No, workers’ compensation benefits are your exclusive remedy against your Employer, as well as any co-employee, for damages from a work injury, even if the Employer or co-employee were negligent in causing the injury. An exception to this rule is if your Employer didn’t have workers’ compensation insurance at the time of your work injury. If the Employer wasn’t insured, an injured worker has the option of suing the Employer for negligence in causing the work injury or, filing a claim under the Pa WC Act. If the injured worker chooses to sue the Employer in a negligence action, he must prove that the Employer was at fault in bringing about the work accident, as opposed to pursuing a claim under the Act which doesn’t require proof of fault before the Employer can be held liable. The Pa WC Act is a no-fault statute meaning that you only have to prove that you were injured at work or, within the course and scope of your employment and, that the injury disables you from work in order to be eligible for compensation under the Act. Pursuing a compensation claim under the Act against an uninsured Employer was made a lot easier by the creation of the Uninsured Employers Guaranty Fund which is applicable to injuries occurring after January 8, 2007. Without getting into specifics, the Fund steps in the shoes of the uninsured Employer and pays any wage loss and medical benefits awarded. The Fund can then file a civil action against the Employer to try and get reimbursed for what the Fund paid the injured worker. Pain and suffering damages are recoverable in a negligence action against the Employer but not in a claim under the Act. This usually means a larger award in a negligence case but again an injured worker’s ability to file a civil action against an Employer for a work injury is extremely limited.
In Pennsylvania, the law requires that the workers’ compensation insurance carrier to pay your support obligation from your weekly workers’ compensation benefits if there is an outstanding child support order against you. Moreover, any back due child support must be satisfied or, at very least arrangements made with the District Attorney’s office to reduce the obligation, before any lump sum settlement of your workers’ compensation case can be paid to you. It is best to let your attorney know as early as possible in your case whether you owe child support so that the amount of any back due child support doesn’t come as a surprise to you, especially when it comes time to settle. Our office has seen a number of settlements blow up because the back due support owed is more than the injured workers’ share of the settlement. If you believe the amount of support being taken from your weekly workers’ compensation check is wrong or, the amount of the back due support is incorrect, you need to hire a Family Law lawyer as soon as possible to try and correct these errors. Your workers’ compensation attorney will likely not be able to help you in your support case short of confirming what your support obligation is because most compensation lawyers don’t practice Family Law. Based on our experience, it is worth every dime you spend to hire a Family Law attorney to resolve support issues well in advance of a settlement of your compensation case. Don’t be fooled! The workers’ compensation judge cannot, and will not, ignore your support obligation in a settlement of your claim. The Judge is required by law to consider your support obligation before approving the settlement.
ABSOLUTELY NOT! As long as you’re receiving wage loss benefits, you’re also entitled to full medical coverage for your work injury. Your employer or, its workers’ compensation insurance carrier are legally obligated to pay for your work-related medical bills, including prescriptions; doctors’ visits; diagnostic studies such as x-rays, MRI’s, CAT Scans; surgery; hospital visits; physical therapy, chiropractic treatment; etc. Do NOT pay for any medical treatment yourself because it’s a lot harder for us to get you or your private health insurance carrier reimbursed than it is for us to force the insurance company to pay your medical provider directly. Plus, you shouldn’t have to pay a co-pay to your doctor or pharmacist when your work-related medical bills and prescriptions are the sole responsibility of the workers’ compensation insurance carrier.
The problem is that many of your doctors and pharmacies who aren’t accustomed to dealing with workers’ compensation claims either don’t want to wait for payment from the insurance company or, they don’t know what’s needed to properly submit their bill for payment. Another problem is if your workers’ compensation claim is denied and you need to hire a lawyer to file a petition to get it recognized. Many doctors and pharmacies that aren’t familiar with the workers’ compensation system won’t treat you or fill your prescriptions without a guarantee that they’ll be paid. The workers’ compensation insurance carrier isn’t responsible for paying your medical and pharmacy bills when your claim is denied until a Judge orders them to pay the bills. But, your attorney can refer you to doctors, diagnostic facilities, therapist and pharmacies that will treat you and fill your prescriptions until a Judge issues a decision in your case.
At Banks Law, we have partnered with WIRX Pharmacy, a local Philadelphia-based mail order and hand delivery pharmacy, who will fill and deliver your work related prescriptions to your home, whether your claim is accepted or not, usually in less than 24 hours. Their customer service and response time are excellent. More importantly, they’re located right here in Philadelphia unlike many of the other mail order pharmacies that you might be used to, so if a mail order delivery problem arises, it can be fixed through a hand delivery. Because Banks Law is an investor in WIRX, we have an incentive to make sure the delivery of your work-related prescription medication is seamless. You’ll direct any pharmacy questions to Banks Law just like you do with any legal issues involved in your case. This eliminates the need to deal with anyone other than Banks Law to resolve issues in your case. WIRX pharmacy is another example of our full service pledge to you. Call us and find out more about the benefits of having your work related prescriptions filled and delivered to your home by WIRX.
The short answer is no. The Workers’ Compensation Act was designed to quickly help injured workers and enable them to obtain benefits while they recuperate after an injury. If you are unable to work in any capacity, your Employer is responsible for paying 2/3rds of your lost wages and for medical treatment you receive because of your work injury. To be eligible for workers’ compensation benefits neither you nor the employer need to be “negligent” or at fault. In other words, to obtain benefits you don’t need to prove your Employer did anything wrong that resulted in your injury. Your friend who was injured in the car accident does have to prove “negligence,” or fault of the other party in order to obtain money damages. Because an injured worker does not have to prove his Employer was at fault for his injury, the worker is not eligible for pain and suffering damages.
Just because you have a pre-existing condition does NOT mean your work injury should be denied. A core concept in the law is the “eggshell plaintiff rule.” It says that even someone whose bones break as easily as an eggshell can still fully recover for all injuries resulting from a tort, even if the act that caused those injuries would not have hurt the average person nearly as badly. In workers’ compensation, that means that even if you have a severe pre-existing condition, if it was made worse by a work-related injury, then you are entitled to workers’ compensation benefits.
A colorful case from Indiana provides a good example of this concept. In it, a morbidly obese employee suffered from diabetes and used a cane because of her bad knees. At an employee appreciation dinner she got stuck in a booth and ended up cracking her femur (thigh bone) trying to get out of the booth. The fact that her pre-existing condition (obesity and leg problems) contributed to her injury was irrelevant thanks to the eggshell plaintiff rule. Waters v. Indiana State Univ., 953 N.E.2d. 1108 (Ind. Ct. App. 2011).
For you, this rule means that even if you had a very bad back before your work injury, for example, you should still get workers’ compensation benefits if your bad back was made worse by a work injury. Oftentimes insurance companies will ignore the eggshell plaintiff rule and deny liability for work injuries because of a pre-existing condition. They are wrong when they do this. You need an attorney to help make the insurance company do the right thing and accept liability for your work injury, even if you have a pre-existing condition. Don’t hesitate. Call Banks Law today.