I have been under medical treatment for more than 2 years my job terminated me 3 months after the accident , before 3 weeks ago I had the last appointment with my doctor where he discharged me with modified duty and after that workers comp stop s...
The adjuster likely saw an opportunity to stab you in the back, in violation of the WC Act, if your doctor discharged you from treatment, even with restrictions. Stopping your checks is a way to inspire you to call to complain, where she can hold over your head the insurer's ability to simply stop sending checks, even though it looks to be a violation of the Act in this situation. In the same conversation, the adjuster may bring up the prospect for a full settlement of your claim -- but it will be at a fraction of its actual value if you do not have an attorney. If you have an attorney, he or she should be hitting back hard when this kind of violation occurs. If you don't, get one who is a Certified Workers Comp specialist and have them push back immediately. You also need to arrange to continue in medical treatment, even if limited to periodic doctor visits simply to monitor your ongoing chronic condition and to document your clinical status, to demonstrate to the insurer that you have continued medical support and that you will not be left without protection when they start more serious moves to stop your checks the legal way, with litigation in the workers' comp forum. Unless and until there is litigation, having an attorney helping you will not cost you anything. Once there is litigation, or if you want a settlement at full proper value, having a good attorney will be essential.See question
employer, hospital, offering early retirement pkg., of course we must sign release....can they have in release that I must relinquish and/all future claims with regards to knee injury (had 5 surgeries to date)..have already been told as long as th...
I agree with my colleagues but would note that accepting a voluntarily retirement would certainly have significant implications for any ongoing WAGE LOSS benefits, and could also impact what leverage you or your attorney will have if there are future disputes over your access to relevant medical treatment. Five surgeries in, I imagine you may already have an attorney. Speak with him or her about how accepting a retirement will impact your specific rights. Have a competent workers compensation attorney review the terms of the release you are asked to sign to see what arguments might come out of that in a workers' compensation setting. You cannot waive or settle your workers' compensation claim by entering another kind of agreement, but a voluntarily change in your employment status, marked by such an agreement or release, would certainly impact your rights.See question
The job I do is very labor intensive. For months, I was stuck doing the same job (drilling) in a very non ergonomic way. Now, here it is nearly 9 months since I started this job, and I'm having serious pain and numbness from what I was doing. My ...
You can look toward a lump settlement for the long-term impact this injury will have on your future earning capacity, but that remedy will be under the Workers' Compensation Act and you will first need to prove the work injury in the workers compensation forum. Contact a savvy workers' compensation lawyer who is a certified specialist in PA workers compensation law.See question
Hurt my knee on 11/27/14. Employer granted TNCP. Originally diagnosed as sprained LCL, about 10 weeks later, no improvement. Employers doctor order MRI, MRI shows complex meniscus tear. 2/20/15 Doctor says arthroscopy, but wants me to lose weight...
This is horribly prejudicial to you. If the employer has admitted that their only question is the duration of your disability arising from a work injury, which they have nevertheless denied, your attorney (if you have one) should be or may be arguing that the employer/insurer should face possible penalties for unreasonable and excessive delay in the payment of compensation as well as unreasonable contest sanctions for denying a claim where they recognize past and current disability and are simply trying to starve you of benefits as a pressure tactic to limit how long you are out for your injury, surgery and recovery - without knowing what the outcome of your treatment will be. Unfortunately, they have a right to deny even claims where all of the evidence points to their liability, and to force you to prove your case in litigation and via a decision from a Judge. If they have truly denied the claim, including a denial of medical, this is also prejudicial, since it leaves you without a source to pay for surgery apart from putting it through any health insurance you have available -- which could mean big co-pays for you for the direct treatment and in the event of any complications, in addition to a prolonged period without wages if the surgery is delayed or if you have complications. You, with your attorney, could consider fighting fire with fire -- advising the insurer you are not comfortable proceeding with surgery where they are denying the claim and giving you no assurance that your surgery recovery time will be compensated, that the surgery itself and any complications or hospitalizations will be covered without driving you to the poor house with co-pays, etc., and advise that you want your WC rights resolved BEFORE you commit to proceed with surgery. This could transform the argument into one about whether the carrier must pay for your surgery, could make for greater exposure to the carrier for your ongoing loss of earnings, etc., but also has some potential to backfire (i.e. if the fact of the work injury or the medical support is less solid than your question indicates or if for any other reason the Judge rules against you). You need to discuss all options with your attorney. If you do not have an attorney, you need a good one, preferably a certified specialist in PA Workers' Compensation law.See question
I'm in my later years, on comp., 2 1/2 years, permanent partial disability, & wishing to settle with the ins. carrier. I've authorized my attorney to ask for a settlement amount that is about 30% less than the payments would be to the end of about...
(1)Your attorney could ask the insurance representative whether they would agree to a voluntary mediation, which might move the matter into active negotiation, though you cannot compel the carrier to participate and they may have no willingness to meet your valuation of the claim. (2) If the existing controlling document has a less than complete description of your injury, even if the carrier is paying medical billing relating to your real diagnoses, a Review Petition to make the carrier formally legally liable for your full diagnoses is one mechanism that would put your claim into active litigation in a way that threatens to increase the insurer's long-term exposure. Having the case in litigation on such a petition would get the insurer's attention and could raise their interest in settlement since it would force the carrier to expend money for litigation costs, put them in fear of increased liability, and force them into regular contact with an attorney handling their end of your case, with whom your attorney might negotiate as proceeding unfold. Also, it would encourage the carrier to participate in a "mandatory" mediation to potentially negotiate a deal. (3) you say you are in later years. If you have not already applied for SSD (which may not be available where you are working light duty) or you are not otherwise currently Medicare eligible, your attorney could highlight plans for the future that would make you soon Medicare eligible -- which then becomes a complicating factor, for both sides, in any WC settlement. If, after discussing the issue with competent counsel, you feel it is in your best interest to pursue a WC settlement BEFORE becoming Medicare eligible, your attorney could stir the pot by raising this prospect. The insurer will sometimes be motivated to get a deal done before they have to concern themselves with a formal Medicare Set Aside Arrangement -- which would be required if they want to settle with a claimant who has already become Medicare eligible.
These are all mechanisms that should be discussed in detail with your attorney, if they are to be considered.See question
I had a meniscus injury back in December of 2014 I had surgery in February of this year and I just reinjured the same knee a week ago and my employer said that I do not have a Workmans Comp claim with them because I injured the same knee that was ...
Your employer is certain to try to manipulate your rights. Where you had surgery in February for an injury in December, it sounds like the employer and insurer for that claim pressed for the surgery to occur within the first 90 days of treatment, which is when the employer and insurer have the most complete control over the claim and the medical evidence. They also strive to push injured workers back to work within that span so that the legal burden of proof if there is an ongoing problem falls to the worker for any extended period of benefits. If the current employer is the same one you worked for in December, your having more problems in the same knee after returning to work throws a wrench in their plans to treat your December 20014 injury as over and done, even though you may never have fully recovered from the injury or the surgery. The employer may try to ignore the new problem entirely, may try to treat it as a new or "aggravation" injury specifically to give them another whole 90 days of leading you by the nose for medical treatment with providers they can control, or may otherwise handle the new complaints in the way that most benefits them and most harms your rights and your access to a true remedy for your injury. You need to call a good, savvy workers' compensation attorney immediately, preferably one who is a certified PA workers' compensation specialist, for advice and guidance. If you do that, you will be able to make this claim work for you.See question
I care for individuals with mental handicaps. I am the supervisor of the house. One of the individuals has had documented bed sores for which he has been receiving treatment. Now I am being accused of neglect and investigated. I am having a baby i...
I see this kind of scenario a lot. The employer and its insurer are likely currently paying your workers' compensation under a "Notice of TEMPORARY Compensation Payable" if you have been disabled less than 90 days. Read the fine print. The form includes a small box labelled "notice to employee" that warns you that your employer and its insurance care have NOT accepted liability for your injury. Essentially, they are paying you voluntarily -- and they can STOP paying your workers' compensation benefits at any time, without doing anything more than sending you a notice, within the first 90 days of disability. If the employer fires you on a pretense, and also stops your workers compensation, it will become your burden in proof to pursue litigation in workers' compensation court on a Claim Petition AND the employer will argue that even if you can prove your injury was work-related and that it is resulting in disability, the employer will add a further argument that you are not entitled to workers' compensation even if disabled -- since you were fired for causes unrelated to your disability status and this is the reason for your income loss. Employers like those who operate group homes tend to be very savvy about the ways they can avoid workers' compensation liability, use the Act against you, and leave you starved for both wages and benefits and with an uphill battle in court, so that it becomes very hard for you to pursue your rights and very easy for them to either escape responsibility or greatly delay accepting any real obligation while starving you into taking a low end settlement even if the evidence favors your rights.
These are the reasons WHY you need an attorney immediately -- to keep your employer and its insurance carrier (or with this kind of often self-insured employer, their insurance administrator or "TPA") playing by the rules and to guide you to make the right moves when they pull stunts like this.
Look for a smart, savvy lawyer who is a certified workers' compensation specialist, with the best possible Avvo rating, and you can't go far wrong. No attorneys fee is due unless and until that attorney secures rights for you in court, approved by a Judge, so that at the current state of your case you can get advice and guidance without it costing you anything unless and until there is a dispute in court (and you win on that dispute) or you agree to a lump sum settlement negotiated by the attorney.See question
I was knocked out and have a concussion that has kept me from work for 2 months
If you have been out for two months, I assume collecting workers' compensation, your workers' compensation claim is likely approaching a very critical time -- although you may not know it. If you are getting benefits, the "controlling document" recognizing your legal right to those benefits is likely a "Notice of TEMPORARY Compensation Payable." That form includes a notice stating that the employer and its WC insurance company have NOT accepted legal liability for your injury, despite paying you, since the notice is "temporary" and they have a right to simply pull the plug on your benefits any time within the first 90 days of disability. If they DON'T cut off your comp within that time, the temporary notice "converts" to one that would be legally binding on them after 90 days of disability. This means that as you get closer to 90 days out, the insurance folks start to try pretty hard to pressure your doctors to release you, pressure the insured employer to put you back into at least light duty work (even if they can't or won't keep you in it for long), possibly start sending "nurse case managers" to your medical appointments to influence how your doctors document your status, etc -- all with the goal of creating a justification to stop your comp before 90 days is up. Then, if you are still having problems or cannot continue working (in light or full duty or whatever they push you back to), it will be YOUR problem, and not theirs. That is, you would have the burden of proof to show ongoing problems, and if you are not actually able to work after the insurance carrier stops "temporary" benefits, they can starve you out as you try to pursue your claim in workers compensation court. Far better if you can make the right moves to stay on comp past 90 days and let the "temporary" notice convert to a binding one -- which then would make the employer and insurer the ones with the burden in court to cut off benefits after 90 days, as well as the burden to keep comp checks coming during a dispute in court. Therefore, get a WC attorney NOW. Look for one who is a certified specialist in PA workers compensation.
Also, since it is car accident, and particularly involving a drunk driver, you should be pursuing your MVA claim -- ideally with the same lawyer. Doing so can actually help soften the defense you will see from the WC insurer and they may be more likely to let your workers compensation right "convert" to become binding, without a fight, since they would have a lien interest (a right to share in your recovery) in your motor vehicle case. Call a WC attorney with experience in MVA cases and address all issues, as soon as possible.See question
I want to sue the insurance company for my accident, but the driver was my aunt. I don't want to sue the company If it would mess up her driving record.
The named defendant in a lawsuit would not be the insurance company, but rather the driver whose negligence caused the accident. Your Aunt's insurance would be making the payout if your aunt is found to be liable. Your Aunt's insurance, and her driving record, could very likely be negatively impacted by the simple finding that she was at fault in causing the accident, even if you decide not to pursue your rights to be compensated for any injuries you may have suffered.See question
During a Vocational survey the insurance company presented to the WC judge and IME Dr. with stale outdated medical evidence that was 18 months old. During that time I changed Dr. had a surgery and multiple office visits all of which medical notes...
These are all points to cross examine the insurance medical expert who testifies in a petition by the insurer seeking to terminate, suspend or modify benefits. While these points may weaken the credibility or weight of the expert testimony, they won't be very good fodder for any penalty, or even for "unreasonable contest" sanctions where the IME doctor gives the insurer the support they need. That is, if the IME expert who testifies gives the insurance company an opinion that matches what they are trying to prove, the judge might accept it or reject it, and may not care that you have competing evidence that contradicts the insurer's case. When you say you have since switched doctors, this may imply that the old record was possibly from a treating doctor -- not just an earlier IME -- and that may make it dangerous for you regardless of your intervening treatment course. The fact the insurer paid intervening medical bills is not relevant and does not constitute an admission by them that they accept the new doctor's view of your injury or disability status.
Do not count on penalties (for which I do not see a likely basis from your question) or on unreasonable contest sanctions, but be glad that defects in the employer/insurer's evidence give you a better chance of defeating their efforts to harm your rights.
I assume you already have an attorney. He or she should be able to tell you much more about how these weak points in the employer's evidence may or may not help you to advance and protect your rights. If you do not have an attorney, get one immediately. Ideally, look for one who is certified as an expert in PA Workers' Compensation Law and who has an AVVO rating of at least 8 and multiple positive client reviews, and you can't go far wrong.See question