Many recipients of Workers’ Compensation benefits will be required to submit from time to time to a so-called Independent Medical Examination with a physician selected by the Employer/Insurance Carrier. Injured workers should understand that the examinations are in no way independent. Many of the regular providers of these examinations are paid hundreds of thousands of dollars a year by insurance companies to conduct these evaluations. Given the lucrative nature of such a practice, the providers obviously know where their bread is buttered.

Injured workers receiving Workers’ Compensation benefits can protect themselves when they attend such exams. Each worker should time the examination, including how much time they actually spend in the room with the doctor. The worker should, immediately upon the conclusion of the examination, make notes regarding what happened during the exam. After receiving a copy of the report of the examination, the workers should compare the information in the report to the note taken following the exam. He should then discuss any differences between the two with his counsel.

Under Pennsylvania Law an injured worker can have a health care provider of his or her own choosing present at the insurance evaluation. As defined under the Pennsylvania Workers’ Compensation Act, this can include a nurse. If the injured worker has a nurse in his or her family, the worker would be wise to ask that person to attend with them. On occasion, with some of the more egregious providers of insurance medical exams, our firm will hire nurses to attend the examination.

The so-called Independent Medical Examination is one of the pressure points placed on injured workers. If the worker has not talked to an attorney before such an exam is scheduled, our firm recommends a call be placed at that time.

If you receive both workers’ compensation benefits and pension benefits, it’s likely that your employer began reducing your compensation benefits when you started receiving pension benefits.  If so, it’s entirely possible that your employer has been taking MORE of a credit than it is entitled to take under the law. 

The Workers’ Compensation Act allows an employer to reduce an injured workers’ compensation benefits against pension benefits, to the extent that the workers’ pension benefits were funded by the employer.  Most injured workers learn that their employer plans to offset workers’ compensation benefits when they receive a “Notice of Workers’ Compensation Benefit Offset” form in the mail.  In many cases, the employer fails to fully explain how it calculated the offset; or, the calculations, if provided, may seem remarkably complex.  As a result, many injured workers simply accept their employers’ representations regarding the amount of the offset. 

For many years, the attorneys at Abes Baumann have aggressively fought efforts by employers to reduce our clients benefits based on pension payments.  When an injured worker chooses to challenge a “Notice of Workers’ Compensation Benefit Offset” form, the employer bears the burden of proving the extent to which the employer funded the pension.  If the employer is unable to convince the Workers’ Compensation Judge (WCJ) that it funded a specific portion of the pension, the WCJ can disallow ANY reduction.  Even if the Judge allows some reduction, the WCJ has the ability to determine whether or not the amount of the reduction claimed by the employer is accurate. 

We are currently litigating several cases involving former employees of the State of Pennsylvania who are currently receiving pension benefits through the State Employee’s Retirement System (SERS).  We believe that SERS has miscalculated the reduction and, as a result, the State of Pennsylvania has taken a larger reduction than that to which it is entitled.  We also believe that SERS has applied the same, flawed, method of calculation in many other cases. 

If you are an injured worker whose workers’ compensation has been reduced because of pension benefits, please contact our firm.  We can determine whether or not your employer is entitled to an reduction and, if so, whether or not the amount is correct.