“I’ve been injured on the job, now what do I do?” This is a very anxious and stressful question. However, the answer is actually quite easy – call the workers’ compensation lawyers at Stern & Cohen. The consultation is always free and we will help guide you through the process. Remember, your employer and their insurance company have workers’ compensation lawyers at their fingertips to help them pay as little as possible. You should have Stern & Cohen provide you guidance on the complex workers’ compensation laws when you are injured at work to make sure you receive everything that you are entitled to. With 25 years of experience with workers’ compensation claims, this is all we do. We serve injured workers in Philadelphia and the surrounding counties and we have recovered millions of dollars for our clients.

What is a work related injury?

Work injuries fall into four categories. All of these forms of injuries entitle you to benefits under the Pennsylvania Workers’ Compensation Act. The first is a physical/physical injury. These are the most common. This can be a lifting incident, a trauma from pushing/pulling, an event from bending or climbing, a slip and fall, an injury from a machine, tool, or piece of equipment, or an automobile accident. Significantly, your compensable work injury does not have to be from a one-time event. It could be from heavy lifting over time, working overhead extensively, or repetitive activity as part of your job. If any of these insults cause injury to your head, shoulders, spine, elbows, hands/fingers, hips, knees, or feet/ankles, you have a compensable claim. The second form of compensable work injury is physical/mental. This is when your physical injury results in mental trauma such as post-traumatic stress disorder, an adjustment disorder, depression or anxiety. A resultant psychological condition from your physical injury is extremely common and there should be no shame associated with this. The third type of injury is a mental/mental injury. This is when a mental stimulus, versus a physical event, causes a mental trauma. These often occur when a worker visually witnesses something abnormal at work that causes lasting psychological impact. The fourth and final form of work injury is a mental/physical injury. These are the least common. This is when a mental stimulus causes a physical injury. Although rare, the most common type of these claims are witnessing something troubling in the workplace causes a heart condition or stroke. If you believe there is any connection between your health condition and something that happened at work, please call us to discuss. The consultation is free.

Do I have to be at my jobsite for my injury to be compensable?

The answer to this question depends on the nature of your job. If you have a fixed place of employment, i.e., you work at the same location every day, then injuries that occur going to or coming from work are not compensable claims. However, if you are in the parking lot or somewhere else on the employer’s premises, you should call us to discuss this, as these events may be covered. If you are injured off-site on a break or a minor deviation from your job duties, this may also be compensable. Employees who travel to multiple sites as part of their job duties are generally covered by the law from the time they leave home for their shift until the time they return. If your employer sends you on a “special mission” – you have a fixed place of employment but you are asked to run an errand or attend a training program – and you are injured while attending to this, your claim is covered. Finally, company-sponsored activities also provide you coverage, e.g., an injury at a company party or softball game. If you feel that your injury had any connection to your work duties, please call us. Remember – the call is free!

If I am an independent contractor, can I make a claim?

Unless you purchased workers’ compensation insurance coverage for yourself, independent contractors are not covered by the law. However, many times, employers will try to escape purchasing insurance coverage by deeming you an independent contractor, but treating you like an employee. The determination whether you are an independent contractor or employee is a question of fact. Just because your employer calls you an independent contractor, or has you sign an independent contractor “agreement,” or furnishes you a 1099 tax form, does not mean you are an independent contractor in the eyes of our law. This is a detailed analysis that examines the control the employer exercised over you. Please do not assume you are not covered since someone called you an independent contractor. Please call us first to evaluate. We are happy to do so completely free of charge.

If I was not injured in Pennsylvania, do I have a case here?

If you were injured out of state, but hired in Pennsylvania and a good portion of your work was here, then you still have a Pennsylvania claim. If you were injured out of state, but hired in Pennsylvania and your work was in numerous states – truck drivers, we are talking to you – then you still have a Pennsylvania claim. Please note that Pennsylvania workers’ compensation laws are more favorable to injured workers than many of our neighbors, so it behooves you to explore this with us. We are happy to do a jurisdictional analysis for you at no charge.

If I work in another state but I was injured in Pennsylvania, do I have a case here?

This one is easy – if you are hurt in Pennsylvania, your claim is automatically covered by Pennsylvania law. If your accident happened here – please call us – the consult is free.

Do I need to give my employer notice if I was hurt?

Yes! This should be the first thing you do if you are injured at work. The law requires you to give “notice” to your employer of your injury. Notice should be given to a supervisor. Telling a co-worker is not enough. You may notify your supervisor verbally. It does not have to be in writing. It is nice to have it in writing if there are any disputes later, but certainly not mandatory. Make sure you tell the supervisor that your medical condition was caused by work. Do not just say, “my back hurts” or “I need treatment on my knee,” please directly tell the supervisor of the cause. In order to collect benefits from day one of your claim, please be sure to notify your employer of the injury within 21 days of its occurrence. If you do not notify your employer within 21 days, you may still supply notice up to 120 days from the incident. If you give notice after 21 days, but within 120 days, you are entitled to benefits as of the day you supply this notice. If your injury is a repetitive injury – in other words, there was not one single event, but rather the injury occurred over time – then it is in your best interest to notify your employer as soon as you discover (either through your own intuition or from a medical provider) the work-relatedness of your medical condition. If you have any concerns about supplying notice or whether you handled this properly, do not hesitate to contact us. The consultation is free.

How long does the insurance company have to accept or deny my case?

The insurance company has 21 days from the time you report your injury to notify you in writing whether your claim has been accepted or denied. Insurance companies will also choose to temporarily accept your claim and then later deny it. The insurance company may accept responsibility for paying medical expenses, lost wages, or both. It is important to note that the 21 rule is strict and failure to make this decision timely can result in you receiving penalties from the insurance company. No matter what decision they make, it is wise to obtain counsel. The consultation with us is completely free.

Can the insurance company only take responsibility for my medical bills?

Even if you are losing time from work for your injury, the insurance company may only accept the medical portion of your case. If you are unable to work due to your injuries or you continue to work at reduced hours and/or pay, you are entitled to payment of your lost wages. This requires the filing of a workers’ compensation Claim Petition. It is highly advisable that you have a lawyer prepare and litigate this Petition for you. If you are in this situation, please call us. We have no upfront fees. We only receive a fee (“contingent fee”), if we are successful in making a financial recovery.

What do I do if the insurance company has denied my case?

If your workers’ compensation injury claim has been denied, you have every right to challenge that determination. This is done by filing a Claim Petition. You have the right to pursue payment of your lost wages and medical expenses. It is highly advisable that you have a lawyer prepare and litigate this Petition for you. If you are in this situation, please call us. We have no upfront fees. We only receive a fee (“contingent fee”), if we are successful in making a financial recovery.

Can the insurance company ‘temporarily’ accept my case?

It is very common practice now for insurance companies to only temporarily accept a case after investigation. Although this was not the intention of our Legislature, the insurance carriers have elected this course of action as it buys them additional time to deny your case. The insurance company is hoping to develop an adequate basis to turn around and deny your claim in the first 90 days. Occasionally, even without an adequate basis to deny, they will still do so in the first 90 days, so as to not be stuck with liability for your claim. Therefore, many of your decisions in the first 90 days are extremely important and you should be counseled along the way. If the insurance company accepted temporary responsibility for your case and they do not deny liability after 90 days, the acceptance of your claim is no longer temporary. The insurance company has different obligations at that point in order to contest your ongoing receipt of benefits. If you have received notice that the insurance company has temporarily accepted your claim, please consider calling us. The call is free.

Do I have to treat with the company doctors?

The answer to this question is one of the most common misnomers in this area of law. Many employers and insurance companies will dispel the myth to injured workers that they “must” treat with certain doctors (often referred to as panel doctors) for 90 days. I sometimes refer to this as the “90 day myth.” There is absolutely no such requirement under Pennsylvania law. In fact, the opposite is true. You are free to choose the doctor that will care for your work injury. There are some very specific laws in terms of payment obligation during the first 90 days. If the employer has adhered to certain rules, then they may only have to pay medical bills for certain providers, but in our experience, these rules are rarely complied with. If the rules are not followed, all medical bills are payable. Even if the employer took necessary steps on their part, there are many medical providers that may still be willing to assist you in the first 90 days. Having control over your own medical care is essential to a healthy recovery and a positive outcome in your case. Unfortunately, some company doctors have inherent bias and cannot provide you the right care and advice. Discussing your medical treatment is part of most initial calls and there is no fee for our consultation.

May I receive other benefits if my claim was denied?

If your workers’ compensation claim has been denied, determining a source of income while we fight your case can be very stressful. You do have the right to collect unemployment compensation, short and long term disability, social security disability, union benefits and other forms of income in the interim. This may invoke certain offsets in your case but there is typically no detriment to you. You also have the right to return to work while your case is in Court. All of these options are commonly discussed during the first meeting. There is no charge to meet with us.

What happens at an independent medical examination (IME)?

The insurance company will choose a doctor (or multiple doctors if your injuries cross into more than one area of medicine) to evaluate you and provide an opinion. There is no doctor-patient relationship established at this exam. The doctor will not offer you any advice for your care. His or her sole purpose is to perform the evaluation and write a report addressing certain questions that will be posed. They often are supplied your medical records and diagnostic studies (x-rays, MRIs, etc.). Some doctors that perform these examinations are very fair in their analysis and you will get a reasonable report. However, many are influenced by the large dollars at stake and consistently write biased reports. You cannot control who is selected to examine you. Do not be startled by the result. Your doctor(s) opinions matter and the Judge has the right to accept your expert’s opinions as fact! If an independent medical examination has been scheduled in your case and you have questions, do not hesitate to call.

How is my workers’ compensation benefit rate determined?

The amount of your workers’ compensation check is based on your earnings before you were injured. The average of your gross weekly earnings is used to calculate your benefits. Workers’ compensation benefits are not taxable, so they are paid at a percentage of your pre-tax earnings while you worked. You should be paid at the same frequency as your pay structure at work – weekly or bi-weekly. All of your earnings, including overtime, must be considered in the calculation. Additionally, if you had more than one job at the time of your injury, the earnings from your other job(s) must be included in calculating your rate. If you have any questions about how much your benefits should be, please call us. The consultation is free.

Will the insurance company do surveillance on me?

This is a popular question. The answer is “maybe,” but it is nothing to be concerned over. Live your life. Unless you are claiming that your injury keeps you confined to your home, then there is nothing wrong with conducting personal activities in public. The standard I always tell clients is that if your doctor would permit the activity, then there is nothing wrong with engaging in it. Keep in mind that it is costly for insurance companies to hire surveillance. Therefore, it is not always done and when it is, it is done sparingly. If you notice a surveillance investigator and you believe they are acting inappropriately, it is fully within your right to call your local law enforcement. I should also note that these days, almost all surveillance efforts include social media screening. Please be very careful about what you post. Often times, an innocent post could be taken out of context and used against you.

Can I settle my case?

Yes, you can settle your case. Workers’ compensation cases can settle in a variety of ways. You can settle the wage loss part of your claim, the medical portion, or both. Far more often than not, the insurance carrier will only be willing to settle both. Settlement is a voluntary process. No one can force you to settle and no one can force the insurance company to settle. Cases commonly resolve when both sides are ready. The timing of this is extremely variable. In exchange for giving up your rights concerning your injury, the insurance company will pay you a lump sum of money. There are numerous factors that go into determining that lump sum. There are no “pain and suffering” damages in workers’ compensation cases, nor “punitive” damages. Typically, the value of your case is determined by what the insurance company will or may pay in the future before your claim ends. It really takes a lawyer with a tremendous amount of experience to guide you through this process. I have settled thousands of cases. If you wish to discuss settling your case, call me – the consultation is free.

I am getting benefits, do I need a lawyer?

Even if the insurance company is currently paying your benefits, it is advisable to hire a lawyer. Importantly, a workers’ compensation attorney may only collect a fee in your case with a Court Order. So, if your case is not in Court, hiring a lawyer will cost you no money. There is only a fee if the lawyer must go to Court to recover benefits or defend you from your benefits being terminated, suspended or modified. You can take advantage of the opportunity to have free representation and someone in your corner to develop a strategy for you moving forward. Many times, insurance companies will hire lawyers to examine your case and strategize a way to reduce money being spent. Make sure you have an attorney in your corner too. If you are receiving workers’ compensation benefits, please call me. The meeting is free.

What can I do if the insurance company is not covering all of my injuries?

This is a very common situation. The insurance company will always seek to accept the least amount of body parts injured as possible and the most minimal description of your diagnoses. You have every right to add additional injuries to your claim. For example, you may hurt your low back and knee and the insurance company may only cover the knee. Or, you may tear your shoulder and the insurance company is only agreeing that it is a “sprain.” I can file a Review Petition and ask a Judge to expand the injuries the insurance company must cover. Unlike many lawyers, I usually do not charge my clients to go to Court for this purpose. It is free to call me and discuss any problems you are having getting the insurance company to cover all your injuries.

What can I do if my workers’ compensation checks are late?

This is one of the most frequent and troubling phone calls that I get. It is against the law for the insurance company to send your checks in an untimely manner. Save your envelopes and check stubs and call me. The insurance company can be assessed penalties up to 50% of the amount of your late payments. This requires the filing of a Penalty Petition in Court. Usually, I can fix this issue with an email. Once the insurance adjuster sees you have counsel and there is an inquiry being made about a late payment, they will address it immediately to avoid the Penalty Petition. I have been quite successful in getting insurance adjusters to overnight payments, if need be. Do not let the insurance company get away with this conduct – you have bills and obligations.

What can I do if my medical bills are not being paid?

It is against the law for the insurance company to refuse to pay for medical bills that are related to your work injury. The insurance company can be assessed penalties up to 50% of the amount of your unpaid bills. The penalty gets paid to you, not the doctor! Thus, it is worth your while to pursue this illegal conduct from the insurance company. A Penalty Petition will be filed in Court to address this behavior. If you let the insurance company get away with not paying the treatment for your work injury, the doctor may bill you. Hence, it is critical that you do not let this occur. If your medical bills are not being paid for your work injury, please call me. The consultation is free.

What can I do if I returned to work after my injury and I can no longer perform my job?

This is a very common situation. Clients often want to make an effort to return to work but have fear that they cannot physically do the job. This always starts with a conversation with your doctor. If your medical provider approves your return to work, you may certainly make a good faith effort to do so. You must be very careful about what you sign or what you receive in the mail from the insurance company after such a return. These documents can be time sensitive and contain language that could compromise your future rights, so you will want a lawyer to review. Significantly, if you return and discover that your pain and limitations make it too difficult to continue, you will want to visit your doctor again and obtain documentation that you should cease working. In many situations, the insurance company will voluntarily reinstate your lost wage benefits. If they do not, we can file a Petition on your behalf seeking reinstatement of these benefits. Under the law, often times, there is actually a legal presumption that you are out of work due to your injury and this is an easier case to prove in Court. Your good faith effort to return to work – even if it ultimately proves to be unsuccessful – is typically viewed favorably by Judges as they see that you were, in fact, motivated to continue working, but your work injury ultimately stood in the way. If you have returned to work following an injury or you are contemplating a return and wish to discuss your legal rights, the consultation with us to discuss this is free.

Can I be fired for bringing a workers’ compensation claim?

The answer here is “no.” You cannot be terminated in retaliation for sustaining a work injury. If this happens to you, there may be additional legal remedies. We are available to discuss all components of your claim.

Should I apply for Social Security Disability?

Applying for Social Security Disability (SSD) benefits while out of work due to an injury may be a very good idea. Keep in mind that a percentage of every paycheck you received during your working career has gone into a Social Security Disability fund. Hence, this is your disability policy – you funded it. It is not some type of government handout. You can receive these benefits simultaneously with your workers’ compensation checks. It is advantageous to have these in place for the day your workers’ compensation case is over. Further, after you are on Social Security Disability for two years, you become eligible for Medicare, so you will have all-important health coverage. Sometimes clients are hesitant to apply for SSD because they feel like they may go back to work at some point. This is not a deterrent. If you decide to return to work and earn over a baseline monthly amount, you can simply turn off your SSD benefits at that point. Not everyone is a viable candidate for these benefits, but it is certainly a discussion worth having with us.

What are my rights if my work injury was from someone else’s negligence?

This is known as a third party claim. You have distinct rights here and they are important. One of the tenants of the Pennsylvania Workers’ Compensation Act is that workers’ compensation benefits are an “exclusive remedy” and you cannot sue your employer in civil court if they caused your work injury. However, many times, an injury at work is due to the negligence of someone other than you or your employer. If that is the situation, you have a third party case. This is a separate cause of action. Damages in a workers’ compensation case are limited to wage loss and medical benefits. A third party case enables recovery for pain and suffering, punitive damages, compensatory damages and consortium. Third party liability is frequently obvious – for example, another driver was at fault for your work related car accident. Occasionally, third party liability is more subtle – for example, a third party cleaning company is responsible for your slip and fall on a wet floor in the course of your job. We are very adept at examining these issues and we can assist you in your pursuit of a third party cause of action. During your free consultation with us, we will examine this issue for you.