Pa Work Injury Law: 15 Common Mistakes That Will Sink Your Pennsylvania Work Comp Claim

Tuesday, October 2, 2012

15 Common Mistakes That Will Sink Your Pennsylvania Work Comp Claim

After more than 17 years of helping victims of workplace injuries collect workers' compensation benefits, I have seen claimants make serious mistakes that hurt their claim and made it more difficult for them to collect full payment. To help you avoid these mistakes, I have categorized the 15 most common mistakes and present them to you. I am confident that after reading this article, you will have a better chance of collecting full payment for your workman's compensation claim.

1. Failure to Report the Accident to Your Employer.

Pennsylvania law requires that a claim be reported to your employer within 120 days from the date of the injury. The best practice is to report an incident immediately, even if you don't go to the hospital right away. The best way to report an injury is to talk to you supervisor and make sure a report about the discussion is made.

2. Failure to File a Claim Petition within the 3 year statue of limitations period.

Reporting an injury to your employer is merely a first step. If you are owed benefits and your employer or its insurance company refuses to pay for your medical bills or wage loss, Pennsylvania law requires that a claim be filed with the Bureau of Workers' Compensation 3 years from the date of the accident. If you wait to contact a lawyer and file a claim beyond the 3 years, you might be precluded from receiving the benefits you deserve.

3. Failure to Inform the Doctor of the Details of Your Accident.

If your medical records do not reflect the fact that you have been in an accident, your claim may be suspect. Insurance companies use any excuse they can find to deny your claim. The absence of any information in your medical records about your accident may give them the excuse they want

4. Failure to Keep a Job Search Log.

The worker has the burden of proving that they are unable to work as a result of a workers' compensation injury or occupational disease. One of the best ways to prove that you cannot work is to show that you have honestly tried to work but were unable to find and maintain a job.

5. Failure to Fully Inform Your Lawyer of All Facts.

Workers' compensation cases are difficult enough to handle successfully, even when a lawyer has all the facts. If you do not fully inform your lawyer concerning all facts, the good, the bad and the ugly, you severely handicap your lawyer's ability to win the case for you. Many facts which you may feel to be adverse can be successfully handled. Do not short change yourself by keeping your lawyer in the dark.

6. Failure to Fully Cooperate with All Vocational Rehabilitation Efforts.

The point at which the insurance company hires a vocational rehabilitation specialist to actively become involved in trying to find a job for you is probably the most critical point in the claims process. You should not attempt to deal with the rehabilitation process without the assistance of an experienced workers' compensation lawyer. Vocational rehabilitation counselors, in the vast majority of cases, are not on your side. It is their job to terminate your benefits, either by your becoming employed or by taking advantage of your failure to cooperate, thereby have your benefits terminated. It is in your best interests to return to work at suitable employment. You should, therefore, fully cooperate with all reasonable vocational rehabilitation efforts.

7. Failure to Accept Suitable Employment.

It is in your best interest to accept suitable employment whether at your prior job or at a new job that may be presented to you. The law does not (and should not) allow a worker to collect workers' compensation benefits if they can work. On the other hand, you are not required to accept any job that your employer or their vocational rehabilitation worker finds for you. The work must be "suitable" to you based upon your physical limitations, age, education, training, and experience. It is important to work closely with an experienced workers' compensation lawyer to help you determine whether any job offered to you is suitable

8. Failure to Anticipate That You Will Be Followed and Videotaped.

It is a mistake to assume that you will not be followed and videotaped by private investigators. Insurance companies would rather pay money to private investigators and lawyers than pay it to you. You should assume that a private investigator will be watching your every move outside of your home. In some cases, they even look inside your home.

9. Working outside Restrictions When You Return to Work.

If a doctor allows you to return to work but conditions your return to work on certain restrictions such as not lifting above a certain weight, or raising your arms above your head, you should follow these restrictions explicitly. When you return to work, there is a temptation to follow your supervisor's instructions even if those instructions would have you working in excess of the limitations your doctor imposes upon you. This is a serious mistake. Carry the doctor's written restrictions with you when you return to work and, if your supervisor tries to coerce you into working outside of those restrictions, give another copy of those restrictions to your immediate supervisor and politely tell that supervisor that your doctor will not allow you to work outside those restrictions

10. Settling Your Claim without the Benefit of an Experienced Workers' Compensation Lawyer.

It is a serious mistake to assume that your employer and its insurance company will treat you fairly. You should understand that in the vast majority of the cases, they will take advantage of you if you let them. The professionals who work for your employer and the insurance company know workers' compensation law inside out. They are looking after themselves, not you. Always seek the advice of an experienced workers' compensation lawyer before you sign any agreements.

11. To Assume That Nurse Case Managers Are Your Friend.

Nurse Case Managers are working for your employer and the insurance company. They are not working for you. They should not be allowed to talk to your doctors nor be present during examinations. They will do everything in their power to attempt to get you back to work, whether you are physically ready to return to work or not.

12. Allowing the Employer to "Doctor Shop".

If your employer accepts your claim and agrees to pay, they do have a right to direct your medical care for the first 90 days, assuming they have posted a list of various doctors at your place of employment. You can choose whom you wish to treat from this list. If you treat outside of that list, then you run of risk of the employer not paying for your medical care. However, there are things the employer must do before they can enforce this rule. If there is no list then you can treat with whoever you want. Further, iff you weren't provided with a copy of that list when you were hired AND right after your injury, then you can choose whoever you want. However, once your medical providers have been established, they cannot switch you to another doctor without your permission. Insurance companies like to have you seen by doctors who they can count on to "sing their song". Do not allow them to do this. If your employer or its insurance carrier attempts to switch you to another doctor, consult an experienced workers' compensation lawyer immediately.

13. Failure to Consider a Second Opinion.

The law allows an injured worker to obtain a second opinion if the worker is not satisfied with the opinion of the doctor concerning the nature and extent of your disability. You should consider asking for a second opinion. However, it is not always wise to ask for a second opinion. This decision is case specific. You should consult with an experienced workers' compensation lawyer to help you decide whether you should ask for a second opinion.

14. Assuming That the Compensation Rate Set by the Employer is Correct.

Most of the benefits you are entitled to receive from your workers' compensation claim are based upon your average weekly wage. The average weekly wage includes the gross amount of your pay before any deductions. Average weekly wage may also be increased because of certain allowances your employer may provide such as a housing allowance. Do not be short changed by settling for an incorrect compensation rate.

15. Failure to Seek Medical Care.

Many injured workers, especially males, try to "shake it off" after they are injured at work and fail to seek appropriate medical attention. It is not unusual for a person to have significant injuries without realizing it. If an injured worker waits several days or weeks before seeking medical attention, the claim is suspect. This delay in treatment gives the employer still another excuse to deny the claim.

1 comment:

Doris Belt said...: Thanks a lot, for giving us a very important that will help a lot of people who doesn't have much knowledge how to claim their benefits in an Insurance company.; January 9, 2013 at 10:57 PM

Successful Case Results

Dandy Mini Mart back injury Lump Sum Settlement - $157,000.00

A 38 year old woman who worked as a clerk at a local Dandy Mini Mart suffered a serious work related back injury several years ago. After the employer, Dandy Mini Mart, denied her claim, James R. Carroll, Jr., Esquire litigated her case and won, forcing Dandy Mini Mart to pay for back surgery and wage loss benefits. After several years of being on workers' compensation, Jim negotiated a lump sum settlement with Dandy Mini Mart in the amount of $157,000.00-- $70,000.00 was a lump sum paid to the injured worker and $87,000.00 was paid to the injured worker to pay for her future medical treatment, which consisted mostly of monthly prescriptions.

WalMart Truck Driver Lump Sum Settlement - $150,000.00

46 year old Walmart truck driver who was involved in a work related truck accident. The client suffered from a back injury. He was on workers' compensation for a few years then returned to part time driving. We settled his workers' compensaiton case for a lump sum of $150,000.00.

Bridge Construction worker with herniated discs in neck - $385,000.00

43 year old male who was a highly paid bridge construction worker injured his neck while lifting on the job. He ultimately had to undergo two cervical surgeries to repair herniated discs in his neck. Thereafter, he developed RSD or Complex Regional Pain Syndrome in his left arm. He ultimately lost the use of his left arm for every, practical uses. He also started experiencing the same symptoms in his right arm, all stemming from the neck injury.Carroll & Carroll, P.C. filed litigation. The insurance company accepted responsibility for the work injury and even agreed that the claimant lost the use of his left arm. However, the workers' compensation insurance company disputed the relatedness of the right arm. The case settled for $385,000.00 which is a record settlement for Carroll & Carroll, P.C. in a workers' compensation case. Also part of the settlement is that the insurance company has agreed to pay whatever medicare set aside amount is required by Medicare.

Repatative Use Injury to Arms - $175,000.00

53 year old woman had worked at a label making plant for over 20 years. Several years ago, she began having pain in her right arm when she would perform her highly repetitive duties making labels for clothing. When she was restricted to one arm work, she had to use her "good" arm too much and began suffering the same symptoms in the left arm.
Carroll & Carroll, P.C. filed a claim petition against the employer and won the case. The workers' compensation judge ruled that the claimant first suffered a right arm epicondylitis and then, due to over-use, suffered the same condition in her left arm later in her employment. An interesting twist in this case was that each "arm injury" was covered by a different insurance company due to the time the injuries arose.

Eventually, Carroll & Carroll, P.C. was able to secure a settlement for the claimant that protected her future medical bills and allowed her to retire with no financial worries.

Loss of use of arm for lumber yard worker - $150,000.00

27 year old male who was working at a local lumber yard injured his arm on a piece of the industrial machinery used to plane wood. While clearing out pieces of debris from the machine, another employee turned it on, locking the client's arm in the machine and causing injury. The client's arm was significantly injured, needing many surgeries.Carroll & Carroll, P.C. filed a petition to force the workers' compensation insurance company to pay the client specific loss benefits. These are benefits an injured employee receives when he/she loses the use of a body part. We argued that the client lost the use of his arm due to the injury. We eventually settled the case for a lump sum payment of $150,000.00. Also, the client is on social security disability. Carroll & Carroll, P.C. has also filed a product liability lawsuit against the manufacturer of the machine due to it being defective for not having proper safeguards designed into the machine.

Construction worker broke leg requiring surgery - $145,000.00

While on a job site, a 45 year old construction worker tripped over some boards, breaking his leg. The break was so bad that surgery had to be done to place screws and plates to mend the bones. Unfortuneately, the client's leg was so disabled that he could not return to construction work. Further, the client developed RSD or what is now referred to as Complex Regional Pain Syndrome. Carroll & Carroll, P.C. was able to win the client's comp benefits after the insurance company denied him what was owed to him. Further, we were able to secure Social Security Disability benefits for the client, then settle his workers' compensation claim for $145,000.00. After the comp settlement, the client will continue to receive his monthly SSD check plus have all of his medical bills paid for through Medicare.

Shop Teacher Amputates Fingers on Table Saw - $125,000.00

A Vocational Tech teacher for a local school severely injured his hand while using a table saw in shop class. Even though the teacher returned to work after a brief period, Carroll & Carroll, P.C. filed a claim for the "specific loss" of use of several fingers.

We were able to prove that the teacher had loss the use of three fingers either through outright amputation or severe damage. The case was ultimately settled for a lump sum of $125,000.00 including the payment of all medical bills and the waiver of the workers' compensation lien against any recovery from the product liability case against the table saw manufacturer.

Lumbar Surgery - $110,000.00

38 year old male injured his lower back while lifting something heavy at work. He eventually had lumbar spine surgery and was totally disabled. He had been on workers' compensation for many years before coming to Carroll & Carroll, P.C. for help in getting some medical bills paid.
We made sure he was approved for Social Security Disability and Medicare. Then we settled his workers' compensation case for $110,000.00. Now the claimant does not have to worry about his benefits being cut off or looking over his shoulder all the time worrying that someone was watching him. He did not have to go to hearings anymore and could move on with his life.

Loss of Use of Hand - $110,000.00

60 year old woman had her hand trapped in a conveyor belt while working at a local cabinet making plant. After several surgeries on her hand and a partial amputation of her index finger, she no longer had much use of the hand. The lawyers at C&C Law filed a petition for specific loss of use of her hand. We put on such a good case that we were able to settle her case for a $110,000.00 lump sum payment plus continued medical coverage for 2 years.

Blister On Foot Nets Big Comp Settlement - $90,000.00

45 year old male who injured his foot at work causing swelling. Because he continued to keep working with the swelled foot, a blister appeared due to his tight fitting shoe. Unfortunately, the blister became infected with MSR. The employee went through many surgeries and loss of a few toes due to the infection. Complicating matters was the fact that the employee had pre-existing diabetes that was obviously not related to work and that contributed to the infection not healing. So, the insurance company argued that the employee's current condition was not related to the original work injury but to his diabetes.

Carroll & Carroll, P.C. filed a Specific Loss petition claiming that due to the many surgeries and infection and loss of a few toes, the claimant had loss the use of his entire foot as if it was actually amputated. Also, there was a question as to jurisdiction of the case. The insurance company wanted to have the case heard in either Maryland (where the original foot injury occurred) or New Jersey (where the employer's corporate headquarters was located) or in New York (where claimant lived), three states that are not as good for injured workers as Pennsylvania.

We were able to negotiate with the insurance company to have the case heard in Pennsylvania. Also, we were able to get all of the medical bills paid. Further, we were able to convince the insurance company that the claimant actually loss the use of his foot. The case was settled for a lump sum of $90,000.00. Also, the claimant was approved for Social Security Disability so he will be receiving monthly benefits in order to pay his living expenses. Further, he was approved for medicare so his future medical bills will be paid.

Shoulder rotator cuff tear with surgery - Shoulder rotator cuff tear with surgery- $85,000.00

A 49 year old woman injured her left shoulder while working at a plastic bag manufacturer. She ultimately had two surgeries to repair a torn rotator cuff. She was eventually returned to work light duty work, but her employer did not have any light duty available.Carroll & Carroll, P.C. forced the insurance company to pay some medical bills and prescriptions that were outstanding. Eventually, the client wanted to settle her case. C&C Law was able to negotiate a lump sum settlement of $85,000.00. Further, we made sure that the client's future medical bills would be covered by other insurance.

Work related back injury but no surgery - $80,000.00

A 26 year old man injured his back lifting something heavy while working at Proctor and Gamble in Meshoppen, Pennsylvania. The client was off work due to his injuries despite the fact that P&G wanted him to come back to work on light duty. The client did not have surgery on his lumbar spine. We were able to settle the case for a lump sum amount for $80,000.00.

Arm Caught In Defective Conveyor Belt In Meat Plant- $500,000+

A 29 year old meat processing worker had his arm caught in a defectively designed conveyor system that lacked the proper guarding. Worker suffers from severe brachial plexus injury to arm and shoulder. We were able to litigate the issue of "specific loss of use" of the arm and won that issue. After settling a third party persoanl injury case against the manufacturers of the conveyor system for a multi-million dollar amount, we settled the workers' compensation case for a lump sum amount that included the establishment of a Medicare Set Aside account that will pay for the injured employee's medical bills for the rest of his life. We also were able to settle the wage portion of his claim that paid him a few hundred thousand lump sum, above and beyond what was paid in the third party case.

GAS INDUSTRY WORKER TRIP AND FALL ON PIPE- $230,000.00

A 58 year old Marcellus Shale Gas Industry worker tripped over a pipe on a well pad site and fell, injuring his ankle. Unfortuneately, the original injury turned into Complex Regional Pain Syndrome (formerly called "RSD") which causes severe pain disability in the affected area. The workers' compensation insurance company disputed that the worker had Complex Regional Pain Syndrome and filed a petition to stop the weekly wage benefits and medical benefits. We were able to keep the wage benefits coming so the employee and his family wouldn't become destitute. Eventually we were able to negotiate a lump sum settlement with the insurance company for $230,000.00.

Client Testimonials

Workers Compensation:

At first I was afraid to contact an attorney because I thought it might affect my job. But the staff and attorneys at Carroll & Carroll, P.C. set me at ease right at the start of my case. They were all very helpful. All of my questions and concerns were always answered. And I was very satisfied with the settlement of my case. This is a very caring law firm and that's why I would recommend them to my family and all of my friends. They helped me gain more self confidence than I had before.

Shirley Goble
Athens, PA

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Dog Attack:

I found your firm to be very caring which made me feel comfortable even though I wished this never happened to me. Everyone that I came into contact with at the office treated me with respect and individual attention. I truly believe I was given the best advice and was in truly caring hands.

Betty Lewis
Towanda, Pa
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Workers' Compensation:

Carroll & Carroll, P.C. exceeded my expectations and everyone who works there was very helpful. Without C&C, I couldn't have kept my wits about me. Nor would I have got the settlement that I did. I would recommend C&C Law to everyone. Thank you so much!

Gary Martz
Chemung, NY

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Workers' Compensation:

Carroll & Carroll, P.C. exceeded my expectations. Everyone at the firm went above and beyond for my case. I would recommend Jim Carroll to everyone. Overall, I was satisfied with the settlement of my workers' compensation case.

Terry Plumely
Painted Post,NY
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Workers' Compensation:

I want to thank all of the staff at Carroll & Carroll, P.C. I can't pick just one, they all went above and beyond and were so nice. Thank you for working so hard on my case. Because of the successful outcome I was able to travel to Texas to visit my son.

Gordon Collins
Horseheads, NY
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Workers' Compensation:

I want to thank you for all the time you and your staff has put into my case. You will never know how much it means to me and how much of a weight has been lifted off of me knowing that all of you are so good to me and that you are there for me. Thank you from the bottom of my heart.

Dorothy Leckie
Mifflinville, PA
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Workers' Compensation:

I thank God I went on the internet and found your law firm. You have helped change my life and added some years that are stress free. My family says that I was a changed person once I talked to Jim and Carla about my case and my future employment opportunities. Thank you all.

Jo Ann Daly
Sayre, PA
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Workers' Compensation:

Before my work injury, I could have done any kind of work. Now I can't. But Jim and Carla taught me a lot about Pennsylvania's workers' compensation system and won my case for me. They were always there to answer my questions and keep me up to date on my case. Even though I was afraid to hire an attorney at first, Carroll & Carroll, P.C. greatly exceeded my expectations. I've already referred family and friends to them.

Donna Pozzi
Towanda, Pa
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Work Injury:

Although I was afraid to hire an attorney at first, Jim answered all of my questions and made me feel a lot better. Carroll & Carroll, P.C. exceeded my expectations and I received a lot more money for my injuries than I thought.

Carl Button
Wyalusing, Pa
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Slip and Fall:

Right from the beginning Jim answered all of my questions and was very patient with me. I was terrified of lawyers because there are a lot of shifty lawyers out there. The staff of Carroll & Carroll, P.C. was so helpful. Carla did so much for me, even travelling to Philadelphia when I had to see the insurance company doctor. I'm so satisfied in in outcome that Jim got for me. I'm financially secure now and don't have to worry about suporting myself and my family. I've already referred friends and family to Carroll & Carroll, P.C.

Lisa Spinner
Barton, NY
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Workers' Compensation:

All I can say is that they didn't quit on me. My case was a long battle but Jim won it. Then he was able to get me a great settlement that made me financially secure in my retirement. They treated me like I was part of the family.

Sandy Henry
Sayre, Pa
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Workers' Compensation:

I wasn't sure I had a case but Jim was very helpful and reassuring. I don't have to worry about my medical bills. Jim made sure that they were taken care of. He always kept me informed and was quick to answer to emails. I would recommend Carroll & Carroll, P.C. to everyone!

John Bryerton
Sayre, PA
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Workers' Compensation:

The way Jim took over and handled everything was unbelievable. I didn't receive checks for months but as soon as Jim started working on my case I began receiving my checks again. I first went to a "big wig" firm but they did nothing for me. When I called Jim I got put right through or he would always return my calls. He even negotiated a great settlement for me that helped me move on from my injury and support my family.

Andrew Glover
Laceyville, Pa
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