to return to work in some capacity. By firing you or by laying you off, you no longer have a job to go back to so by law your employer has to continue paying you workers’ compensation benefits until they show that there is other work available to you with a different employer within the restrictions caused by your injury.

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