Injured Workers Pharmacy

One of the many issues that haunt our Pennsylvania workers' compensation clients is the payment of work-related medical bills, particularly prescriptions. Often times, the insurance company withholds payments to the pharmacy or refuses to refund out of pocket prescription payments that the injured worker makes. Sometimes it's just a matter of too much red tape and paperwork that gets in the way, thus preventing injured workers their needed prescriptions in order to get better.

One of the ways to fix this problem is to insert a "middle-man" into the mix. That's where a company called Injured Workers' Pharmacy comes in. I'm not associated with this company in any way. However, many of my clients have used their resources.

Here's a blurb from their promotional materials:

IWP is a national pharmacy service working on behalf of injured individuals. As an advocate for those who have been injured, IWP takes the financial burden out of the medication process by shipping medications directly to the patient and collecting payment from the insurance company.

We provide Workers' Compensation medications for injured workers. We are an independent pharmacy service, which means we're concerned with your interest. And yours alone.

Call us and we'll ship your Workers' Compensation medications right to your door, hassle free. We'll work on your behalf, filling your prescription needs even if your claim has been denied or goes through litigation.

What Can I expect from IWP?

● Your prescriptions and medical equipment when you need it
● A dedicated customer service team
● Licensed pharmacists available for consultation
● Free next day home delivery for all approved claims
● Multi-lingual assistance
● Caring, respectful, professional service
● Freedom from time and stress spent on phone calls and paperwork

What Won't I Have to Worry About?

● Confusing claim forms
● Out-of-pocket expenses on approved Workers' Compensation claims
● Waiting for reimbursement

What are the most important things an injured worker should know about Pennsylvania Workers' Compensation rights?

Below are some initial questions many clients have when they first contact Carroll & Carroll, P.C. The questions below may address many initial concerns you may have. If you don't find the answers here, you should contact us for answers to questions specific to your case. The consultation is free.

Q: What are the most important things an injured individual should know about workers' compensation rights?

• 
  Always report a work injury even if you might not lose time from work or need immediate medical care. It is critical that you require your employer to complete an accident report. Remember to keep an independent record of the date, time, and nature of your work injury. In addition, make a list of witnesses as well as the person to whom the injury is reported. Be sure to provide a complete and accurate account of the type of injury you sustained and how your injury occurred as well as your past medical history.
• If your employer fails to accept your claim within 21 days of the date you notify them, seek legal assistance and file a petition for compensation. Should your employer accept your injury, be certain that the wages upon which your compensation is based are accurate. In most cases your compensation should be 66 2/3% of your gross wages from all sources of employment.
• If, after receiving compensation, your employer or the insurance company asks you to see another physician, seek legal advice immediately as this is your employer's first step in their attempt to either terminate your compensation or modify your benefits. It is possible that your employer may offer you modified work based on medical proof that you are able to perform that work. This can cause you to lose your benefits by failing to accept the newly defined work.
• You might be contacted by a vocational rehabilitation firm attempting to find you a new job. Your compensation can be effected if you fail to cooperate with the vocational firm.
• Should you receive a petition in the mail to terminate, suspend or modify your compensation, seek legal advice. NEVER sign a supplement agreement or final receipt without having it reviewed by an attorney.

Acupuncture may help reduce back pain, research finds

A vast majority of our workers' compensation cases at Carroll & Carroll, P.C. involve clients who have suffered a back injury. Over the years of practicing workers' compensation law, the alternative medical procedure of "acupuncture" has gradually gained prominence.

I remember the early days when acupuncture was considered a bogus procedure. Now, most insurance companies will pay for acupuncture treatment.

A new study appears to show that acupuncture can be an effective treatment for chronic back pain with sufferers reporting a 20% reduction in pain.

Attached is a link to a telegraph article on the study.

Use of pre-paid debit cards in workers' compensation cases

Some of the major issues that our workers’ compensation clients face on a daily basis is the payment of medical bills, the payment for prescriptions and the timely receipt of their bi-weekly or weekly wage benefit checks. Often, the staff at C&C law take care of what is normally a minor issue of red tape but is a major issue for injured workers who either cannot get prescribed medications or cannot pay their bills because their workers compensation check is late.

Our friends at Ziff Law pointed this out on their blog:

J.P. Morgan announced that they are issuing prepaid debit cards so insurance companies can deliver workers’ compensation benefits to injured or disabled workers in a timely and effective way. From the press release from J.P. Morgan, “card holders benefit from efficient, economical and reliable access to insurance payments without having to wait for a check to arrive in the mail.” One of the “benefits” of having this type of debit card, as per the press release, is that the injured worker would be able to receive cash back at ATM machines and retail locations and also pay bills on-line and make purchases that accept Visa debit cards.

Although this seems, at first glance, a benefit, it certainly has the risk of being abused and/or misunderstood. If we ever see these cards in our practice area, I am sure that a separate letter and counseling to the injured worker would be in order to ensure the cards are not a credit card and provide credit. They are merely a debit card and will only work if there are funds in the account.

In any event, it is certainly a intriguing use of current technology for a burdened workers’ compensation system.

Sayre Borough: Workers compensation claim filed against Sayre Borough

I'm in the news!! To see the front page story on the Morning Times website, go here.

Workers’ compensation litigation has been filed against Sayre Borough by former secretary Jo Ann Daly, who resigned from her position with the borough July 9 and is now working in a position at Keystone College. The litigation was filed against the borough on June 9, a month prior to her resignation, according to James Carroll, Esq., who is representing her in the matter.

Daly had worked for the borough in various capacities for nearly 12 years, according to Carroll, and had suffered with a long-standing work related injury prior to her resignation. “She truly enjoyed her job but felt that continuing to work in the building under the requirements established by her employer would be detrimental to her health,” said Carroll. The litigation was filed due to the borough’s alleged refusal to change these working conditions, despite several attempts, that caused Daly’s injury.

Sayre Borough Council President Henry Farley noted that the injury referred to is a skin condition, but didn’t have any further comment on the issue since the borough hadn’t officially received her letter of resignation. She’s currently receiving workers’ compensation, Farley added, and he hopes they can address the issue at the borough’s regular monthly meeting on Thursday at 6 p.m.Borough solicitor Jonathan Foster, Esq., was unable to comment on the issue due to it being a personnel matter.

Can I settle my Pennsylvania workers' compensation case?

Sure! (Well, most of the time.) At C&C Law, we represent injured workers who receive PA workers’ comp. Sometimes, a case is just right to “settle” - or “put an end to” - either your medical benefits, wage benefits or even both.

Settling a Workers’ Comp case means that the injured worker and the insurance company, after negotiation, have come to an agreement as to just how much ‘value’ (or ‘money’) the case is worth when considering medical bills and treatment as well as any past or future lost wages. Once everyone agrees on a value for the case, a Workers’ Comp Judge reviews the terms of the settlement (in Comp lingo, called a ‘Compromise and Release Agreement’). Then, the Judge issues a Decision approving the C&R and the insurance company pays you the ‘value’ you agreed upon. Here is .pdf version of a blank Compromise and Release Agreement that must be filled out and submitted to the Judge for review.


Do we settle every case? Definitely not! In most cases we start thinking about settling only after our client is finished treating with his/her doctor and once we know the client’s long-term prognosis. It makes no sense to settle your case if you are unsure about the need for future surgery, therapy or the like. It also makes no sense to settle the case if you are unsure whether you’ll be returning to work at the same wage you earned before the injury or whether you might not return to work at all.

And then there are the times that settling the case is the right thing to do despite the medical or wage issues. Based on our years of experience in litigating Pennsylvania Workers’ Comp cases, we may have reason to believe that your chances of winning before the Judge are slim. If this is
the case, it may be in your best interest to settle the case rather than risk losing before the Judge and getting no Comp benefits at all.

It is important to remember that each case is different. You need to evaluate your case based on these and other factors to determine if settlement is appropriate. More likely than not, there is value in your case and many times the insurance company can be motivated to pay “top dollar” to clear their books of open claims. Because every case is different, there is no way to give you a "value " for a lump sum settlement of your case by using an easy equation. You may have heard of an equation of 10 years' worth of wage benefits. Or another one often cited is 3 to 5 years worth of wage benefits. Although some times cases settle within these general guidelines, often times cases settle for more or even less, depending on many circumstances.

At C&C Law, we will evaluate your case to determine if it’s ready to settle, and if so, the fair ‘value’ of your case so you can move on in your life and support your family. Send us an email, give us a call or just stop by if we can help with your PA Workers’ Comp case.

Frequently Asked Questions About Pennsylvania Workers' Compensation

Q: What is Workers' Compensation?

A: Workers' Compensation is insurance your employer must carry in the event an employee is injured on the job, becomes ill due to circumstances surrounding their job or even if death. Benefits include medical expenses, lost wages, specific loss benefits for amputation or loss of the use of an extremity, disfigurement benefits, and death benefits.

Q: Who provides the benefits under the Workers' Compensation Act?

A: By law the employer is responsible for providing Workers' Compensation Insurance. In some instances the employer provides benefits directly by being self-insured otherwise the employer provides the benefit indirectly through a Workers' Compensation insurance company. A worker cannot be charged for benefits provided or any portion of their employer's Workers' Compensation insurance premium.

Q: What are the rights and responsibilities of the injured worker?

A: An injured worker may be entitled to: receive wage benefits; receive medical care reasonable and necessary to treat a work-related injury or illness without any specific time limit; initially choose a doctor under certain circumstances; hire an attorney to help get benefits or to help resolve disputes; confidentiality. If you are injured, you may be responsible to: inform his or her employer about a work-related injury or illness; complete a claim form and submit it to the employer; tell his or her doctor how the injury occurred and if it was work related.

Q: What are the most important things an injured individual should know about workers' compensation rights?

A: Always report a work injury even if you might not lose time from work or need immediate medical care. It is critical that you require your employer to complete an accident report; Remember to keep an independent record of the date, time, and nature of your work injury. In addition, make a list of witnesses as well as the person to whom the injury is reported; Be sure to provide a complete and accurate account of the type of injury you sustained and how your injury occurred as well as your past medical history; If your employer fails to accept your claim within 21 days of the date you notify them, seek legal assistance and file a petition for compensation; Should your employer accept your injury, be certain that the wages upon which your compensation is based are accurate. In most cases your compensation should be 66 2/3% of your gross wages from all sources of employment; If, after receiving compensation, your employer or the insurance company asks you to see another physician, seek legal advice immediately as this is your employer's first step in their attempt to either terminate your compensation or modify your benefits; It is possible that your employer may offer you modified work based on medical proof that you are able to perform that work. This can cause you to lose your benefits by failing to accept the newly defined work; You might be contacted by a vocational rehabilitation firm attempting to find you a new job. Your compensation can be effected if you fail to cooperate with the vocational firm; Should you receive a petition in the mail to terminate, suspend or modify your compensation, seek legal advice; NEVER sign a supplement agreement or final receipt without having it reviewed by an attorney.

Q: What injuries are covered by the Act?

A: Any worker who has sustained an injury arising out of and in the course of their employment has a potential Workers' Compensation claim. As long as your injury is job-related, it's covered. You are covered if you are injured while traveling on business, doing a work-related errand or even attending a required business-related social function. Any injury or illness that occurs due to employment is considered a workers' compensation injury. Under workers' compensation law, you may receive benefits if you are injured no matter who was at fault. Some types of workers' compensation injuries are: broken/fractured bones, back problems/pain, knee problems/injuries, grip loss, heart attacks, hypertension, wrist injuries including carpal tunnel syndrome, burns, shoulder pain, neck pain, headaches, etc. You may be entitled to benefits even if you are still working.

Q: Does an injury have to have a specific date of onset in order to be covered?

A: Your injury does not need to be caused by a specific accident such as a fall. Many workers receive compensation for repetitive trauma injuries such as back problems that are caused by overuse or misuse over a long period of time in the performance of their normal work activity. You may also be compensated for some illnesses and diseases that are the gradual result of work conditions such as lung disease. Due to the fact that symptoms with these types of injuries reveal themselves over a period of time, the worker might not associate the eventual diagnosis of the injury as being work-related.

Q: What workers are covered by the Act?

A: Many states require an employer to carry Workers' Compensation insurance only if they have a minimum number of employees such as 3 or 5. As a general rule though, if a company has employees, then they should have Workers' Compensation insurance. Each state has its own workers' comp laws, as well as its own administrative and legal structure for handling claims and disputes. Some states also require workers' comp only for employees in "hazardous" occupations. What is considered a "hazardous" category can vary widely from state to state. Most employees are also covered if they are injured while working in another state or injured while working in another state for an employer whose principle place of business is in their home state. Without Workers' Compensation coverage, an employer can be sued by an injured worker for medical and disability costs, plus damages. Federal government employees are also excluded from state workers' compensation coverage. Employees of the federal government receive workers' compensation benefits under a separate federal law.

Q: What should I do if I get injured on the job?

A: Seek emergency medical attention if needed. Immediately report your injury to your employer. An injured worker must report any accident to their employer or any employee of the employer who is in a supervisory capacity (foreman, superintendent, company nurse, etc.). Notification must be done within a set amount of time as set by state law. If an injury occurs over time (for example, a breathing problem or carpel tunnel syndrome), you must report your condition soon after you discover and realize that it is caused by your work. Your employer will provide you with a claim form on which you must describe your injury and how, when, and where it occurred. Make sure you save copies of all correspondence with your employer, its insurance carrier and your doctor concerning your workers' comp claim.

Q: How long after an injury do I have to report it to my employer?

A: Immediately report your injury or illness to your supervisor. To be eligible for benefits, in Pennsylvania you must report the injury within 21 days. If you have received medical benefits, the statutory time limit to file a petition for benefits is usually three years from the date of the last payment [to file a claim for medical benefits]. If you have not received any medical benefits, the statutory time limit to file a petition is three years from the date of your injury or illness. Your employer is then required to make a report of the injury and notify its insurance company and/or the Workers' Compensation Commission. If no disability benefits are paid to the injured worker by the employer or carrier within the statutory time limit, and no petition is filed, then the right to any and all benefits may be barred.

Q: Can I lose my job because of a workers' compensation injury?

A: Laws prohibit your employer from discharging or discriminating against you because of your workers' compensation injury. If it is proven that an employer fires or forces you to resign in retaliation for filing a Workers' Compensation claim, the worker could file a civil lawsuit against his employer seeking damages in court.

Q: If I receive workers' compensation, can I also sue my employer in court?

A: Generally, no. In exchange for giving up the right to sue an employer in court, you get Workers' Compensation benefits no matter who was at fault. [You may be able to sue in court if your injury was caused by someone other than your employer or a co-employee, such as a visitor or outside contractor, some third party or if it was caused by a defective product.]

Q: What workers' compensation benefits am I entitled to?

A: You may be entitled to receive all reasonable and necessary medical treatment, benefits for lost wages, benefits for specific injuries resulting in permanent losses such as loss of use of an extremity and/or disfigurement (scars). You may also qualify to participate in certain physical and vocational rehabilitation programs. If the injury causes the death of an injured worker, burial expenses are covered and the spouse and/or dependents of the deceased worker may be entitled to certain benefits. If you become temporarily unable to work, you'll generally receive two-thirds of your average wage up to a fixed ceiling. These benefits are tax-free. You will be eligible for these wage-loss replacement benefits as soon as you've lost a set amount of work because of an injury or illness that is covered by workers' compensation as set by state law.

Q: What medical benefits does the Act provide to a worker after they have sustained an on-the-job injury?

A: An injured worker is entitled to receive 100% of all reasonable and necessary medical expenses incurred as a result of a job-related injury. These include first aid, emergency room services, inpatient and/or outpatient hospital care, doctor's fees, prescriptions and other related expenses.

Q: Should an injured worker apply for unemployment benefits?

A: In applying for unemployment benefits during the period a worker is off work due to an on-the-job injury, the worker must state in writing that they are willing and able to work. The Workers' Compensation insurance company could argue that the injured worker's statement to unemployment is contrary to their claim that they are unable to work. Recent court decisions have recognized the financial difficulties facing an injured worker who is not receiving Temporary Disability benefits under the Act and have ruled that a worker who has applied for unemployment benefits, in certain circumstances, is not barred from claiming they are entitled to certain workers' compensation benefits. It is advisable that an injured worker discuss the circumstances of their accident with a Workers' Compensation attorney before attempting to apply for unemployment benefits.

Q: If I am injured on the job can I choose the doctor who treats me?

A: Under Pennsylvania Workers' Compensation laws, the employer may restrict an injured worker's medical treatment, during the initial 90 days following an injury, to a set list of at least six medical providers. These providers are known as "panel providers." However, in order to compel an employee to treat with a panel provider, the employer must fulfill certain specific requirements [which are to]: Have a posted list or providers; and Have the employee sign an acknowledgement of receipt of the list at the time of hire and after the injury.

Q: If I am unable to return to the type of work I did before I was injured, what happens?

A: If your employer has employment available to you within your medical restrictions and you decline, your employer may request a suspension, modification or termination of your benefits. If you do return to work and wages are less than what you earned before the injury, you may be entitled to partial disability. Wage benefits usually will equal approximately 2/3 of the difference between your current earnings and what you earned before your injury, not exceeding the maximum compensation rate for the year you were injured.

Q: What happens if I return to a modified duty job and then I am laid off?

A: If you are still suffering from your work injury, you may be entitled to reinstatement to full disability.

Q: My employer has denied my claim, what do I do?

A: Immediately contact an attorney to discuss whether the facts of your circumstances entitle you to workers' compensation benefits. If so, a Claim Petition should be immediately filed on your behalf to obtain a hearing before a Workers' Compensation Judge.

Q: When is a Workers' Compensation claim considered settled and permanently closed?

A: A Workers' Compensation claim is considered settled only after a Compromise & Release Agreement is prepared and signed by both the employer and employee and approved by a Workers' Compensation Judge at a hearing.

Q: Do I need an attorney?

A: You have the right to be represented by an attorney for your work- related injury. Your attorney will assist you in seeing that your benefits are properly protected. While individuals can sometimes represent themselves in these matters, it is advised to contact a Workers' Compensation Attorney as soon as possible after an accident or diagnosis of a disease or condition in order to protect your legal rights. Workers' Compensation laws are constantly changing and an attorney will be in a better position to advise you in order to protect your rights.
Q: How do I find out my state's workers' comp requirements?

A: Since the state government sets Workers' Compensation requirements, they can vary greatly from state to state. You can consult the Pennsylvania Bureau of Workers' Compensation website or contact an attorney.

Former Welder's $1 Million Verdict Will Stand

Though the welding industry continues to vigorously defend itself against a growing tidal wave of welding rod litigation, it was dealt a serious blow in March 2006 when its repeated attempts to overturn a welding rod fumes case failed in the Illinois Supreme Court. The case is a landmark in welding rod litigation, in which former welders claim that exposure to fumes from welding rods caused manganism and even Parkinson's disease.

The Original Case

Though several welding rod cases have produced multi-million dollar settlements, the original case in question is a landmark because it is the only welding rod verdict ever decided in favor of the plaintiff. The case, entitled Elam v. A.O. Smith, contended that the plaintiff, a 64-year-old Illinois welder who worked in the profession for 30 years, suffered neurological damage from long-term exposure to the toxic fumes that are a byproduct of welding rods. The case was previously tried before a hung jury (Illinois law demands a unanimous jury); in its retrial, Jack Elam was awarded $1 million in "compensatory damages" for his welding rod-related Parkinson's disease. The jury found that A.O. Smith failed to provide adequate safety warnings about the dangers of manganese in welding rod fumes.

The verdict was a watershed in more ways than one - it unleashed a wave of welding rod litigation once attorneys knew that it was possible for a verdict to be awarded in the plaintiff's favor. The welding rod cases have become so numerous that a multi-district litigation is underway in Ohio; it numbers well over 3,000 plaintiffs.

Lost on Appeal

The defendants in the original case quickly appealed the case, contending that it did in fact adequately warn workers of the dangers of working with welding rod fumes. However, in December 2005, the 5th District Appellate Court of Illinois found that the company did not warn workers adequately, upholding the $1 million verdict. On second appeal, the court was taken up before the Illinois Supreme Court. However, it dealt a devastating blow to the welding industry - and gave an encouraging nod to former welders looking to get compensated for their own occupational welding rod-related illnesses - when it effectively upheld the verdict by declining to review the case.

Former Welders Cling to Hope; Continue to Litigate

Despite the fact that the $1 million verdict is the only one ever given to a welding rod litigant, former welders who are suffering from Parkinson's, manganism and other occupational illnesses related to their welding work are retaining hope. Welding rod attorneys hope that the Elam v. A.O. Smith will set a precedent that allows other litigants to collect damages for their occupational exposure to manganese. If you are suffering health problems due to your work as a welder, contact a doctor and then an experienced welding rod litigation attorney who can analyze your case and tell you whether you may be qualified to monetary damages.

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Employment Accidents -- An Overview

Three Department of Labor (DOL) agencies have responsibility for the administration and enforcement of the laws enacted to protect the safety and health of workers. These are the Occupational Safety and Health (OSH) Act, the Mine Safety and Health Administration (MSHA) and the Fair Labor Standards Act (FLSA), which contains rules concerning the employment of workers under the age of 18. Almost every state has a workers' compensation department, the benefits under which vary from state to state (here is Pennsylvania's Workers' Compensation Bureau).

OSHA or OSHA-approved systems regulate safety and health conditions in most private industries. Nearly every employee comes under OSHA's jurisdiction. There are some exceptions such as miners, some transportation workers, many public employees, and the self-employed. In addition to the requirements to comply with the regulations and safety and health standards contained in the OSH Act, employers subject to the Act have a general duty to provide work and a workplace free from recognized, serious hazards.According to the Act, every employer shall furnish to every employee a place of employment that is free from recognized hazards that are causing or are likely to cause death or serious physical harm to employees. In addition, employers shall comply with occupational safety and health standards that are included in the Act.

The Department of Labor has an Employment Standards Administration division (ESA) whose mission is to enhance the welfare and protect the rights of workers. As an enforcement and benefit delivery agency, the ESA is composed of four major programs one of which is responsible for workers' compensation, the Office of Workers' Compensation Programs.

Workers who are injured while on the job, who have been injured in association with their job or who have safety or health issues directly related to their job may be covered under workers' compensation. Workers' compensation is a system of laws outlining specific benefits to which an injured employee is entitled, including lost wages and medical expenses. In other words, it is an important safety net for employees when they are injured while on the job or because of a job. The specific issues associated with each case must be explored to determine the benefits an employee may be entitled to receive. In addition, depending upon the type of accident and injury, the worker may also be able to file a personal injury suit against one or more of the contractors involved, which does not affect workers' compensation claims or benefits.

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Do you really have to see the company doctor? Exploding the Myth of the 90 Day Rule

Here is an excellent article by Attorney Dan Siegel regarding whether an injured employee really has to treat with the company doctor.

I often tell my clients that it is not necessary and they can treat with whomever they want. Seriously, wouldn't you be more comfortable treating with your family physician or receiving a referral to a specialist from your family physician? 9 out of 10 times the employer's doctor has the employer's best interest in mind instead of the patient.

As Dan's article explains, in order for the "90 Day Rule" to apply, employers and insurance carriers must jump through so many hoops that a vast majority always get it wrong. It's an extremely rare case that everything was done correctly that would require the injured worker to treat with the company doctor. I see it on a daily basis.

So, the next time your human resources rep tells you who you HAVE to treat with, show them a copy of this article and watch them spit and sputter. Then call me...or Dan. We'll set them straight.

Dan is an attorney in the Philly area. Check out his other websites if you get a chance.