By: Thomas C. Baumann

If you are injured on the job the workers compensation insurance carrier has the right under the Pennsylvania Worker’s Compensation act to require you to submit to a so-called independent medical examination(IME). While the examination is referred to as” independent”, it is rarely truly independent. There are numerous physicians in Western Pennsylvania to make several hundred thousand dollars a year examining injured workers at the request of employers and insurance companies and testifying on behalf of those entities. The lucrative nature of such business often renders the examination rather one-sided.

Injured workers can do several things to protect themselves with attending an IME. The injured worker should always time exactly how long he or she spends with the IME doctor. Based on feedback that Abes Baumann receives from its clients, the examinations rarely exceed 5 to 10 minutes. Yet, the IME doctors often testified they spend a half-hour to an hour with the worker. By timing the examination, the injured worker can testify how brief the examination was and help undermine the credibility of the IME doctor.

The injured worker should write down the time he or she arrived at the facility for the examination. He or she should then record the exact time he/she returned to the vehicle. Recording this timeframe will correlate with the actual time spent with the physician and lend credibility to testimony as to the brevity of the examination.

Injured workers should make notes regarding what happened at the examination immediately following the appointment. By writing down what happened, injured workers can buttress testimony regarding how short a period of time was spent with the doctor.

If the injured worker has a healthcare provider in the family or one who is a close friend, that person can be brought to the examination. The Worker’s Compensation act provides that an injured worker has the right to have a healthcare provider of his or her choosing attend the examination. Healthcare providers can include nurses, chiropractors or physicians. When a healthcare provider attends an IME, there is usually a much more thorough and fair evaluation.

Injured workers should always see treating physicians as soon after the IME as possible. This allows for fresh evidence to rebut the  opinions of the IME doctor. When you receive notice of an IME, and injured worker should always speak to his/her lawyer. If the injured worker has not yet retained counsel, he/she should definitely talk to a lawyer once they receive notice of an IME. That almost always means the insurance carrier starting to move against the worker.

By: Eric D. Abes

If you have been injured at work, you may be entitle to indemnity benefits, a fancy way of saying lost wages. There are two types of lost wages benefits: total disability and partial disability. Total disability means that your doctor has restricted you for all work. Partial disability means that you are capable of doing some work.

Total disability benefits are paid according to a formula dictated by the Pennsylvania Workers’ Compensation Act, approximately two-thirds or your pre-injury earnings. Benefits are capped at $978.00 per week (as of 2016). Low wage earners are entitled to a higher percentage of their pre-injury income.

These benefits are theoretically payable for life, however, the insurance company for your employer has many legal options to limit or end your benefits. Your employer may send you for an examination to attempt to prove you are capable of working. Also, once you have received 104 weeks of total disability, your employer may send you to a doctor to determine your level of disability according to the American Medical Association. If your level is less than 50%, your benefits would be limited to 500 weeks.

If your doctors think you can work a light duty job for a lower wage, and work is available, you would be entitled to two-thirds of the difference between your pre-injury earnings and your light duty earnings. These benefits are subject to a maximum of $978.00 (as of 2016). Partial disability is capped at 500 weeks of benefits.

If you have been hurt at work contact Abes Baumann to make sure you are getting all the benefits you are entitled to under the law.

By: Douglas A. Williams

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.

How can parents of a disabled child be assured that monies they have worked hard for and saved will not prevent their disabled child from accessing government benefits such as Medicaid or Supplemental Security Income once the parents are deceased?

To prevent this from happening, Congress passed the ABLE Act in December, 2014. This Act modeled after 529 College Savings Account creates tax favored accounts for children and adults whose disability occurred before age 26. These accounts, modeled after the Section 529 College Savings Accounts, will not have their assets count against the disabled child when applying for need based government expenses such Supplemental Security Income and Medicaid. 

Of course there are limits such as only the first $100,000 in each ABLE account would be disregarded. Also, the accounts can receive only the amounts up to the annual gift tax exemption. 

Each state must pass enabling legislation. Over half of the states have done so. Pennsylvania has not. Although enabling legislation was introduced in the State House February 12, 2015 and in the State Senate April 23, 2015, the process has not been completed. These Bills now reside in various committees. Contacting your state legislator to move this enabling legislation along will hasten the day that qualified disabled Pennsylvania residents can benefit from this legislation.

By: Eric D. Abes

In Workers’ Compensation, injured workers are entitled to two main types of benefits: lost wages and medical care. Lost wages benefits are relatively self-explanatory: replace the wages you are not earning due to your injury.

Each year, the Pennsylvania Department of Labor and Industry, Bureau of Workers’ Compensation sets the ranges for workers’ compensation indemnity benefits. As benefits are paid weekly, so too are the wages calculated. This is referred to as the Average Weekly Wage. But how do you calculate the wages at the time of injury?

For someone with a fixed salary, it is easy. However, in my experience, very few injured workers are paid a fixed wage. More common are those paid hourly wages where the hours vary. Typically, you add up the wages for the past four thirteen week periods of work, immediately prior to the injury, take an average of the three highest periods, and calculate the weekly average. But what about overtime? What about per diem for travel, food, or lodging? What about bonus? What if an employee only works seasonally?

As you can see, all of this is very complicated. Over my next few posts I will attempt to explain at least some of this. However, your best bet is to contact an attorney. The laws governing workers’ compensation are very complex and confusing. You need a professional who knows the law and can make sure you receive the benefits you deserve.