Blog 14 - Abes Baumann

Who Chooses my Doctor for a Work Injury?

Eric Abes on March 9, 2016

If you have been injured at work it’s possible that your employer, or its workers’ compensation insurance carrier, have instructed you to treat with one particular doctor. Many injured workers believe that they must treat with the doctor to whom they are sent. However, this is not the case.

The Pennsylvania Workers’ Compensation Act permits an employer to maintain a list of panel of physician. Each list must contain at least six (6) different medical providers. It is true that, if your employer maintains such a list, the workers’ compensation insurance carrier only has to pay for treatment provided by those doctors – at least during the first 90 days after the first date of treatment for the injury. But, what employers and insurance carriers rarely tell injured workers is that the worker has the right to choose the doctor (or doctors) who will provide treatment. So, if your employer tries to tell you that you must see one particular doctor, ask your employer to see the list of panel physicians – and then choose whichever doctor with whom you want to treat.

It’s also important to remember that you have the right to switch from one doctor to another if you desire. Thus, if you’ve chosen to treat with one doctor on the list of panel physicians and you are not pleased with that doctor, you have the right to begin treating with a different doctor. In fact, you can treat with all of the doctors on the list of panel physicians if you wish. As long as you are treating with one of the doctors on that list, the insurance carrier must pay for the treatment.

Finally, you should also be aware that, if you’re employer doesn’t maintain a list of panel doctors, you are free to treat with any doctor of your choosing. Moreover, if you wish to see a specialist – such as an orthopedic surgeon, neurologist, etc. – you are not required to get a referral from your family doctor as is often the case with health insurance plans. Rather, you may simply call the doctor, make the appointment, and the insurance carrier will have to pay for the treatment as long as the treatment was necessitated by the work-related injury and is reasonable and necessary.

THE DOWN-SIDE OF AN EMPLOYER PROVIDED VEHICLE

Eric Abes on March 3, 2016

By: Roger D. Horgan

You have just landed a new job, or received a promotion, which has the added benefit of a company car. You even get to take it home and use it as your personal car. What could possibly be wrong with that set up?

A lot. You get in an accident while driving your shiny new company car. The other driver admits responsibility, and his insurance company tenders his policy limits, which, in Pennsylvania, may be as little as $15,000.00. Since the responsible driver has inadequate insurance, you want to look at the company car policy to see if it has any underinsured motorist coverage, known as UIM coverage. The policy covering the employer-provided vehicle may or may not have UIM coverage. Further, even if it has such coverage it still may be inadequate to cover the value of a serious injury claim. The next place to look is the policy you have purchased to cover your personal vehicles. You determine, thank goodness, that you have purchased a great deal of UIM coverage, and initially feel relief that you had such great foresight to protect you and your family.

Unfortunately, your relief is likely to be short lived because your insurance carrier is likely to deny your UIM claim. Virtually every automobile insurance policy issued in the state of Pennsylvania contains a limitation on UIM claims that applies when the insured is injured while occupying a vehicle that he does not own, but regularly uses. This is known as the Regularly Used/Non-owned Vehicle Exclusion. These exclusions are written into auto insurance policies because the insurance company does not want to be responsible for vehicles that it does not insure, and for activities of the driver beyond what the insurance company expects when the policy is issued. They contend that, if required to pay to such UIM claims, they would be forced to pay benefits for claims that were not anticipated by the premiums they charged.

The saddest examples of the Regularly Used/Non-owned Vehicle Exclusion have to do with police officers who are seriously injured in an automobile accidents while on the job. While the officer was entitled to the police equivalent of worker’s compensation, those benefits are not intended to and do not cover all of his damages. His only sources of compensation for his other damages is a claim against the defendant driver, plus any available UIM coverage. Most employers do not provide UIM coverage on their vehicles because it is not required by law, and therefore it is an avoidable expense. Even if the employer does have UIM coverage it may well be inadequate in serious injury cases. By operation of the Regularly Used/Non–owned Vehicle Exclusion in his personal policy the injured police officer cannot tap into the UIM coverage he purchased, and he can be left far from fully compensated for his losses.

This outcome was challenged by a police officer in the Pennsylvania Supreme Court case of Williams v. GEICO Gov’t Employees. Ins. Co., 613 Pa. 113 (Pa. 2011). The policy language prohibited recovery of UIM benefits, but the officer argued that enforcing that language, and denying such benefits, violated the strong public policy in favor of protecting police officers. The court sympathized with the officer’s predicament, but nevertheless found that public policy was not violated by the Regularly Used/Non-owned Vehicle Exclusion, and confirmed the denial of his claim for UIM benefits.

“In summary, we reaffirm the decision in Burstein, holding that the regular-use exclusion is not void as against public policy. A contrary decision is untenable, as it would require insurers to compensate for risks they have not agreed to insure, and for which premiums have not been collected.” Williams v. GEICO Gov’t Employees. Ins. Co., 613 Pa. at 135 (Pa. 2011).

This is now well-settled law in Pennsylvania, and the question is what can a person who regularly drives a vehicle which he does not own to protect himself? Unfortunately, there appears to be no perfect answer. One suggestion is to purchase accident disability coverage separate and apart from automobile insurance. However, recovery under such policies is generally limited to a particular, monthly dollar amount. Worse, some of them would reduce payments of benefits by the amount of workers compensation or similar benefits received by the victim. Another suggestion would be to convince the employer, if possible, to purchase adequate UIM coverage for the vehicles it provides to employees. This should be a part of any labor/management negotiations where employees are provided with vehicles by the employer, and it should be requested by any employee who regularly drives a vehicle provided by an employer. In any event, be careful out there!

Did You Serve with the 911th Aeromedical Evacuation or Aircraft Maintenance Squadrons or the 758th Airlift Squadron Between 1972-1982?

Eric Abes on February 25, 2016

By: Susan Paczak

If you served with one of these units from 1972-1982, you may qualify for VA Benefits. The VA now recognizes that if you operated, maintained, or served aboard a C-123 aircraft known to have sprayed Agent Orange- you were exposed to Agent Orange. This means that you may be eligible for compensation if you suffer from diseases that the VA agrees were caused by Agent Orange. This includes diseases such as: type II diabetes, heart disease (heart attack, coronary artery disease), prostate cancer, lung cancer, certain types of leukemia, and other cancers and conditions.

In order to qualify you must have served regularly and repeatedly aboard a contaminated aircraft in one of the following positions:

–pilot/co-pilot
–flight nurse
–flight engineer
–aircraft loadmaster
–aircrew life support specialist
–aircraft maintenance specialist
–flight technician

Veterans who had active duty service, active duty for training, or inactive duty for training on such aircraft all qualify for benefits.

If you filed an application for benefits in the past that was denied or have never filed an application, you need to call out office to discuss this matter. When you call, please have the following information available: your DD214, any VA decisions on this issue, a list of the diseases that you believe were caused by Agent Orange, and a list of the doctors who have treated you these conditions. An attorney will then discuss this matter with you and give you a free analysis of your case.

One Accident; Multiple Cases

Eric Abes on January 11, 2016

By: Roger D. Horgan

Our firm has a varied, injury based practice. We handle workers compensation claims, automobile accidents, trip and fall accidents, social security claims, veteran’s claims, and other injury related matters, often all for one client, for one injury. An individual is struck and permanently disabled by an automobile on the job may well have several claims to bring: a Worker’s Compensation claim, a claim against the negligent driver, a claim against his own automobile insurance Company, a claim against a disability plan, and, finally, a claim for Social Security disability benefits. Our experience and expertise across these various types of cases can be very important when a particular accident leads to two or more claims.

Proceeding with any one of these claims without accounting for its impact upon other potential claims can lead to unexpected, and potentially disastrous, results. One potential disaster would be failing to meet the prerequisites for bringing an underinsured motorist claim, also known as UIM, against one’s own insurance company. A UIM claim arises when the defendant driver’s automobile insurance policy limits are not adequate to meet the value of the claim against him. If the victim has purchased UIM coverage it would step in where the defendant’s liability limits leave off. So, if the defendant has the state minimum liability limits of $15,000, and the case is worth $30,000 a victim who has purchased UIM coverage will have a claim for the difference. However, if the victim has taken the $15,000 offered by the defendants insurance company without notifying and obtaining approval from his own insurance carrier, he will have lost his right to bring the claim for UIM benefits. That is because his insurance company has the right to pursue a claim against the driver for anything it is required to pay its policyholder. This is commonly known as a waiver of subrogation. While insurance companies very rarely refuse to waive subrogation, they routinely rely upon the failure to obtain waiver of subrogation before the settlement with the defendant driver to defeat claims for UIM benefits.

As another example of one case affecting another was seen in the recent case of McConnell v. DelPrincipe from Lawrence County. The victim in that case was hit by a car during the course of his work day. Because it was a work related accident his first step was to bring a Worker’s Compensation claim. In that case, the Worker’s Compensation Judge determined that the victim was not disabled, did not sustain a loss of earnings and that he had fully recovered from his cervical strain/sprain caused by the accident. The victim did not file an appeal from the Worker’s Compensation judge’s decision.

Thereafter, he brought a lawsuit against the driver claiming that he had suffered injuries including a herniated disc in his cervical spine, headaches, cervical sprain/strain, aggravation of degenerative disc disease, and other injuries that limited his work activities. However, because the issue of his injuries had been previously litigated in the Worker’s Compensation claim he was prohibited under the doctrine of collateral estoppel from claiming anything more than a cervical sprain/strain in the lawsuit against the driver. The failure to coordinate the handling of these cases, and in particular the failure to file an appeal from the Worker’s Compensation decision, made the claim against the defendant driver nearly worthless.

At Abes Baumann, we are vigilant and experienced in coordinating the various claims that may arise from one accident so as to maximize recovery and prevent unexpected and negative results.

Who Chooses my Doctor for a Work Injury?

THE DOWN-SIDE OF AN EMPLOYER PROVIDED VEHICLE

Did You Serve with the 911th Aeromedical Evacuation or Aircraft Maintenance Squadrons or the 758th Airlift Squadron Between 1972-1982?

Friendly Guidance for:

Areas of Practice:

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