What is a Peer Review and why isn’t my Auto Insurance paying my Medical Bills?

Peer Review of Medical Bills under Act 6What is a Peer Review?

In Pennsylvania, your automobile insurance provides medical coverage to pay your medical bills for medical treatment for injuries sustained in car accidents. Generally, your car insurance company is obligated to pay all bills for treatment which is reasonable and necessary. It is not necessary that you get pre-authorization for treatment. It is your carrier’s responsibility to object to bills it considers unreasonable or unnecessary. Medical bills which are not paid within 30 days are subject to penalties under the Motor Vehicle Financial Responsibility Law (MVFRL). When an auto insurance company wishes to contest the bills submitted by treatment providers, it will send them out for a Peer Review.

An insurance carrier can challenge bills by Peer Review for up to 90 days prior to the challenge. The regulations require that the carrier send the challenged bills with supportive records to an authorized PRO (Peer Review Organization). This is an entity which has been approved by the Insurance Commissioner for this purpose. Bills which deal with particular treatment can only be peer reviewed by an entity in the same specialty. For instance, chiropractic bills can only be reviewed by a chiropractor. The peer reviewer does not see the patient for an examination. His job is to simply review the records and bills, and in accordance with accepted norms and guidelines, render an opinion as to whether treatment is reasonable and necessary. The reviewer does not even have to contact your doctor.

What should I do after a Peer Review?

Over 80% of Peer Reviews are unfavorable, in whole or in part to the patient. If your bills are peer reviewed, and the review is unfavorable, the report will advise you as to your appeal rights. Probably the worst strategy is to appeal an unfavorable Peer Review. Reconsiderations of peer reviews are also over 80% unfavorable to insureds and the loser of the appeal has to pay the fees (usually $450.00-$500.00). Insureds also have the right to file suit against their own insurance company immediately. There are numerous regulations which have been promulgated to protect insureds. Many of these are ignored or abused by carriers.

Do I need a lawyer if my bills have been the subject of a Peer Review?

To protect your rights in an automobile accident claim, it is always prudent to hire a lawyer as soon as possible after you have been involved in an accident. It is even more important to seek and retain counsel whenever an insured receives notice that his/her bills are being peer reviewed. Failing to challenge your carrier for refusal to pay appropriate bills can affect your treatment and affect your claim against the at-fault driver. Call our office today for a free consultation.

Should I Settle my Workers’ Compensation Case?

Thinking about Settling Workers' Compensation CaseShould I Settle my Pennsylvania Workers’ Compensation Case?

In Pennsylvania, workers’ compensation settlements are entirely voluntary.  Workers’ compensation settlements require an injured worker and their employer and/or their employer’s workers’ compensation insurance carrier to agree on the terms and conditions of the settlement.  Workers’ compensation settlement negotiations focus heavily on two components:

  1. The amount of a lump sum payment; and
  2. How long the employer/insurance carrier will continue to pay for an injured worker’s work related medical expenses.

An injured worker should not complete their assessment as to whether or not to settle their workers’ compensation case based only on these two components.

An injured worker must take many factors into consideration before determining whether settlement of their workers’ compensation may be in their best interest.  The terms of a workers’ comp settlement are reduced to writing in a document known as a Compromise and Release Agreement.  An injured worker wishing to settle their work comp claim will be required to testify in front of a workers’ compensation judge.  The workers’ compensation judge will then make a determination as to whether or not the injured worker understands the rights they are giving up in exchange for the settlement.

Once a workers’ compensation settlement has been approved by a workers’ compensation judge the terms of the settlement are final.  An injured worker should never settle their workers’ compensation case before first consulting with an experienced workers’ compensation attorney.  Settlement of a workers’ compensation requires much more consideration than just a dollar figure.  An experienced workers’ compensation attorney will guarantee that all factors have been given proper consideration prior to the workers’ compensation settlement being finalized.

More importantly an experienced workers’ compensation attorney will be able to explain to an injured worker how settlement of their workers’ compensation will affect other benefits (i.e. Social Security Disability, Pension, Social Security Retirement, Medicare, Medicaid) or claims (i.e. Third Party – Personal Injury, Social Security Disability, Social Security Retirement, Unemployment Compensation, Wage and Hour, Discrimination, ADA) the injured worker may currently have or will seek in the future.

Contact one of our experienced workers’ compensation attorney’s for a free, no obligation, meeting to discuss whether and under what terms settlement of your workers’ compensation claim is the right decision for your and your family’s future. 

What happens to my Workers’ Compensation benefits if I die?

What happens to your Pennsylvania Workers’ Compensation benefits if you die?

Husband and wife workers' compensationIn a typical case where a worker is receiving workers’ compensation wage-loss benefits for a work injury, all benefits stop upon that worker’s death. This is not to be confused with the case where an employee is killed at work. When an injured worker dies as a result of his work injury, there may be benefits available to any dependents and a lawyer should be involved immediately. But that is the subject for another post. If a loved one was killed at work, please call our office right away to schedule a free consultation.

The important point is that there is no general right for the surviving spouse or children to continue receiving workers’ compensation wage-loss benefits after the death of the injured worker, provided the injured worker’s death wasn’t work-related. This can have a devastating economic impact on the surviving spouse, who is already grief-stricken and then saddled with economic hardship from the spouse’s work injury.

I remember vividly the sad case of a young man that I represented many years ago. We negotiated a settlement for him, but he decided not to settle. A few months he came back and had changed his mind, and we were able to reopen negotiations. Sadly, within a few months of the settlement, he died unexpectedly of a heart attack. Fortunately, however, since his case was settled, his widow at least had some funds in the bank as a result of the previous settlement. Had he not settled, she would have received nothing after his unexpected passing.

There are many factors to consider in deciding whether or not to settle your workers’ compensation case. At Bernard Stuczynski Barnett & Lager, we offer a free consultation to discuss your injury claim. There are many reasons why a settlement of a compensation claim may or may not be advisable. Providing some peace of mind to your spouse may be a factor that you had not previously considered. If you wish to speak with one of our Erie lawyers. call us at 814-452-6232.

Volunteer Firefighters are entitled to Workers’ Compensation in Pennsylvania

Can volunteer firefighters get workers’ compensation in Pennsylvania?

When volunteer firefighters are injured in the line of duty in Pennsylvania, they are potentially entitled to workers’ compensation benefits under Section 601 (a)(1) of the Workers’ Compensation Act, 77 P.S. § 1031 (a)(1), even though they are volunteering without pay:

(a) In addition to those persons included within the definition of the word “employe” as defined in section 104,1 “employe” shall also include…(1) members of volunteer fire departments or volunteer fire companies…

How much workers’ compensation is a volunteer firefighter paid?

Workers' Compensation for FirefightersOrdinarily, when receiving workers’ compensation benefits, an injured worker is entitled to a portion of his or her average weekly wage (averaging wages from all of his or her concurrent jobs combined). Interestingly, when a volunteer firefighter is receiving workers’ compensation and is unable to work, he or she is presumed to be earning wages equal to at least the “state-wide average weekly wage” for the purposed of calculating the amount of his or her wage-loss benefits.

This means that, whether or not a volunteer firefighter’s actual wages are equal to the state-wide average weekly wage, his or her wage-loss benefits will be paid as if he or she were earning at least the state-wide average weekly wage. As such, a volunteer firefighter will receive wage-loss benefits even if he or she is otherwise unemployed or even retired.

Should an injured volunteer firefighter hire an attorney?

If you or a loved one is a volunteer firefighter who was injured in the line of duty, you should hire a skilled Erie workers’ compensation lawyer to protect your rights. Insurance companies, unfortunately, rarely do the right thing. Our law firm offers free consultations to injured firefighters and does not charge a fee unless we obtain a recovery. With offices in both Erie and Smethport, our lawyers represent first-responders throughout Northwestern Pennsylvania. Call today to set up an in-person meeting with one of our Erie Lawyers at 814-452-6232.

What is the difference between Disability and SSI?

SSD vs SSISSD vs. SSI

What is the difference between Social Security Disability Income (SSDI or SSD) and Supplemental Security Income (SSI)?

If you are thinking of applying for Social Security Disability or have already applied, you may be wondering what the difference between SSD and SSI is.  Although the two programs are both administered by the Social Security Administration and the criteria to obtain benefits under either program are substantially similar, it is important to note that SSD and SSI are two separate and independent programs with different eligibility requirements.

What is Social Security Disability Income (SSDI)?

Social Security Disability Income, or SSD, provides disability benefits to individuals who are insured through their contributions to the Social Security trust fund.  Workers contribute to this fund through FICA Social Security taxes that are taken in the form of payroll taxes when a person is working.  In exchange for this, an individual who is working obtains work credits through Social Security.  These work credits are used to determine if an individual is eligible for SSD benefits.  Each individual who stops working will have a date last insured, which is the last date that the work credits they have earned will allow them to remain insured and eligible for SSD benefits.  Once this date last insured has passed, it is no longer possible to obtain SSD benefits and because of this, it is very important to obtain an experienced Social Security Disability attorney to help you protect your rights and benefits.

In addition, the amount of SSD benefits an individual can earn is dependent upon a worker’s lifetime average earnings covered by Social Security.  And, if an individual obtains SSD benefits they will become eligible for Medicare after receiving SSD benefits for two years.

What is Supplemental Security Income (SSI)?

Supplemental Security Income, or SSI, is not an insurance program like SSD.  Instead, SSI is a means-tested program that is administered by Social Security based solely upon an individual’s needs according to income and assets.  SSI is not funded through payroll taxes but instead is funded through general tax revenues.  In order to be eligible for SSI benefits an individual must not exceed the asset limit that is determined by Social Security and you must not exceed a certain monthly income rate.

SSI benefits are not calculated based upon the earnings that an individual has made but instead they are calculated based upon a set rate that deducts any countable income that an individual may be earning.  Additionally, an individual who is receiving SSI benefits is not eligible for Medicare like an individual who is receiving SSD benefits, instead, SSI recipients are eligible to receive Medicaid.

How do I apply for SSD or SSI?

Because there are many differences between SSD and SSI it is important to obtain an experienced Social Security Disability attorney in the event that you are seeking to obtain disability benefits from Social Security.  Our office will do everything in our power to aid you in the process of obtaining Social Security disability benefits.  Contact one of our attorneys today for a free consultation.

Matthew Lager named Erie’s 2017 Pro Bono Award Recipient

Matt Lager recognized as Erie’s “Outstanding Pro Bono Lawyer” of 2017

Matt Lager named as Erie's Outstanding Pro Bono Lawyer of 2017 We at Bernard Stuczynski Barnett & Lager are proud to announce that our newest partner, Matt Lager, has been named as Erie County’s “Outstanding Pro Bono Lawyer” of 2017 by the Erie County Bar Association and by Northwestern Legal Services. In earning this achievement, Matt Lager follows in the footsteps of fellow partner, Adam Barnett, who was similarly afforded this great honor in 2015.

This award was presented at the ECBA’s annual Law Day Luncheon, of which this firm is a proud sponsor, where keynote speakers Attorneys Dean Strang and Jerry Buting, defense counsel for Steven Avery in the hit Netflix series, “Making a Murderer, spoke about their involvement with the trial and with the legal problems facing indigent defendants across America.

Matt Lager Receiving Pro Bono AwardIn addition to providing excellent legal representation to our clients, Bernard Stuczynski Barnett & Lager is dedicated to giving back to the Erie Community through the Erie County Bar Association’s Legal Aid Volunteer Attorneys (LAVA) Program, administered through Northwestern Legal Services.

If you are in need of legal representation, do not hesitate to contact our office. If we can’t help you, we can certainly point you in the right direction.

Can I work while on Social Security Disability Benefits?

Can you work when receiving Social Security Disability Benefits?

working on social security disabilityPeople often wonder whether or not they can work while receiving Social Security Disability benefits. The simple answer is yes—under certain conditions.  It is strongly recommended that. if you are considering making an effort to work while receiving Social Security Disability benefits, you consult with an experienced Social Security Disability attorney.  The rules and regulations that apply are complex and one size does not fit all. There are many factors that need to be considered by an attorney and there are numerous pitfalls to avoid.

Social Security Disability recipients are provided with a “trial work period.”  So long as an individual is within a “trial work period,” the individual can continue to receive Social Security Disability benefits regardless of the amount of the individual’s income during the “trial work period.”   At the time this article was written, a “trial work period” expires once an individual has achieved gross monthly earnings exceeding $840.00 in nine months.  It is important to note that these nine months need not be consecutive.

After an individual’s “trial work period” has concluded, they can continue to work, but they can only continue to receive Social Security Disability benefits so long as that individual’s gross monthly earnings do not exceed $1,170.00* (*in 2017; this number changes every year).  If an individual’s gross monthly earnings exceed $1,170.00* they are considered by the Social Security Administration to be engaged in “substantial gainful activity.”

If an individual’s Social Security Disability benefits have ceased because the individual is engaged in “substantial gainful activity,” the individual’s Social Security Disability benefits may be reinstated immediately at any time within a five year window if the individual must stop working again as a result of their disability.

*As stated above, the gross monthly earning thresholds identified above apply to calendar year 2017.  The Social Security Administration adjusts the gross monthly earning thresholds on a yearly basis.  An individual that is receiving Social Security Disability benefits due to blindness has a significantly higher gross monthly earning threshold.

There are numerous additional Social Security Administration rules and regulations that apply to and affect an individual’s ability to work while receiving Social Security Disability benefits.  Know your rights and responsibilities.  Be safe instead of sorry.  Call our office to speak with one of our experienced Social Security Disability attorneys for a free consultation.

Attorney Lager to Speak at Advanced Rehabilitation in Erie, PA

Workers’ Compensation From The Injured Worker’s Perspective: Thoughts From A Claimant’s Attorney

Advanced Rehabilitation Physical TherapyOn April 19, 2017, from 11:45 a.m. to 1:00 p.m., Attorney Matt Lager will be giving a seminar on Workers’ Compensation (for non-attorneys!) at Advanced Rehabilitation at 3347 W 12th St., Erie, PA, 16505. Advanced Rehabilitation is a premier Erie, PA Physical Therapy facility that provides state-of-the-art rehabilitation techniques and prides itself on helping injured workers recover from injuries so they can safely get back to work and return to their normal lives! Advanced Rehabilitation also provides useful services, such as Functional Capacity Evaluations, which help injured workers return to work in such a capacity that they will not re-injure themselves.

These informational seminars are free to attend, include lunch, and also serve as valuable networking luncheons to those who regularly interact with the workers’ compensation system. Past speakers have included orthopedic surgeons and nurses on a variety of topics, from back surgeries to Medicare Set Asides (MSAs).

What will be covered in this seminar?

Attorney Lager’s speaking topics are likely to include the following:

  • Types of Workers’ Compensation Claims
  • Medical Treatment for an Injured Worker
  • Billing problems under the Workers’ Compensation Act
  • How workers’ compensation interacts with the ADA
  • An injured worker’s choice of medical providers
  • Functional Capacity Evaluations
  • Employee’s and Employer’s Rights
  • Modified Duty
  • How Social Security Disability interacts with Workers’ Compensation
  • HIPAA and Workers’ Compensation

After the seminar, there will be an open Q & A where you will be free to ask general workers’ compensation questions (but nothing case specific!). This will be an open-ended discussion where those in attendance can get a claimant’s attorney’s perspective on the workers’ compensation system.

What if I have questions but can’t attend the seminar?

If you have any questions regarding any of the above topics, or are in injured worker looking for legal representation, call our office today for a free consultation at 814-452-6232!

No Recovery, No Fee Lawyers in Erie, PA: What does “Contingent Fee” Mean?

No Recovery No Fee Lawyer in Erie PAHow do I find a lawyer in Erie that charges no fee unless they settle my case?

When watching TV, you’ll see that many lawyers advertise No recovery, No Fee payment structures, wherein the lawyer won’t charge a fee for your personal injury case unless he or she gets you money by way of a lump-sum settlement or a verdict. During our free consultations, this is often the first question we get when meeting with a new client. Like all personal injury law firms in Erie, PA, we do not charge a fee unless we obtain a recovery for our client.

What is a contingent fee?

This sort of “no recovery no fee” arrangement is referred to as a “contingent fee,” and it is the standard practice for nearly all attorneys in Erie, PA that handle car accidents and other personal injury claims. When you see some of the heavy-advertisers focus on this structure in their commercials, don’t be fooled into thinking they’re the only ones that don’t charge hourly fees and don’t charge big retainers; they’re simply the only ones that shout about it on television. Knowing that this is standard practice for nearly all lawyers, you’re free to do your research and pick the best attorney for you without having to worry about draining your savings account.

Are contingent fees fair? Should I pay hourly instead?

Contingent no-recovery-no-fee arrangements give great power to personal injury victims who are looking for a lawyer: instead of being stuck with the cheapest option out there and operating on a shoestring budget, he or she can hire the best attorney in Erie to fight the insurance company on his or her behalf. Insurance companies hate paying out a fair value for claims and hire good lawyers to help minimize their exposure: our contingent-fee arrangements allow you to even the playing field and fight for fair compensation.

Who pays for the expenses in a lawsuit?

In addition to charging no fee unless we obtain a recovery, our firm also fronts all litigation expenses: what this means is that you don’t have to worry about coming up with thousands of dollars for expert reports, medical depositions, records, expert witnesses, et cetera. Because insurance companies spare no expense when it comes to building their case, we front the money for whatever it takes to prove the significance and extent of your injuries. Our firm doesn’t let insurance companies win by simply outspending us. We ensure things are fair.

What should I do?

If you have been injured in a car accident or have a workers’ compensation claim, don’t think that you can’t afford a good lawyer. Give our Erie, PA Lawyers a call and we’ll arrange a free consultation. If, after meeting us, you want to move forward—feel safe knowing that we don’t charge a fee unless there’s a recovery.

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

Fired for a workers' compensation claimMany injured workers in Pennsylvania are worried that their boss will either fire them or retaliate against them for filing a workers’ compensation claim after a work injury. Although not unheard of, such an event is illegal and should not dissuade you from filing a workers’ compensation claim after getting hurt at work.

It is illegal for an employer to fire you for filing a workers’ compensation claim.

Employers propagate this notion that injured workers should “tough it out” after an injury and “keep quiet” in order to keep their insurance premiums down. This is why many workplaces have environments where employees appear to look down on their injured coworkers. This sort of environment is inappropriate and is designed to take advantage of you.

Unfortunately for injured workers, failing to report injuries or failing to make workers’ compensation claims can potentially prevent them from being compensated for their missed work or having their medical bills paid. If you fail to take appropriate steps after an injury, you could find yourself without a job, without health insurance, and with a disabling injury that prevents you from returning to work. Although it might seem frightening, you cannot let that happen. Fortunately, you don’t have to be alone in this fight. With our low percentage-based fees, anybody can afford to have a lawyer on their side.

Although it might seem counter-intuitive, after an injured worker hires a workers’ compensation lawyer, employers are typically on their best behavior. And if they aren’t, you at least have a lawyer on your side to help protect your rights.

What are your rights under Pennsylvania workers’ compensation law?

After getting hurt at work in Pennsylvania, you’re entitled to have your injury-related medical bills paid and you’re entitled to be compensated while you’re unable to work because of your injury. While it seems simple, it often isn’t. Don’t let your boss or the insurance company tell you that you aren’t entitled to workers’ compensation or pressure you into not filing. If your injury ends up more serious than you expect sometime down the road, and now you’re missing work and need a surgery you can’t afford, you very well could find yourself out of luck with nobody to help.

I want to know more.

If you have questions about the Pennsylvania Workers’ Compensation system or your case, please do not hesitate to give me a call. I don’t charge for consultations and, if you need to hire me, we only work on a contingent, recovery-based fee. Anybody can afford our law firm.