Worker's Compensation Guidebook for Employees

TABLE OF CONTENTS

I. INTRODUCTION TO THE WORKERS’ COMPENSATION SYSTEM

II. DEFINITION OF “INJURY”

A. Accidental Injuries
B. Aggravations of Previous Medical Conditions

1. Aggravation of prior work-related injuries
2. Aggravation of a non work-related medical condition
   

C. Other Types of Injuries

1. Occupational diseases
2. Hearing loss
3. Specific loss
4. Death benefits
   

III. WHAT TO DO WHEN AN INJURY OCCURS

A. Notice to Employer

1. Definition of notice
2. Time limitations for giving notice
3. Importance of promptly giving notice
   

B. Where to Seek Medical Treatment

1. Employer’s list of panel providers
2. Choosing your own provider
   

C. Payment of Workers’ Compensation Benefits

1. Payment of medical benefits
2. Payment of wage loss benefits
   

a. The waiting period
b. The Notice of Compensation Payable
c. Amount of benefits payable
d. Length of time for receiving benefits
e. Offsets against other income

IV. WHAT TO DO IF YOUR CLAIM IS DENIED

A. Filing a Claim Petition with the Bureau of Workers’ Compensation

1. Time limitations for filing
2. Filing on your own vs. seeking legal advice
   

B. Issues Regarding Workers’ Compensation Petitions

1. Retaining an attorney
2. Procedures before the judge
3. Sources of income during litigation
4. Payment of medical bills during litigation
5. The Judge’s decision
   

a. Receiving a favorable decision
b. Receiving an unfavorable decision

V. RETURNING TO WORK AFTER AN INJURY

A. What to do When Your Doctor Releases You for Work

1. Obtaining the work release
2. Presenting the release to your employer
3. Disagreeing with your doctor’s release
   

B. The Independent Medical Evaluation (“IME”) as a Basis for Work Release

1. The IME appointment
2. Presenting the release to your employer

C. Receiving a Worker’s Compensation Form Upon Your Return to Work

1. Notification of Suspension or Modification
2. Supplemental Agreements
   

D. The Employer’s Presentation of a Final Receipt

E. Medical Treatment after Return to Work and Reinstatement of Benefits Upon Worsening of Condition

VI. PROBLEMS WHICH MAY OCCUR WHILE YOUARE OFF WORK AND RECEIVING WORKERS’ COMPENSATION BENEFITS

A. Suspension or Modification Petition Filed by Employer

1. Issues specific to Suspension/Modification Petitions
2. Issues relating to “available” work

a. Actual job offer by same employer
b. Job referrals to new employers
c. Labor market surveys

3. Petition procedures

a. Supersedeas request
b. The Judge’s decision

i. Favorable decision
ii. Unfavorable decision

B. Employee Verification Forms

C. Surveillance by Employer

VII. MEDICAL QUESTIONS AFTER YOUR CLAIM IS ACCEPTED

VIII. TERMINATION OF WORKERS’ COMPENSATION BENEFITS

A. The Opinion of an Independent Medical Evaluator that You Are Fully Recovered from Your Injury

B. What to Do if You Receive a Termination Petition

1. Receiving a Favorable Decision
2. Receiving an Unfavorable Decision

IX. SETTLEMENT OF YOUR WORKERS’ COMPENSATION CLAIM

A. Compromise and Release Agreements

1. Wage Loss Benefits
2. Medical Benefits
3. Procedure for Compromise and Release Agreements

B. Commutations

X. OTHER LAWS WHICH MAY IMPACT ON WORKERS’ COMPENSATION CLAIMS

A. The Pennsylvania Heart and Lung Act
B. The Family and Medical Leave Act
C. The Americans with Disabilities Act
D. The Social Security Act

XI. CONCLUSION

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