Pennsylvania Work Injury Law Overview

Suspension of Benefits

If you are receiving wage loss benefits as a result of not being able to return to work after sustaining a work injury, the workers' compensation insurance carrier, at some point, is going to attempt to stop or modify your wage loss benefits. Your wage loss benefits may be suspended based upon returning to work, voluntarily withdrawing from the labor market, becoming disabled from a non-work-related condition, failure to complete an LIBC 760, being incarcerated after a criminal conviction, refusing to receive reasonable medical treatment, refusing a job offer from your employer, having it determined that your have earning power capacity greater than your average weekly wage, or refusing to comply with an Order directing you to undergo a medical examination or expert interview.

Unless you receive a "Notice of Suspension" from the insurer, the insurer may not unilaterally stop your wage loss benefits. It must first file a Petition with the Court, and a hearing must be held.

Cases Concerning Suspension of Benefits:

• Keene v. WCAB (Ogden Corp.), 92 A.3d 897 (Pa. Commw. 2014) 2014 WL 2508084, filed June 4, 2014.
  
  
• Chesik v. W.C.A.B. (Department of Military & Veterans' Affairs) Commonwealth Court of Pennsylvania, November 9, 2015.
  
  
• Dixon v. WCAB (Medrad, Inc.) - This case shows that an injured employees wage loss benefits can be stopped even if he/she has restrictions because of his/her injury. In this case the insurers own doctor said the claimant had work restrictions. The employer offered the claimant a job which it said was within the restrictions. Because the claimant failed to follow through, in good faith, with the job offer his benefits were suspended, which means his wage loss benefits were stopped even though he was not actually working. This is a suspension based upon a claimant's bad faith refusal to accept a job. Click on the case title to read the whole case.

Reinstatement of Benefits

If your Workers' Comp Wage Loss Benefits have been suspended or modified as a result of you returning to work for either your at time of injury employer, or for another employer, and you subsequently stop working, you may be entitled a reinstatement of your total disability wage loss benefits. A clear example of when you would be entitled to a reinstatement of your benefits is if you had returned to work with restrictions and then laid off for economic or other reasons. If your benefits have been suspended or modified and you are no longer working, you need to call Attorney Vendetti immediately to determine whether you are entitled to a reinstatement of your benefits.

Cases Concerning Reinstatement of Benefits:

• Daugherty v. W.C.A.B. (QVC Inc.) decided October 14, 2014.
• Sloane v. W.C.A.B. Commonwealth Court Decision October 1, 2015.

Course of Employment

Injuries may be sustained in the course of employment in two distinct situations: (1) where the employee, whether on or off the employer's premises, is injured while actually engaged in the furtherance of the employer's business or affairs, or (2) where the employee although not actually engaged in the furtherance of the employer's business or affairs (a) is on the premises occupied or under the control of the employer, or upon which the employer's business or affairs are being carried on; (b) is required by the nature of his employment to be present on his employer's premises; and (c) sustains injuries caused by the condition of the premises or by operation of the employer's business or affairs thereon.

Cases Concerning Course of Employment:

• Walter Wetzel vs. WCAB (Parkway Service Station), 92 A.3rd 130, 2014 WL 2187363 (Pa. Cmwlth. 2014) filed May 27, 2014.
• Ace Wire Spring and Form Company v. WCAB (Walshesky). 93 A.3rd 923, (Pa. Cmwlth, 2014), 2104 WL 2576059, filed June 10, 2014.
• Marazas v. WCAB No. 337 C.D. 2014, (Pa. Cmwlth, 2014).

Course of Employment - Traveling Employee

As a general rule, an injury received by an employee while traveling to and from work is not compensable. However, such an injury is compensable if one of the following exceptions to the “coming and going rule” exist: (1) the employment contract included transportation to and from work; (2) the employee has no fixed place of work; (3) the employee is on a special mission; or (4) special circumstances are such that the employee was furthering the business of the employer.

Cases Concerning Traveling Employees:

• Simko v. WCAB (United States Steel Corporation – Edgar Thomason Works), September 5, 2014.

Notification of a Pennsylvania Work Injury

If you believe you have suffered a work injury while working for your employer you must notify your employer of your injury within 120 days from the date of your injury. If you fail to notify your employer of the injury within the 120 days you may be forever barred from receiving workers’ compensation benefits for your work injury. 77 P.S. Section 631.

Repetitive Use of Body Part Injury

Pursuant to the Pennsylvania Workers’ Compensation Act, an injury may result from the repetitive use or motion of a body part. Examples of this could be shoulder, elbow or knee injuries. If you have a job that requires repetitive tasks, and have been diagnosed with an injury you believe is related to the repetitive task, you may be entitled to Pennsylvania Workers’ Compensation Benefits. Pursuant to the Act, for an injury that is the result of continuing multiple trauma, the injury does not take place until the last day of exposure or trauma occurs, which is usually the last day of work. This may delay the period in which you must give notice of your work injury.

Average Weekly Wage

Cases Concerning Average Weekly Wage:

• Anderson v. WCAB

Impairment Rating Evaluation (IRE)

Pursuant to the Pennsylvania Workers' Compensation Act, a workers' compensation claimant will be required to submit to a medical exam (IRE) to determine the percentage of impairment, if any, at the expiration of a claimant's receipt of 104 weeks of total disability benefits. The impairment rating evaluation is a mechanism for adjusting the status of workers' compensation benefits between total and partial disability. A claimant may not be required to submit to more than two (2) IREs during a 12 month period. If it is determine that the claimant is 50% or less impaired by his/her injury, then his/her benefits will modified from total to partial. The dollar amount of wage loss benefits being paid the claimant will not change, just the explanation of benefits being paid. Pursuant to the Act a claimant may receive unlimited amounts of weeks of total disability benefits, but is allowed to receive only 500 weeks of partial disability benefits. Therefore, a workers' compensation insurance carrier who successfully modifies a claimant's benefits through an IRE limits the amount of benefits it needs to pay the claimant to only 500 weeks.

Cases Concerning IREs:

• Village at Palmerton Assist. Living v. W.C.A.B.: When Parties Cannot agree on Impairment Rating Evaluation Physician, the date the workers' compensation insurer requests the physician performs the IRE is the determinative date whether the IRE request was timely under Section 306(a.2)(1) of the Act, 77 P.S. 511.1(1). The Court determined that the Workers' Compensation Board erred by holding that, to secure an automatic change in the claimant's benefits, the employer need to request the designation of the IRE physician by filing Form LIBC-766 and request the claimant attend the IRE by filing Form LIBC-765 within 60 days of when the claimant had received 104 weeks of temporary total disability.
  
  
• Neff v. W.C.A.B. Maximum Medical Improvement - Impairment Rating Evaluation
  The Workers Compensation Judge has broad discretion to find a medical witness credible, and to accept his or her medical opinions as fact, regardless if the other party has medical opinions adverse to the medical opinions of the medical expert. In the case of Neff v. WCAB the WCJ had the discretion to determine that the workers compensation claimant had reached maximum medical improvement, even though the claimant could undergo surgery that could improve his condition. Just because the claimant could undergo this surgery, did not mean that he was not at MMI, which allowed the Insurer’s Impairment Rating Evaluation to stand and modify the claimant’s benefits from total disability benefits to partial.

Statutory Employer - Pursuant to Section 302(a) of the Act:

A Statutory Employer is a master who is not a contractual or common law one, but is made one by the Act. It is usually when a general contractor hires a subcontractor to do work, and the subcontractor does not have workers' compensation insurance. in that case the general contractor and its insurer become liable to the claimant for his/her injury, as though the general contractor was the claimant's employer at the time of his/her injury.

Cases Concerning Statutory Employers:

• Saladworks v. W.C.A.B. - Joinder Petition / Statutory Employer: When franchisor in business of sale of franchises to franchisees who desire to use its name and system is not in restaurant business or business of selling salads it cannot be statutory employer joined in action seeking damages to employer of franchisee.

Uninsured Employers Guaranty Fund

Act 147 created the Uninsured Employers Guaranty Fund. This fund is available to pay claims for injuries sustained by an employee who is working for an employer that is not carrying workers' compensation insurance. Prior to filing a petition seeking benefits under this fund, the employee must first file a notice of claim against the uninsured employer (Form LIBC-551). A claim petition for benefits from the UEGF may not be filed until at least 21 days after the notice of claim against has been filed.

Cases Concerning the UEGF:

• UEGF v. WCAB (Kendrick and Timberline Tree) - Case explains the importance of Immediate Notice to Uninsured Employers Guaranty Fund . The Court Held that if an employee does not notify the UEGF within 45 days from the date of his/her injury, then the UEGF is not responsible for any medical bills or wage loss payments until the date it received notice of the claim. The UEGF exists to cover injured employees of employers that do not carry workers' compensation insurance. It is a violation of law for an Employer not to carry workers' comp insurance, but in the rare case that this happens the UEGF is supposed to cover the claim.

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