How Long Does A Pennsylvania Work Comp Case Take?

This question is usually one of the first questions a client or prospective client asks me.

The answer? It depends. A very “lawyer-like” answer, I know. But it’s simply the truth.

Some cases are settled in mere days or weeks and others take years or never settle.

Also, there is a difference between the life of a claim and the life of litigation. What do I mean by this? If you are currently receiving Pennsylvania Workers’ Compensation benefits, and there is no litigation, well, the life of your claim could have no end- it depends on many things- Did you settle the case? Did you go back to work? When a petition is filed, this starts the litigation process. For example, if you are receiving Pennsylvania Workers’ Compensation benefits, but the insurance company sends you to an Independent Medical Examiner and if that doctor writes a report claiming you are recovered, then the insurance company’s lawyer will file a Petition to Terminate benefits. This puts your case before a PA Work Comp Judge and the litigation can take up to a year or more- again, depending on many things.

People get sick of hearing “every case is different” but it’s the reality. I’ve handled thousands of cases over 14 years and no two cases have been identical. It is highly recommended that you don’t seek legal advice from neighbors, co-workers, doctors, or family members. Get legal advice from a Certified Pennsylvania Work Comp Attorney! Pennsylvania Workers’ Compensation is a complex maze of rules and regulations and procedural quirks. Trying to navigate this without an experienced attorney is foolish- and most Judges, at the very first hearing- if you are unrepresented- will tell you this. The insurance company adjustors are not on an equal playing field with you, as they know how to set you up for a weak claim- an attorney like me, who only handles PA Work Comp Cases, will equal that playing field for you and help you maximize your case so that you can get your health back with the income stream to survive.

For a specific time frame in your case, feel free to call or email me 7 days a week at (215) 206- 9068 or MyPhillyWorkersComp@Gmail.com  All consults are free

PA Workers Comp Help

The Cardamone Law Firm, LLC

The Firm For Injured Workers In Pennsylvania

If I Have A Workers’ Comp Case In Pennsylvania, Will I Get Pain And Suffering Money?

No!

The Pennsylvania Workers’ Compensation Act provides wage loss and medical benefits. The purpose of the Act is to provide injured workers with an income stream and medical benefits until their earning power is restored.

Pennsylvania Work Comp benefits are payable without regard to fault. In other words, it doesn’t matter if you were injured as a result of your fault (intentional injuries aren’t covered of course), the employer’s fault, or no one’s fault. Benefits are payable if you were 1) employed, 2) suffered an injury or disease, 3) in the course and scope of employment.

If you have a third party case- that is, a case against an entity other than your employer for negligence, then pain and suffering damages may be relevant. For example, if you were working and in a car accident, you would have a Pennsylvania Work Comp case against your employer, and a 3rd party personal injury case against the driver who caused the accident- assuming they were negligent and that the negligence caused the injuries. In these situations, the Pennsylvania Workers’ Compensation carrier has the right to subrogation- which means reimbursement- from the proceeds of the 3rd party case, using a specific formula.

So, if there are no pain and suffering damages in Pennsylvania Workers’ Compensation cases, why do I hear about lump sum settlements? You hear about lump sum settlements because the settlements are for past and future loss of earning power, and medical benefits. In other words, the insurer wants to buy the claims to end their exposure- and the parties negotiate a lump sum to end the case. Not every case results in a lump sum settlement. An example of this would be if a Work Comp Judge found an injured worker to be fully recovered, or if an injured worker return to work and wasn’t interested in settling out the medical benefits.

It is very important to recognize that every case is different. I always remind clients of this because many people call me and tell me their co-worker got X amount of money. There are probably 100 or more important distinguishing factors in any two cases. Comparing your situation to someone else’s is not a wise way to spend your time. I am available 7 days a week to give  you a free consult.

215-206-9068 or myphillyworkerscomp@gmail.com

The Cardamone Law Firm, LLC

Certified PA Work Injury Lawyer

 

 

If I Settle My Pennsylvania Work Comp Case, Will I Have To Resign From My Job?

It depends. Many employers in Pennsylvania require a resignation from the pre-injury employer as part of a global Pennsylvania Work Comp Settlement which is called a “Compromise & Release“. While a resignation has no bearing on whether the settlement will be approved by the Work Comp Judge, (the Judge has no jurisdiction over the issue), many employers require a resignation so that they can be assured that the injured worker will not seek re-employment with them. In fact, the resignation language is usually something like this: “I, John Doe, hereby resign my employment with Employer as of ___ and agree not to seek re-employment with Employer…”  The idea from the employer’s perspective is that they want to part ways with the employee- in most cases, my clients don’t object to parting ways either due to ongoing tension, or an inability of the employer to accommodate the restrictions, or due to hostility from cynical co-workers, etc.

Most employers will also bargain for language that states the resignation is voluntary.  This has implications with respect to Unemployment Compensation. If an injured worker voluntarily resigns from employment, he/she will not be eligible for Unemployment Compensation as it will be deemed a voluntary quit. If the employer does not wish to contest an application for Unemployment, you may be able to bargain for language that carves out an exception to this concept by asserting that the voluntary resignation is due to the work injuries and the fact that the employer could not accommodate the worker’s restrictions.

The resignation issue can frustrate some injured workers as some of them have already been terminated or laid off prior to the PA Work Comp Settlement. Signing a resignation with a Compromise & Release Agreement can feel like overkill. However, it can also be a positive thing as it allows an injured worker to tell a prospective employer that he/she resigned rather than being fired.

If you are working with a new employer at the time of your PA Work Comp Settlement, resignation from that employment is not relevant- only with the pre-injury employer.

If you have questions about the effect of a resignation and your PA Work Comp Settlement, call or email me 7 days a week at (215)206-9068 or MyPhillyWorkersComp@Gmail.com

-Michael W. Cardamone, Certified PA Work Comp Law Specialist

The Cardamone Law Firm, LLC– 100% For Injured Workers In Pennsylvania

How Much Do I Get Paid For A Pennsylvania Workers’ Compensation Injury

Pursuant to Section 306 of the Pennsylvania Workers’ Compensation Act, (a) (1), “for total disability, sixty-six and two thirds per centum of the wages of the injured employe as defined in Section 309 beginning after the seventh day of total disability, and payable for the duration of total disability, but the compensation shall not be more than the maximum compensation payable as defined in Section 105.2.”

For most injured workers in Pennsylvania, the above language means 2/3 of the pre-injury average weekly wage. However, if the earnings are below a certain level, the compensation rate can go up to 90%.

If you have a Pennsylvania Workers’ Compensation claim, make sure the adjustor sends you a Statement of Wages– this document reflects the pre- injury earnings and lists the data/gross earnings during various periods before the work injury. You will want to have an experienced and Certified PA Work Comp Attorney review this to make sure your pre -injury wages were calculated properly. If they weren’t, I can file a Petition to Review on your behalf to challenge the calculations. I have many clients who were never sent this document. The adjustors often forget to send this to the injured worker at the outset of a case.

There are maximum compensation rates for weekly benefits for each year. For 2013, the maximum weekly compensation rate is $917.00 per week. So, even if you earned $4000.00 per week pre- injury, your comp rate is capped out at $917.00 per week.

Per Section 306 (a)(1), if the benefit so calculated is less than fifty percent of the Statewide average weekly wage, then the benefit payable shall be the lower of fifty percent of the Statewide average weekly wage or ninety percent of the workers’ average weekly wage.

If you need help analyzing your PA Workers’ Compensation rate, feel free to call or email me 7 days a week at (215) 206-9068 or myphillyworkerscomp@gmail.com. We cover all costs and there are no out of pocket charges- Free Consults

The Cardamone Law Firm, LLC

Workers Comp Attorney PA

Information On Pennsylvania Workers’ Compensation Settlements and Medicare Set Asides

A Workers’ Compensation Medicare Set Aside is a financial arrangement which allocates a certain portion of a Workers’ Compensation Settlement for future medical care. The Medicare Set Aside funds must be used up before Medicare pays for the work-related injury or illness.

What is the purpose of a Medicare Set Aside? The purpose is to protect Medicare’s interests. Medicare doesn’t want the burden of work-related medical treatment shifted to them. Indeed, Medicare is a secondary payer. The Medicare Set Aside protects Medicare by ensuring that the workers’ compensation insurer is funding payments for future work-related treatment.

The Medicare Set Aside process is done on a case by case basis. While no statute requires a Medicare Set Aside, it is highly recommended in certain situations.

The Center for Medicare and Medicaid Services will only review a Workers’ Compensation Medicare Set Aside proposal if:

A.   Claimant is a medicare beneficiary and the total settlement is over $250,000.00

OR

B.   If Claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date AND the anticipated total settlement for future medical and disability/lost wages over the life or duration of the settlement is expected to be greater than $250,000.00.

Attorneys and injured workers who are involved in Pennsylvania Workers’ Compensation cases should be cautioned that every settlement has to consider Medicare’s interests. Does that mean every case needs a Medicare Set Aside? No, per the above, CMS will only review when certain factors apply. But, to protect yourself, it is recommended that a certain portion of the settlement proceeds be designated as future medical, even if an MSA is not required, in certain cases where 1) claimant is on Medicare already, 2) claimant will soon be on Medicare, 3) the Pennsylvania Work Comp Settlement is large, 4) you reasonably expect some future work-related medical treatment to take place, or 5) a combination of the above applies. In other words, insert language into the Pennsylvania Compromise and Release Agreement that Claimant will set aside X amount of dollars to pay for future work-related treatment.

Do these rules apply to a Pennsylvania Workers’ Compensation Settlement? Yes!

What about an annuity? How does Medicare determine if the value of the annuity meets the $250,000.00 threshold? Medicare determines the value of an annuity based on how much the annuity is expected to pay over the life of the settlement, not on the Present Day Value or cost of funding the annuity.

If I intend on using other insurance and promise not to have Medicare billed, can I reduce the amount of the Medicare Set Aside? No. The regional officers who review the MSAs cannot approve settlements that promise not to bill Medicare.

Can I state in the settlement agreement that the proceeds are only for past medical treatment in order to circumvent CMS review? You won’t need a set aside if you can prove A) the facts of the case demonstrate that you are being compensated for past medical expenses, B) there is no evidence that you are trying to maximize other parts of the settlement to the detriment of Medicare AND C) your treating doctor writes a report concluding that to a reasonable degree of medical certainty you will no longer require any Medicare-covered treatments for the work injury.

The issue of determining whether a formal Medicare Set Aside proposal in a Pennsylvania Workers’ Compensation case is an important one and should not be taken lightly. Reviewing the cms.gov website and memoranda on a regular basis is recommended.

For a free analysis of your Pennsylvania Workers’ Compensation case, call or email Certified Specialist In PA Workers Comp, Michael W. Cardamone at 215-206-9068 or mcardamone@krasno.com  Free consultations 7 days a week.

Note that nothing on this blog should be construed as legal advice. No attorney-client relationship is formed unless you sign a Fee Agreement with my office. Every case is different and requires an individual analysis. Michael is licensed to practice law in Pennsylvania. Michael is a senior trial attorney, and managing attorney for Krasno Krasno & Onwudinjo’s Blue Bell, PA office. Michael handles PA Work Comp cases across Pennsylvania. MyPhilly WorkersComp is Michael’s personal brand and is trademarked.