Pennsylvania's Workers' Compensation Laws

     According to recent studies, every day 183 Americans die from work-related injuries and occupational diseases.  On the same day, more than 39,000 non-fatal injuries and illnesses will occur in America’s workplaces.  Unfortunately, instead of focusing on making the workplace safer a company’s “bottom line” is often more important than its employees.  Employers and the insurance industry have spent millions propagating the myth that many of these claims are fraudulent.  This is simply not true.  Most people seeking workers’ compensation benefits are legitimate, and want to return to work as soon as possible.  No one is getting rich collecting workers’ compensation benefits.  Workers’ compensation only pays a portion of an injured employee’s loss.  It does not pay for the full wage loss, pain and suffering, or compensate that worker for the loss of enjoyment of many of life’s pleasures.  Despite its many shortcomings, workers’ compensation benefits are still the most important resource available to an injured worker.  It is vitally important that you understand your rights and make sure that your employer meets its obligation under the law.

Today's entry will be the first of a series of entries outlining some of the frequently and infrequently asked questions regarding PA Worker's Compensation Laws.

 What is workers’ compensation?                        

The Pennsylvania Workers’ Compensation Act is the state law established to protect individuals who have sustained injuries on the job. The Act provides for weekly disability income benefits, medical treatment, and death benefits to surviving family members of workers killed on the job. However, workers’ compensation only pays a portion of an individual’s overall loss. It does not reimburse an injured worker for the entire wage loss, nor does it provide compensation for pain and suffering. Despite its many shortcomings, workers’ compensation is the most important resource available to an injured worker.

     

To whom does the PA Workers’ Compensation Act apply?

 The Pennsylvania Workers’ Compensation Act covers nearly every Pennsylvania worker, including public employees. Employers must provide compensation insurance for all of their employees, including part-time workers, professionals and executives. Non-profit corporations, unincorporated businesses, and even employers with only one employee, must comply with the Act’s requirements.

                  Most employers purchase workers’ compensation insurance coverage from a private insurance carrier. However, if an employer has sufficient resources, it may “self-insure”. An employer who fails to maintain workers’ compensation insurance coverage can be subjected to criminal prosecution and substantial monetary fines. Although most Pennsylvania employees are protected by the provisions of the Act, there are some exemptions. The most common exemptions are federal civilian employees, railroad workers, longshoremen, and domestic servants.

Who is entitled to benefits under the PA Workers’ Compensation Act?

               In order to be entitled to benefits, the injured worker must be an “employee”--this means that the individual’s work must be under the direction and control of the employer. Independent contractors are not covered. Trade persons hired for a specific job and who maintain control over their work are not employees. However, in many instances an individual’s status as an employee or independent contractor is not always clear. Employers often attempt to have individuals sign an acknowledgement that they are independent contractors in an attempt to avoid responsibility for workers’ compensation coverage. Such written acknowledgements will not defeat a claim for benefits if the employer exercised direction and control over the work performed by the injured individual. Competent legal counsel is needed to assess whether an employment relationship existed thereby enabling the injured individual to collect workers’ compensation benefits.

“Social Security Legal Update”

In the case of Lingenfelter v. Astrue, 504 F.3d 1028 (9th Cir. 2007) the court held that the Social Security judge failed to provide clear and convincing reasons for finding that the claimant’s alleged pain and symptoms were not credible. The court found that the Social Security judge’s finding that the claimant’s testimony conflicted with the medical opinion in the record ignored the opinion of the claimant’s treating physicians who were supportive of his complaints. The claimant had returned to work for a nine week period of time and the Social Security judge found that the brief return to work was proof that the claimant’s pain was not disabling. The court found, however, that the attempt at unsuccessful return to work due to difficult financial circumstances was not a clear or convincing reason to find that the claimant was not disabled and therefore the Social Security judge was required to include the limitations, suffered by the claimant, and assessing his residual functional capacity. Since the judge failed to make that assessment then his opinion was not supported by substantial evidence and the court noted that the vocational expert testimony that there were no jobs the claimant could perform within the limitations alleged by the claimant was sufficient to award benefits. The claimant, accordingly, was given benefits in that particular case.

It appears to me that the Lingenfelter case is important in not penalizing claimants who attempt to return to work due to the necessity of paying everyday bills such as mortgage payments or light bills. Clearly, an attempt to return to work should not be used to punish the claimant given the existence of dire financial straights.