Workers Compensation Lawyers in Delaware County: What to Do When Your Checks Stop

The first three things to do

Tell your employer in writing. A verbal mention to a supervisor is easy to deny later, so put it in writing and keep a copy. Get medical treatment and say plainly that the injury happened at work, because a treatment note that does not link the injury to your job is the first thing an insurer will point at. Then write down what happened while you still remember it: the date, the time, what you were doing, who saw it.

Those three steps take an afternoon and they decide most of what follows.

The deadlines that decide whether you have a claim

Pennsylvania gives you less time than people expect, and the clock starts at the injury, not at the moment the pain got bad enough to stop working.

Repetitive injuries are where people get caught. If your shoulder gave out over two years of overhead work, the notice clock generally runs from when you knew, or should have known, that the job caused it. That date is arguable, and insurers argue it. If you are near any of these numbers, that is a reason to call today rather than next week.

What workers compensation actually pays

Three things, and it helps to know which is which, because insurers often stop one while continuing another and people assume the whole claim ended.

• Wage loss. Roughly two thirds of your average weekly wage, subject to a statewide cap that changes each year. It is not taxed, which is why the number often lands closer to your take home pay than the fraction suggests.
• Medical treatment. Reasonable and necessary treatment for the work injury, paid at a set fee schedule. You do not pay a deductible or a copay for it.
• Specific loss. A separate award for losing a body part or permanently losing its use, including hearing and vision. This is paid whether or not you went back to work, and it is the benefit most often missed.

What it does not pay is pain and suffering. There is no such award in Pennsylvania workers compensation, which is exactly why the third party claim below matters so much.

Why claims get denied, and what we do about it

A denial is not the end of the claim. It is the start of the part that needs a lawyer. The common reasons are narrower than they look:

• “Not work related.” Usually built on a treatment note that recorded the injury without recording the cause. Fixable with the treating doctor’s testimony.
• “Pre-existing condition.” Pennsylvania law covers the aggravation of a condition you already had. A bad back that your job made worse is still a work injury.
• “You did not report it in time.” Often wrong on the facts once we pull the incident reports and the coworker accounts.
• “You can go back to work.” Based on a doctor who examined you once, for the insurer, which is the next section.

The IME, and why it is not a neutral exam

Your employer can require you to be examined by a physician of its choosing. It is called an independent medical examination, and the name does more work than the exam does. That doctor is selected and paid by the insurer, often sees you for twenty minutes, and writes a report that the insurer then uses to stop your checks.

Go to it. Refusing can suspend your benefits. But go knowing what it is: describe your symptoms consistently, do not minimize and do not exaggerate, and tell us the moment it is scheduled so we can prepare you and, where it matters, arrange our own examination to put against it.

After 104 weeks of total disability the insurer can also request an impairment rating evaluation. If that rating comes back under the statutory threshold, your status can shift from total to partial and your benefits become capped at 500 weeks. That is a moment worth having a lawyer for.

The third party claim most firms leave on the table

Workers compensation is generally the only claim you have against your employer. It is not the only claim you have.

If someone other than your employer contributed to the injury, there is usually a second case running alongside the comp claim, and that one does pay for pain and suffering. A delivery driver hit by another motorist. A tradesperson hurt by a general contractor’s crew on a site. A machine operator injured by equipment that was defectively designed or had its guard removed by the manufacturer.

Firms that only handle comp file the comp claim and stop. We look for the second case in every work injury, because it is often worth more than the first one.

What it costs to hire us

Nothing up front, and nothing at all unless we recover for you. In a Pennsylvania workers compensation case the attorney fee is a percentage of what we recover, commonly twenty percent, and a workers compensation judge has to approve it. You will see the number before you agree to anything, and we will explain what comes out of a settlement and why before you sign it.

If we do not think you have a claim, we will tell you that on the first call instead of signing you up.