What is a Workers’ Compensation Claim Denial?
What is a Workers’ Compensation Claim Denial?
After you suffer a work injury and give Notice to your employer, your employer will forward the claim to their workers’ compensation carrier. From the date of receipt, the assigned workers’ compensation adjustor has 21 days to either accept or deny your claim for workers’ compensation benefits. If your claim has been denied, you will not be receiving workers’ compensation benefits- medical or wage loss. If you receive a Denial you should contact a workers’ compensation lawyer right away to file a Claim Petition. A Claim Petition will be litigated before a Workers’ Compensation Judge.
Please note that even if your Claim is accepted, it could be accepted for a “Medical Only”, and could also be accepted as “Temporary”, which could mean that you are technically denied. Please note that if and when you receive a Denial, this is a time sensitive issue and should be dealt with as quickly as possible.
Thank you for taking the time to learn more about workers’ compensation through our Workers’ Comp Wednesdays with Kara Curry on 99.9 The Hawk. If you or a loved one has a question regarding your work injury or claim I invite you to contact me via phone (215) 530-7166, email or the form to the right. As a certified workers’ compensation attorney, I am happy to offer free consultations. – Paula Robinson, Esq.
What is an Notice of Compensation Payable (NCP)?
Once an employer sends the Workers’ Compensation Carrier notice of your work injury they have 21 days to respond in the form of a Denial or Notice of Compensation Payable. The notice will come in the form of a letter via the postal mail. Whether denied or accepted, I always advise to consult a Workers’ Compensation attorney to review your case and be prepared to respond when necessary.
What is an NCP?
Notice of Compensation Payable
A NCP or Notice of Compensation Payable is issued by the Workers’ Compensation Carrier accepting the claim, agreeing to pay wage loss and medical benefits or just medical benefits. This can also be in the form of a Notice of Temporary Compensation Payable, which is only for 90 days.
Notice of Compensation Payable is your ticket and the document you want to receive! In short the Workers’ Compensation Carrier has agreed to cover your work injury.
Keep in mind that in time the Workers’ Compensation Carrier will want to stop benefits. This may be in the form of a settlement or a request to modify, suspend, or terminate benefits. Even if you receive a NCP, it is still a good idea to retain a workers’ compensation attorney to have on your side for all issues that will come up. It is not a matter of “if”….it is a matter of “when”.
What is “Donate Life”?
Did you know in the United States of America April is designated as National Donate Life Month!
To celebrate, let us explore more about the non-profit organization Donate Life America and what it could mean for the residents of the Commonwealth of Pennsylvania.
“Donate Life Pennsylvania is a collaborative initiative between Gift of Life Donor Program (GOL), the Center for Organ Recovery & Education (CORE), and the Pennsylvania Departments of Health and Transportation. It is funded by residents of Pennsylvania through voluntary contributions included with driver’s license renewals, vehicle registrations and state income tax filings. All contributions are used by the Governor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund to educate Pennsylvanians, build awareness about the importance of organ and tissue donation, and increase the number of people who sign up to become donors on their driver’s license, learner’s permit or state identification card.” Donate Life
How can you get involved or support Donate Life PA?
It’s pretty easy. Simply sign up to be an organ donor or make a monetary donation!
Good news for Pennsylvania residents, you do not have to wait for your driver’s license renewal to change your Organ Donor status. You can sign up anytime online with the following information:
- PA Driver’s License Number
- Date of Birth
- Last four digits of your Social Security Number.
Here are a few staggering statistics from the Donate Life website regarding the need for organ donations. Read More
PA Workers’ Compensation Employee Rights Scenarios
Employee Legal Awareness Day was established by an Australian lawyer, Paul Brennan. His aim was to emphasize the importance of legal education for employees and small businesses and reduce their risk of legal problems. The day isn’t only about laws though, Brennan also suggests that employees should increase their awareness of their company’s policies. According to him, it is important for employees to have a copy of the employer’s handbook, where you can find information about bereavement policy, attendance and punctuality, conflict of interest statements and non-disclosure agreements. We thought it would be the perfect opportunity to focus on the employees’ rights in the event of a work injury. Here are a few “what if” scenarios:
What if you at work and you are required to work outside, and you slip and fall on ice or some slippery substance and you are injured? In order for you to have the right to pursue a workers’ compensation claim in PA, you need to meet the following requirements: There is a definite employment relationship between you and the employer; that the accident happened in Pennsylvania in the course of employment; and that your activity at the time of the injury is related to the employment. If you met that burden, then next comes your burden of “Notice” to your employer of your work injury.
You must give notice of your work injury within 120 days of the injury. There are cases, such as cases of work-related aggravation of preexisting conditions, such as asthma or emphysema that may extend that time period of giving notice. In such cases, it could be argued that the time period did not begin to run until you know or by reasonable diligence should have known that your condition is related to the employment. In the cases of repetitive trauma, such as typing or data entry causing a diagnosis of carpal tunnel syndrome, for example, the 120 days would not begin to run until after the last day or work. Of course, these different scenarios would be on a case by case basis.
Who should “notice” be given to? Proper notice should be given to a Supervisor, Foreman, Boss, whoever is your Superior at your workplace. Notice to a co-worker is not enough for you to meet your burden. You can give oral, text, or written notice, but you must be able to prove that you actually gave notice of your work injury. Read More
Re-entering the Workforce After a Work Injury
Life After a Work Injury
A work injury can oftentimes alter a person’s career path. Recovering from a work injury is not always easy. January is commonly known as a month of new beginnings, a fresh start or clean slate. If you or a loved one has suffered a work injury, these phrases may have a new meaning as it maybe be an unfamiliar beginning. Work injuries affect more than just the injured worker, it affects the family and the life they have known.
Redirection or a career course correction is often needed, although at the time it can be difficult. Like many of life’s hurdles there is often a silver lining when we look for it. What is your silver lining? In the spirit of starting the New Year off on the right foot, despite a work injury, here are a few tips to evaluating your new quality of life and making the most of your future despite the potential limitations of a work injury.
Tools to a New Career After a Work Injury
CareerLink – https://www.careerlinklehighvalley.org/
PA CareerLink®’s mission is “to implement a PA CareerLink® delivery system which serves our community as a clearinghouse of resources, inclusive of all information, employment opportunities, training and education options and economic development linkages, through a customer focused system based on the current and future labor market of the Lehigh Valley.” As a resident of Pennsylvania you are able to use these resources for your career, training and more at no cost to you. This is an excellent starting point for many!
Online Assessments
With the potential new limitations of a work injury, finding that new career path can seem very daunting especially when recovering from a work injury and you will not be 100%. The good news is there are a few tests and online assessments that can help you identify areas of interest, or what you might be good at as it relates to careers. Here are a few popular online assessments to consider.
- Myers-Briggs Assessment – http://www.mbtionline.com/
This assessment will help you identify your personality and how you prefer to communicate. It will cost about $50, but is one of the most popular and said to be personally beneficial to help with understanding how you work best with others.
Added Benefits to Serving as a Volunteer
The Pennsylvania Workers’ Compensation Act is geared to be, for the most part, charitable and caring to the injured worker. A perfect example of this is the section of the Act dealing with volunteer workers. In Pennsylvania, volunteer emergency workers, including volunteer fire departments, volunteer ambulance workers, and even volunteer forest firefighters are included as employees under the Act. Because they unselfishly give of their time and services, they have the presumption that their wages are at least equal to the statewide average weekly wage for the purpose of calculating their weekly compensation rate.
When an injured worker is out of work, and it is proven that they are out of work due to the work injury, then they are entitled to “wage loss benefits” which are generally calculated off of the gross earnings that the worker earned per week at the time of injury, going back four (4) quarters, if available. Back in 1972, the PA Workers’ Compensation Act was amended, introducing the concept of the “Statewide Average Weekly Wage” (SAWW). Every year, the Department of Labor and Industry determines the SAWW as of January 1 of every year. The SAWW is equal to the maximum weekly compensation payable, meaning that there is maximum amount of weekly wages that a PA injured worker can receive per week. For the year 2017, the most one could receive per week was $995.00. In 2018, the SAWW is $1,025.00 per week.
If an injured worker has regular employment in addition to the volunteer position, to determine what his/her weekly compensation rate would be, it would be the higher of the two. For example, if the injured worker earned $400.00 per week gross at his/her regular job, the weekly compensation rate (according to the PA Workers’ Compensation Rating Chart) would be $360.00 per week. If the injury were in 2017, then the SAWW weekly compensation rate would be $995.00. So, the injured worker would be entitled to receive the higher rate of $995.00 per week.
If you or a loved one have a work injury and seek out the advice of an experienced workers’ compensation attorney, make sure that any volunteer work is mentioned, as it could make a huge difference in the amount of benefits received on a weekly basis, and a possible settlement down the road. For all of the volunteers out there, thank you for your unselfish service to the public Robinson Law LLC.
Chiropractic Connections
Without our health, it is difficult to enjoy all life has to offer. So, when a serious work injury happens and you’re unable to work, earn an income, or do simple tasks it can take a toll on us both physically and emotionally.
October was National Chiropractic Health Month and it got me thinking about all of the wonderful Chiropractors who I have come into contact with in the workers’ comp field in Pennsylvania.
Chiropractors are the type of people that you don’t give much thought to until you need them, but they are vital to keeping your body healthy and functioning correctly. I suggest visiting one even if you haven’t had an injury to prevent any issues from arising. If you are receiving workers’ compensation you may be eligible to visit a chiropractor as part of your treatment. To find out more about which medical expenses are covered under workers’ compensation see my previous blog.
Below are a few resources for finding the right chiropractor for you.
Pennsylvania Chiropractic Association
American Chiropractic Association
International Chiropractors Association
There are many more resources available, but these are a few of the best, and a great place to get started.
Once again, thank you to all the chiropractors I have worked with in the past and keep up the good work!
Post-Hurricane Season – Lessons Learned for Future Preparedness
This year North America had a very active hurricane season leaving us to look back and ask the questions, what can we take away or do differently to prevent loss of life, excessive property damage and to ensure a quick recovery post-natural disaster. Having a plan prepared for the unlikely event of a disaster, with or without warning, can be a huge help when disaster strikes. After seeing the devastation brought on this year by Hurricane Harvey, Irma, Jose, and Maria it is clear that weather can be fierce and unpredictable.
Although we cannot control the weather, we can control our actions. Here are a few things we can be mindful of prior to the next massive weather event.
1. Evacuation Route (Flooding, Snow or Nuclear)
- Know the evacuation route and the proper road signs to look for when traveling.
- Identify your shelters and your final destination to reunite with family. Based on the type of emergency, the location and evacuation route may change.
- Contact your township for evacuation routes, local resources and emergency phone numbers.
- Print a copy of maps, locations and numbers in case of a power, cell tower or phone outage.
- Consider a practice drive and be sure to discuss the plan with your extended family so they know your plan.
2. Emergency Numbers/Plan
- Make sure you have all important phone numbers written out. If you lose power and your phone dies you want to make sure you have access to them. Also, it wouldn’t hurt to laminate them to protect from water damage.
- Have any valuables you want to keep protected from flooding? A tip that was floating around various news outlets says to put them in the dishwasher and lock it, since it is waterproof everything will stay dry.
3. Backup Radio/Batteries/Water/Food
- It’s impossible to know how long you will be without power during and after a natural disaster, so make sure you have extra batteries stored in a high, dry place.
- Fill your bathtubs and sinks with water before a storm, as well as filling up large gallon ziploc bags of water and putting them in the freezer. It will help food stay cool as it melts and be fresh drinking water.
- Knowing that food in the fridge or freezer could go bad if the power goes out, make sure to stock up on non-perishable foods that require little preparation or cooking.
- Make sure you have a few radios that are either battery operated or hand powered so you can stay informed throughout.
- Consider buying a satellite phone in case the cell towers are down for extended periods of time and you want to contact loved ones.
Hopefully, we will never see as devastating of a hurricane season again as we have in 2017, but if we do, I hope that people are able to be prepared for all of the disastrous possibilities that might happen.
Traveling Employees Beware of Drowsy Driving
How many times do you travel on roads around where you live? Probably almost every day right? When you are out traveling, how often do you see trucks in all different sizes hauling goods and products, ranging from oil, gas, UPS, FedEx, Amazon, Groceries, you name it! All of those drivers are working as drivers or drivers/deliverers. So, if they are driving to further the business of their Pennsylvania employers, and they are in an unfortunate accident, then they most likely should be entitled to workers’ compensation benefits.
How do those accidents occur? There are any number of ways accidents can occur. The week of November 5-11, 2017 is Drowsy Driving Prevention week across the nation. Certainly, drowsy driving is a cause, as the driver drifts off in their mind and body, then can drift off the road or into another vehicle, person, or object. Drunk or buzzed driving is certainly another cause; however, this would most likely not be accepted as an accepted work injury in Pennsylvania as this would be against the law. Other causes of accidents could be texting, eating, or just not paying attention to the road while driving. Weather or smoke from fires can also play a role, creating slick conditions and limit vision.
Work injuries can come in all forms from scratches and bruises to broken bones, head concussions, eye injuries torn muscles and tendons to even post-traumatic stress disorder. These injuries can either result in no missed time from work to many months out of work and treating for the injury(ies). Certainly, every case is different and should be handled on a case by case basis.
What happens if you or a loved one is simply traveling to and from work in Pennsylvania, is that covered by PA workers’ compensation? Typically, traveling back and forth from work in PA is not considered to be within the course of employment, however, there are some exceptions. These exceptions are as follows: The contract between the employer and employee specifically included transportation to and from work; the injured worker had no fixed place of work; the injured worker was on some special assignment for his or her employer; or some special circumstance where the injured worker was actually furthering the business of the employer. Again, these cases are fact specific and whether they are indeed covered as an accepted injury depends on the circumstances, the involved employer and workers’ compensation carrier, and eventually the Workers’ Compensation Judge, if left to go to a Decision in Court.
Did you know that in Pennsylvania, there are special rules that apply to drivers and passengers of van pools? To read the complete Legislation, please click the link below. http://www.legis.state.pa.us/WU01/LI/LI/US/HTM/1982/0/0279..HTM
Essentially, the Ride Sharing Act, and not the Pennsylvania Workers’ Compensation Act, comes into play when the employees are mere passengers hurt while in the van pool on their way to work; their employer has no ownership, lease, or contract for the van involved; and the employer simply provides information about the van pooling. Because the PA Workers’ Compensation Act is not involved, the injured workers can file a direct tort action, and not be limited to only workers’ compensation as their remedy. For answers to your traveling questions, feel free to contact Robinson Law LLC for an initial free consultation.
Organize Your Medical Information for Your PA Workers’ Compensation Case
If you have a PA work injury, one thing that you can do that will make your life easier is organize your medical records regarding your work injury. Some tips for how to get started follow. First, get an expandable folder to hold all of your paperwork. Everything should be in printed form, even if you type notes on your computer or handwrite it all. Next, what are some of the things that you should include in your organizational file? All of your medical appointments with doctors, physical therapists, and/or chiropractors should be documented and kept in chronological order. Also, all diagnostic studies, such as X-rays, MRIs, CAT Scans, EMG and Nerve Conduction studies should come out not only on CDs, but also in reports. These reports are invaluable to your case. After each Dr. visit, you will receive a note regarding the history that you gave, your symptoms, your examination findings, the diagnosis, and recommendations for future treatment. Keep all of these in chronological order.
There may be instances where your doctor refers you to a specialist, such as an orthopedic surgeon or a neuro-surgeon. In addition, you may require surgery or surgeries. These will require you to have pre-admission testing, an operative report regarding the procedure, and certainly follow-up visits. It is recommended that you keep the various surgeries in different folders for simplicity sake. Also to consider, if you are to do a home exercise program, keep a log of your daily progress.
Why is it so important to keep good records and be organized? If you need to hire a lawyer, your lawyer is going to want your records to review to decide if he or she wants to take your case, and evaluate your medical condition. Also, what if you have a hearing coming up quickly and need to obtain medical treatment right away to help your case? If you don’t have your records readily available, then your chances of succeeding with your case, or defending against a Petition filed to stop your benefits in some way are greatly reduced. Also, what if you are fast approaching your Statute of Limitations, meaning that you are running out of time to file a Claim Petition to allege a work injury, or file a Reinstatement Petition to try to start your benefits back up, if they were stopped? If you have all of your records, this makes it very easy for your lawyer to do his or her job, as they do not have to subpoena records, which is time consuming and due to certain rules, takes weeks to actually obtain.
Some other items to keep copies of are the initial Injury Report, if your employer actually completed one, and copies of all of your wage loss workers’ compensation checks. Keep track of telephone conversations and days missed from work. In addition, if you are involved in litigation, then keep copies of all the Petitions and/or Answers that your lawyer and the other lawyer file. When you are in litigation, you and your lawyer must work as a team. It is important that you keep your lawyer apprised of your medical condition, your return to work in any capacity, and the status of your receipt of your wage loss workers’ compensation checks. It might sound simple and like common sense…..because it is and will make things easier for you and your PA workers’ compensation case.
