Frequently Asked Questions

The "workers' compensation bargain" states that an injured worker gives up his right to sue his employer or a coworker for negligence in exchange for modest, yet guaranteed, wage and medical benefits. 

Yes, workers' compensation is what is known as a no-fault system.  Unless the injured worker intentionally injured himself/herself, they are still entitled to workers' compensation wage and medical benefits. 

You are entitled to all medical treatment that is reasonable, necessary and related to the work-accident, and these expenses should be paid by the workers' compensation insurance carrier.  Carriers are hesitant to authorize surgical treatment until "all conservative treatment measures have been exhausted."  In other words, workers' compensation insurance carriers routinely require injured workers to complete physical therapy and/or injections before considering more aggressive forms of treatment. 

 If you are injured in the course and scope of employment, and if you are removed from work for a period of at least one week (or if your employer is unable to accommodate your work restrictions for at least one week), you are entitled to temporary total disability (TTD) indemnity payments.  These TTD payments are what people in the Commonwealth commonly refer to as their "work comp checks."  These payments may be made weekly or biweekly.  The amount of these checks is calculated by the injured worker's average weekly wage.  Injured workers can expect to receive 2/3 of their average weekly wage; however, that is subject to a maximum amount.  It is important to remember that an injured worker's wages include any contributions made by the employer with regards to per diem allowances, housing compensation, bonuses or the like. 

In the simplest of cases, average weekly wage is calculated by taking the best quarter's wages (best 13-week pay period) the injured worker obtained during the year (365 days) preceding the date of injury.  That 13-week average is the claimant's average weekly, and their TTD rate is 2/3 of that number. 

 Yes, an injured worker is entitled to select his/her own physician.  Many claimants get themselves into trouble by allowing the workers' compensation insurance carrier to direct their medical treatment.  Injured workers not only have the right to designate/choose their own treating physician, they are entitled to change that physician one time during the life of their claim as a matter of right.  

When you are scheduled for an "Independent Medical Evaluation," if you have not done so already, it is time to speak with an attorney.  While these evaluations are labeled as "independent," they are anything but.  There are about 10-15 physicians throughout the Commonwealth who provide 90% of these evaluations for the various workers' compensation insurance carriers.  Most of these IME physicians do not actually treat any patients of their own; rather, they simply are de facto employees of workers' compensation insurance carriers and their goals are to stop your medical treatment, cutoff your wage benefits and generate a report containing a very low permanent impairment rating.  Most of these independent evaluations will consist of a physical evaluation that will last less than 5 minutes and, unfortunately, some of these IME physicians will have already predetermined the contents of the report prior to a fair evaluation. 

 Maximum Medical Improvement simply means that a physician has determined that you are as good as you are going to get, and that there is no other imminent medical treatment.  Significantly, however, once any physician places you at MMI, your temporary total disability (TTD) indemnity payments will be cutoff by the workers' compensation insurance carrier.  If you have not hired a workers' compensation attorney at this point, now would be a good time to do so.  

 If you have sustained permanent injuries as a result of a work-related accident, you are entitled to an award of permanent partial disability (PPD) or permanent total disability (PTD) wage benefits.  There are 3 primary factors that serve as the driving forces of the value of a workers' compensation claim: 1. Average Weekly Wage; 2. Permanent Impairment Rating; and 3. Ability/Inability to return to the same job making the same or greater wages. 

Probably not.  If you have not hired an attorney familiar with the workers' compensation system, it is extremely likely that the terms of your settlement offer are not favorable to you.  It is even more likely that the settlement that has been offered is based on the workers' compensation insurance carrier's not-so independent medical evaluator's impairment rating.  Just because the carrier's physician has provided a low permanent impairment rating, that does not mean that his/her opinion must be relied upon.  Consult with an attorney immediately to improve your chance of obtaining the settlement or award that you deserve. 

Good news! Workers' compensation attorney's fees are "contingent" in nature, which means that if there is no recovery on your behalf, you will have no obligation to pay your attorney.  Additionally, most attorneys will advance any and all costs associated with your claim and, if there is no recovery, there will likewise be no obligation to repay these costs.  Workers' compensation attorney's fees are set, and limited, by statute.  This means that irrespective of who you hire to prosecute your claim, the lawyer will be paid pursuant to the same fee schedule: 20% of the first $25,000.00; 15% of the next $25,000.00; 10% of anything above $50,000.00, but never to exceed a total of $18,000.00.