The Law Office of Lisa J. Buday
P.O. Box 488
California, PA 15419

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10 Things You Probably Didn’t Know about Workers’ Compensation

1.    PRE-EXISTING CONDITIONS WORSENED BY WORK ARE COVERED

If your injury or disease was caused, aggravated or made worse by your employment, you may have a compensable injury. Even if you have a previous physical condition it does not matter. If work made it worse, your condition may be covered by workers’ compensation.

2.    OCCUPATIONAL DISEASES AND WORK EXPOSURES ARE COVERED

You might be exposed to chemicals or fumes at work that can cause serious problems. If you are suffering from a disease, tell the doctor what you are exposed to at work. Your representative can help you get material safety data sheets (MSDS) which can explain the type of chemicals you use at work.

3. HEARING LOSS CLAIMS

Long-term exposure to hazardous noise can result in hearing loss. If your hearing loss is of a sufficient level and work related, you may be able to collect benefits. Even if you’ve retired, it may not be too late to get what you are entitled to. A claim for benefits must be filed within 3 years of the last work related exposure.

4. SCARS

You may be entitled to money if a work injury resulted in facial scarring and disfigurement. Even if it is a surgical scar from neck surgery, you might be entitled to benefits.

5. HEALTH INSURANCE

The Employer’s continuation of health insurance coverage is not required by the Pennsylvania Workers’ Compensation Act. However, you may have important rights under COBRA or FMLA which could assist with continued coverage, although you may have to pay the premiums.

6. SETTLEMENTS

There is no specific “right” to a lump sum settlement of your case. There is no set time frame where you must settle. Additionally, the insurance carrier cannot “force” you to settle. Each situation is very unique with many factors to be considered before a case is settled. In some instances it is not in the best interest of the injured worker to settle their case.  This is something you should thoroughly discuss with a knowledgeable workers’ compensation attorney.

7. IT MIGHT BE YOUR FAULT BUT YOU ARE STILL COVERED

Workers’ Compensation is a “no fault” program. Even if your actions caused your injury, in most cases you are still covered. Specific exceptions exist for certain intentional acts and injuries.

8. THERE IS NO PRE-AUTHORIZATION REQUIRED FOR TREATMENT

Medical coverage is for any treatment that is reasonable, necessary and related to the work injury. While doctors obviously want paid, there is no requirement that an insurance adjuster pre-authorize treatment.  The only way to get certain pre-authorization is for a doctor to ask for a prospective Utilization Review for a specific treatment plan.  This is rarely done.

9. YES, YOU MIGHT HAVE TO GO BACK TO WORK LIGHT DUTY

If your treating doctor has released you to return to work with modifications and your employer is willing to meet those modifications, you should abide by your doctor and return to work. Working closely with your physician to monitor your progress after a return to work is important in case your condition worsens and further job modification is needed. Any time you are released to work at any level by any doctor, you should consult an attorney to make sure you fully protect yourself.

10. YOUR BENEFITS CANNOT JUST STOP WITHOUT NOTICE

Once your claim is accepted and benefits begin, an insurance carrier cannot just stop paying. Unless you return to work and a Notice of Modification/Suspension is issued or you sign a Supplemental Agreement, your benefits will continue until a Judge determines that you are no longer entitled to them. If your checks simply stop or if you receive a Petition to Terminate, Modify or Suspend benefits, you should contact an attorney immediately.