Theoretically, forever. However, this is rare. Let’s review the two types of situations with respect to wage loss benefits. One is called TTD- Temporary Total Disability. This is when you are out of work, receiving a full work comp check due to no earnings as a result of the work injury. This can last a lifetime, but again, that’s a rare situation. The other scenario is is Partial Disability- which has a limit of 500 weeks under the Pennsylvania Workers’ Compensation Act. An injured worker is on Partial Disability if they are earning money post injury, or if the Judge finds an earning power, or if the injured worker has reached maximum medical improvement (MMI) and undergone an IRE- Impairment Rating Evaluation which resulted in a whole body impairment of under 35%.
Why is it rare that an injured worker doesn’t stay on TTD too long? One word- Independent Medical Exams! (well, three words, but one term) These are biased exams, that can happen every six months or so, whereby the insurance company hand selects a doctor to examine you, to review records, and to write a report with his/her opinions. They usually favor the insurer in some way, if not completely. So the insurance companies gain leverage this way and many cases settle as a result of the threat that a Judge could side with their doctor over your own treating physician. Also, some people have minor injuries and recover and go back to work- either with the time of injury employer, or another employer. Moreover, its’ extremely difficult to meet the 35% IRE threshold, so once an injured worker is on TTD for 2 years, (104 weeks), the insurer will request the IRE- and probably 95-99% of exams will fall under the 35% threshold, which means the worker gets put on partial disability status- and therefore, the 500 weeks begins to run. In other cases, the matter settles fully for a Compromise & Release, and sometimes a case goes to a Decision from a Workers’ Compensation Judge and the Judge finds an earning power or a full recovery. So when you put all these scenarios together, you don’t find many situations where an injured workers is on TTD for more than 3 to 5 years. It happens, but it’s not real frequent.
Image Source: unsplash/Debby Hudson
As for medical benefits, these tend to last longer. Why? There are fewer mechanisms to end those benefits. They end with a full Compromise & Release of the claim, or if a Judge finds a full recovery after a Petition to Terminate is filed/litigated. (or if it’s stipulated to). Of course, when you have open medical benefits, they are subject to challenge by way of Utilization Review- which is a challenge as to whether certain treatment is reasonable and necessary. We’ll discuss that in another blog post.
For more information, always free free to contact us at (215) 206-9068 or email Michael@CardamoneLaw.com