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OFFSETS, CREDITS and MORE; OH MY!

Congratulations! Your case has been decided by a Workers’ Compensation Judge, and you’ve won! You are now receiving workers’ compensation benefits every week. Everything is smooth sailing now, right? Sadly, this is very wrong. Normally, when a suit is brought against a defendant, the final outcome concludes the entire case. In Workers’ Compensation, there are many methods the Employer has at its disposal to try and stop, or reduce, your benefits even after your injury has been accepted as work related. Even if a Judge grants your claim, the Employer will likely use one of these methods, to try and stop or reduce your benefits. This means, every time an Employer tries to stop or reduce your benefits, you’ll end up back in Court. Just because your claim was accepted doesn’t mean all litigation is over.

Many ways exist that allow your Employer to reduce your benefits, simply by filing some forms with the bureau of workers’ compensation. This type of reduction of your benefits is called an Employer credit/offset. Simply, the Employer can reduce the overall amount of workers’ compensation wage payments they make if you receive certain types of income, in addition to Workers’ Compensation.

The Employer can reduce, or take a credit/offset of your benefits, for the receipt of the following types of income:

  1. Severance
  2. Wages Earned with a new Employer
  3. Social Security Retirement
  4. Short/Long Term Disability Benefits
  5. Unemployment Compensation Benefits
  6. Pension

There are certain procedures the Employer must follow before reducing your benefits. The Employer must send you a notice telling you they are going to reduce your benefits. This notice gives you 20 days before the reduction takes place. Further, there are times the Employer is not allowed to take a credit/offset for your receipt of other benefits. For example, if you receive Social Security Retirement Benefits before your work injury, these benefits will not reduce your workers’ compensation. This is why we tell clients that they need an attorney even though they are already receiving workers’ compensation benefits. Without an attorney’s guidance, and knowledge, the Employer can take credits that they might not be entitled to.

It is important to tell your attorney whether you are receiving any other benefits because of your work injury. The Employer will send you verification forms every six months to find out if you are receiving other benefits for your work injury that might offset/reduce your workers’ compensation. You must complete these Employee Verification forms. If you don’t, your employer can automatically suspend your wage loss benefits until you complete these forms.

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Do claimant’s get reimbursed for travel expenses under Worker’s Compensation?

Unfortunately, a work-related injury can be financially disturbing for many workers and their families.  You will not receive workers’ compensation benefits if your claim is denied.  Even if your work-related injury is accepted, many injured workers struggle, because, depending on your pre-injury wages, normally your worker’s compensation benefits are 2/3 of your gross income.  For some people who live paycheck to paycheck, reduced wages can be a financial hardship.  

Worker’s compensation injuries involve a lot of medical treatment.  People often ask if travel expenses are reimbursed by the Carrier.  There is a persuasive argument that the carrier should reimburse your travel costs.   Unfortunately, following the issuance of an appellate case, Helen Mining Co. V. WCAB, 616 A.2d 759, the law changed.   If necessary medical treatment is not available in your area, and you can prove that it’s absolutely necessary to travel out of the state for treatment, there’s a good chance that your expenses should be reimbursed.  

“The other rare exceptions were carved out in Helen Mining Co. v. WCAB (Tantlinger), 616 A.2d 759 (Pa.Cmwlth. 1992), in which the court said:

  1.  If treatment is available locally, the claimant is not entitled to reimbursement for travel expenses except in exceptional circumstances;
  2.  If treatment is available locally and the claimant chooses a physician outside the local area, the claimant is not entitled to reimbursement for travel expenses;

3.  If treatment is not available locally, the claimant is entitled to reimbursement for travel expenses as long as the claimant travels to a facility where others are or would be referred.”

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What You Need To Know About Social Security Disability

Social Security benefits are not just for disabled adult workers.  Children under the age of 18 years old may qualify for Supplemental Security Income (SSI) benefits.  The requirements to receive SSI benefits are very different for children.  In order to be awarded SSI benefits, it must be shown that the child has at least two “marked” limitations or one “extreme” limitation in six areas of functioning.  These six areas are:

  1. Acquiring and Using information
  2. Interacting and Relating to Others
  3. Attending and Completing Tasks
  4. Moving About and Manipulating Objects
  5. Caring for Self
  6. Health and Physical Well-Being

A “marked” limitation seriously interferes with the child’s ability to initiate, sustain, or complete independent tasks.  An “extreme” limitation is a limitation that very seriously interferes with the child’s ability to initiate, sustain, or complete independent tasks.  Most SSI cases involve children who suffer from ADHD, Oppositional Defiant Disorder, and other diagnoses that cause behavioral issues.  However, physical issues such as uncontrolled seizures, severe asthma, and serious orthopedic issues may interfere with one or more of the six areas of functioning.

As with any disability matter, it is crucial that the child maintain regular medical treatment with his or her physicians and mental health providers.  It is also extremely important that all medications prescribed by a medical doctor are taken as prescribed and on a regular basis.  Official school records, report cards, Individualized Evaluation Plans (IEPs),  and school attendance/lateness logs can be very helpful.

Because the Social Security Administration denies many child SSI claims each year, it is crucial that you do not go at it alone.  The attorneys at Banks Law will be happy to speak with you regarding your child’s SSI case and answer any questions you may have.

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Homeless Veterans Assistance

 

There are approximately four hundred homeless veterans within the City of Philadelphia.  Many of these veterans have served our country overseas and have returned with a number of physically and mentally disabling conditions.  In that, the veterans are unable to continue to maintain gainful employment leaving them no choice but to take to the streets.  Unfortunately, these individuals are unaware of the amount of resources they have access to.  Below are two links that offer help to our homeless veterans.

This information is provided directly from the Veterans Affairs and offers health care, housing assistance, employment assistance, foreclosure assistance and advises on how to apply for same.

http://www.benefits.va.gov/persona/veteran-homeless.asp

This link is for the VMC (Veterans Multi-Service Center), which is the only non-profit agency in Philadelphia and the surrounding areas that offers services to all veterans, including the homeless.  The VMC also offers job opportunities, assistance with GI Bills, information on presumptive disabilities and supportive services for veterans and their families.

http://www.vmcenter.org/?gclid=CLy3idSP1NICFQ-BswodJEoBJA

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Home Car Modifications

Did You Know…? In some cases injured workers’ are entitled to have modifications of their home or vehicle paid for by the workers’ compensation insurance company?

Generally, Section 306(f) of the PA Workers’ Compensation Act, provides for payment of reasonable medical expenses that are related a person’s work injury. These services include, among other things, surgery, medicines, supplies prosthesis, chiropractic care and even massages and acupuncture. Until the employer can establish that any or all of this care is not reasonable or necessary, bills for related medical treatment must be paid no later than 30 days after the insurance company receives the bill from the doctor. The Workers’ Compensation insurance company is only responsible for paying for treatment related to the claimed work injury. If you break your ankle at work, do not expect the workers’ compensation insurance company to pay for treatment for an unrelated heart condition.

In some cases, a person’s injury is so severe, that she might need more assistance than traditional medical care. What happens if a person is so severely injured that she can no longer drive? What happens if a person is so severely injured that she can no longer climb stairs to her own bedroom? In special circumstances, the Workers’ Compensation insurance carrier may be liable to pay for modifications to an injured workers’ home or vehicle, when necessary, because of a work related injury.

The Courts in Pennsylvania have found that the remodeling of a home and modification of an automobile should be treated as necessary orthopedic appliances, that are eligible for payment. Enterprise Rent-A-Car v. WCAB (Clabaugh), 934 A.2d 124 (Pa.Cmwlth.2007). In one situation, PA Courts found that modifications to a vehicle weren’t enough to help an injured worker, and ordered the insurance co. to pay for the purchase price of a special van that could be outfitted with wheelchair lift. Griffiths v. WCAB (Seven Stars Farm, Inc.), 943 A.2d 242 (Pa.2008). The costs required to retrofit a van with hand controls and other modifications are the employer’s obligation under the Act. Petrilla v. WCAB (People’s Natural Gas), 692 A.2d 242 (Pa. 2008). Other medical supplies the insurance carrier is normally responsible for paying for include, wheelchairs, walkers, chair lifts, special beds ect.

Whether you can force the Workers’ Compensation insurance company to pay for modifications to your home or vehicle depends on the unique circumstances surrounding your work injury. Insurance Companies normally do not pay for these expensive items without a fight. That is why it is always important to have an experienced attorney protect your rights, and to fight for your best interests.

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Pursuing PTSD Claims

As a VA attorney, I speak to many potential clients who wish to pursue claims for post-traumatic stress disorder (PTSD).  For VA purposes, PTSD occurs when a veteran experiences a traumatic event while in the military.    According to the VA, the symptoms of PTSD include “reliving the event, avoiding places or things that remind you of the event, a shift to more negative thoughts and feelings, feeling numb, and feeling keyed up (also called hyperarousal)”.  Often times these symptoms can arise many years after the traumatic event.

A lot of people believe that only veterans who experienced a traumatic event during combat can get VA benefits for PTSD.  This is false.    Banks Law has been successful in litigating PTSD claims involving events such as a physical altercation while in the military, sexual harassment by superiors, and near death experiences while in training.

It is important to remember that if you believe you are experiencing symptoms of PTSD and you feel it is related to the military, you must get treatment for it so that there is enough medical evidence to support your case.

If you feel you may have a VA claim for PTSD, please call Banks Law.  Our attorneys would be happy to discuss your case with you.

The article below is a great example of how a paratrooper was awarded PTSD from a non-combat event.  After 43 years, he was finally awarded PTSD as a result of a botched parachute jump:

https://www.armytimes.com/articles/after-43-years-the-army-is-finally-recognizing-this-paratroopers-ptsd

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The Importance Of Medical Treatment For Disability Claims

Medical evidence is a key factor for any disability claim, whether it is workers’ compensation, social security, etc.

The consistency of one’s medical treatment is very important. The length of time and frequency can be helpful to a Judge deciding your case. If there are gaps in your medical care, it’s less likely a Judge will rule in your favor. It’s harder to convince a Judge that you are disabled if you don’t take the time to address your injury with your doctor. The more you treat, the more medical documentation there is to support your claim.

Be open and honest with your treating physicians. Be sure to tell your doctor any and all symptoms you are experiencing. It’s also very important to advise your doctor of any injuries you sustained. Many Claimants leave out factors because it’s not their primary reason for their visit or think it’s not relevant.

Apart from this affecting your legal case, this may affect your condition for the rest of your life.

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April is National Social Security Month!

April is National Social Security Month!  The Social Security website has provided five steps to assist in your financial security.

Step One: Allows you to get to know your Social Security and explains how Social Security is more than just retirement benefits.

Step Two: Allows you to review and verify your earnings by logging into or creating an account through my Social Security.  Please note that in order to be eligible for disability, retirement, and Medicare benefits you need to have earned 40 work credits.  $1300.00 = 1 credit and an individual can earn up to 4 credits a year.

Step Three: Shows how to calculate and estimate your social security benefits.  Planning for retirement can be tedious, however, social security has devised a system to assist in determining how long someone will have to work in order to live comfortably in their retirement.

Step Four: Shows how to apply for benefits.  The Social Security Administrations does accommodate all individuals and allows those who cannot leave their home to apply by phone as well.

Step Five: Allows you to manage your benefits and control your benefits when you need to via your my Social Security account.

Click the link below to review additional information regarding the above five steps.

https://www.ssa.gov/agency/5-steps-toward-your-financial-security/

 

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Worker’s Compensation: Fact vs. Fiction

1) I tell you negative things about your case because it is important. TRUE.   At some point in time after your workers’ compensation case has gone to court, you are going to be given the opportunity to settle your case. Part of settling your case is evaluating all the pros and cons to our arguments. We determine the value of your case (for settlement purposes) based on many things, but in part how strong we believe our arguments are. Because litigation is uncertain, it is important to know your chances of having a Judge decide your case in your favor versus the certainty of settlement.

2) I can help you with more than just your case. TRUE!

I am a counselor at law so I can give you advice on where you should go for medical treatment, whether you have the right to sue anyone else other than your employer, and whether you can protect your job while you are out of work.

3) I hate it when you call. FALSE, FALSE, FALSE!

I love to talk about your case with you. I really do. Your case is why I have a job. I put time, energy and brain power into your case. If you have questions, I want to answer them. My goal is that you are comfortable and informed of the process every step of the way in your workers’ compensation case.

4) Your past is important. TRUE

I ask about past injuries because I need to know if your injury is an aggravation of a condition you had before your work related injury, or if you were completely asymptomatic before you were hurt making your injury acute/new or, traumatic. By the way, both types of injuries, aggravations and new/acute injuries, are compensable under the PA Workers’ Compensation Act though how the claim is litigated depends on the type of injury involved.

5) I filed for Workers’ Compensation benefits and have a hearing scheduled. I’ll get my benefits awarded at that first hearing. FALSE.

Unfortunately this is false. If your Employer denies your workers’ compensation claim, you will have to file a Claim Petition and go to court to obtain wage loss and medical benefits. Your petition will be heard by a Judge who will ultimately decide whether he/she believes you were injured and, whether the injury disabled you from work. Both the injured worker and the employer have the opportunity to present evidence to the Judge. Litigation takes time. It can take a year or more before the Judge issues a decision. This is one of the many reasons it is so important to have an experienced workers’ compensation attorney represent you. Your attorney can make sure this process goes as quickly as possible and, that the best case is presented to get you the workers’ compensation benefits.

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How much may I be eligible to collect in weekly workers’ compensation benefits if I am injured and how do they come up with that figure?

As one may expect, a work-injury and the missed income following that injury can have a devastating effect on the injured worker and his or her family. This is especially true if your employer’s workers’ compensation insurance carrier decides not to pick up your claim and instead decides to deny you benefits. The good news is, the attorneys and staff at Banks Law will work hard to ensure that you get the best representation which will give you the best opportunity to recover your lost wages and secure your compensation and medical benefits going forward. However, it is important to know that even if you are successful in having the insurance carrier recognize your claim and accept your work injury, you will not receive a weekly check that is equal to what you made while you were working. The amount of weekly compensation benefits an injured worker may be eligible to receive is based on his or her average weekly wage. Depending on what the average weekly wage is, that figure is then used to determine what the injured worker’s weekly compensation benefits rate is. The Workers’ Compensation Rate Schedule is determined by the Pennsylvania Legislature and is updated yearly. The rate schedule for 2017, and the years prior, can be found at http://www.dli.pa.gov/Businesses/Compensation/WC/claims/Pages/Statewide-Average-Weekly-Wage-(SAWW).aspx.

If you have any questions about Workers’ Compensation, Social Security Disability, Long-Term Disability or Veterans Disability, please call and put the hardworking attorneys of Banks Law to work for you.

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