Who pays your medical bills after a car accident in Pennsylvania?

Who pays for my medical bills after a car accident in Pennsylvania?

car accidentOne of the things that most people find surprising if they have never been in an auto accident is that the guy who ran the red light may not be responsible for their medical bills. at least not initially  Nonetheless, the above statement is true because Pennsylvania, like many of the states, has adopted a no-fault automobile insurance system.

The system mandates that auto insurance policies provide certain mandatory coverage offerings.  Those required coverages include:

  1. Medical coverage;
  2. Income loss benefits;
  3. Funeral expenses; and
  4. Death benefits.

These coverages are required offerings, but it is not required that the insured actually purchase that coverage on his or her policy.  Many people have health insurance and disability coverage through their employment, so they minimize or reject any required coverages in an effort to be economical and save costs.  In Pennsylvania, it is only required that there be at least $5,000.00 in medical coverage issued under the policy.  You can select the amount of coverage you are willing to purchase.  Additional policy amounts are typically $10,000.00, $15,000.00, $25,000.00, $50,000.00 or $100,000.00.  There is even a separate catastrophic loss coverage that adds $1,000,000.00 in medical benefits.  If you have good health insurance, should you purchase more coverage than the required minimum?

How much insurance should I buy?

First of all, the cost of increasing the coverage amount is usually very affordable.  I never recommend that a client spend all of their extra money on insurance, however, it is wise to carry more than the minimum coverage.  Health insurance plans typically have “subrogation” rights (this is the right to participate in any third-party recovery and it could have very serious ramifications for you).  I usually recommend a higher amount if it is within your budget.

Income loss benefits are also extremely important, however, it is not mandatory that an insured pay for same and include them on his or her policy.  Many people do not include these benefits because they are unaware of the coverage or because they have disability benefits through their employer.

Frequently, an accident will disable a person and he or she becomes unable to work for an extended period of time.  If you don’t have income loss benefits, you will be dependent upon your savings, disability insurance payments or a spouse’s earnings.  Thus, it is wise to carry this coverage.  The minimum amount is $5,000.00, but it usually can also be obtained for $15,000.00, $25,000.00 or $50,000.00.  Additionally, this coverage is some of the most economical coverage available for purchase.  You should purchase enough so that you can rely on the coverage to support your household if you are unable to work for an extended period of time.

These coverages are payable by your insurance company regardless of whether an accident is entirely your fault or the fault of another party up.  If the accident is the fault of another, you can recover losses in excess of your coverage amounts in a 3rd party action.

Frequently, insureds get into fights with their own insurance company regarding payment of ongoing medical expense or income loss benefits.

If you are told your insurance company is not going to pay for your medical bills and/or your income loss, you should contact an attorney as soon as possible.

How to get Social Security Disability for Seizures and Epilepsy

Can I get disability or SSI benefits for my seizures?

EEG testing for seizures in Social Security Disability cases
EEG testing can be useful in Social Security Disability cases for proving you suffer from seizures.

If you suffer from epilepsy or some other seizure disorder and have uncontrolled seizures, you may be wondering if it is possible to obtain Social Security disability benefits.  The answer to this question is yes, it is possible to obtain Social Security disability benefits as a result of your seizures.  There are several conditions that must be met before a successful claim for disability benefits because of seizures can be made.

Social Security Disability Rules for Seizures

Under Social Security disability, there are certain impairments that are considered severe enough that they prevent a person from performing substantial gainful activity.  If an individual is able to meet the requirements for one of these listings, then they are considered to be disabled and can be awarded Social Security disability benefits.

Epilepsy (and other seizure disorders) are evaluated under listing 11.02, which focuses on epilepsy and seizure disorders.  Under this listing, there are four ways to obtain disability benefits by meeting the requirements of the listing.  Two of the options are for individuals who suffer generalized tonic-clonic seizures, also known as “grand mal” seizures.  The other two options are for individuals who suffer from dyscognitive seizures, also known absence as “petit mal” seizures. Under any of the options, it is a requirement that an individual is following the treatment that has been prescribed by a medical professional.  Furthermore, it is necessary to be able to provide proof of medical treatment in order to be successful in any disability claim.

In order to meet the listing for tonic-clonic seizures an individual must either have a tonic-clonic seizure at least once a month for three consecutive months despite medical treatment or the tonic-clonic seizures must occur at least once every two months for at least four consecutive months and have a marked limitation in: (1) physical functioning, (2) understanding, remembering, or applying information, (3) interaction with others, (4) concentrating, persisting or maintaining pace or (5) adapting or managing oneself despite medical treatment.

To meet the listing for a dyscognitive seizure an individual must have either a dyscognitive seizure at least once a week for at least three consecutive months despite treatment or have at least one dyscognitive seizure every two weeks for at least 3 consecutive months despite treatment and the individual must have a marked limitation in: : (1) physical functioning, (2) understanding, remembering, or applying information, (3) interaction with others, (4) concentrating, persisting or maintaining pace or (5) adapting or managing oneself.

How Drug and Alcohol Use affects disability for Seizures

Another factor that must be considered for disability involving seizures is whether there is evidence of drug addiction or alcoholism.  For Social Security disability, if there is evidence of past drug or alcohol use, then the administrative law judge conducting the hearing may find that the drug or alcohol use is a contributing factor material to the determination of disability.  If this is the case, then the judge has determined that the disabling limitations have resulted from drug or alcohol use and that any limitations not caused by drugs or alcohol are not severe enough to be disabling.  For individuals who are afflicted with seizures and have a past history of drug or alcohol use, the judge will ultimately determine if the drugs and/or alcohol contributed to the seizures and if it did, then a claim for disability benefits might be unsuccessful.

What should I do if I want to get disability for my seizures?

Successfully obtaining Social Security disability benefits as a result of epilepsy or another seizure disorder is a difficult and involving process that contains many different factors and considerations.  In order to optimize your chances of obtaining benefits if you do suffer from seizures, it is important to retain an experienced Social Security Disability lawyer who understands the Social Security disability system and seizure disorder.  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.

What should I do if I injure my neck and back in a car accident

What should I do if I injured my neck and back in a car accident?

Neck and Back Pain after a Car AccidentInjuring your neck and back in a car accident can be devastating. Although neck and back injuries are the most common injuries after a crash, they can be the hardest to prove and the hardest for which to get fair settlements from the insurance company. Your claim will be denied because it’s preexisting, because you can’t prove it’s related, or because you have “limited tort.” If you’ve injured your neck and back in a car accident, here’s how to maximize your settlement:

Make sure the paramedics and emergency room doctors know if you’re experiencing neck and back pain.

The human neck and back are fragile, so it’s no surprise that neck and back injuries are often pre-existing (to some extent) and have causes other than car accidents. That’s why, after a car wreck, if your neck and back are in pain, it’s important that you tell your doctor! If an ambulance responds to your accident, be sure to let the paramedics know your neck and back are hurting if they’re in pain—don’t assume it’s temporary! It’s common for insurance adjusters to deny claims for neck and back injuries because the pain wasn’t immediately reported to paramedics or emergency room staff!

If your neck and back don’t start hurting until a few days after the car accident, make an appointment with a doctor or a chiropractor

It’s common for neck and back pain to start several days after a collision. Unfortunately, what ends up happening is that, once the pain starts, many people don’t start treating until months later when the pain doesn’t get better on its own. If your injury ends up being more serious than the sprain/strain you thought it was, the insurance company will say that this “treatment gap” indicates you must have hurt your neck and back somewhere else—not in the car accident! Without any doctor having seen you for months, it’s almost impossible to prove you actually hurt your neck and back in the accident. If your neck and back start hurting a few days later, make an appointment with your family doctor or chiropractor to get things looked at. In Pennsylvania, your car insurance is required to pay for medical treatment related to the accident; most people have at least $5,000.00 in medical coverage for accident related treatment (which includes chiropractors!).

How do I make the insurance company pay fair settlement value for my neck and back injury?

How to get the insurance company to pay you a fair settlement for your neck and back injury is a simple answer: get a lawyer. Because you do not have the ability to file a lawsuit and work your case up properly, the insurance adjuster will not pay you fair value for your neck and back injury. They know that, whatever they offer, you have no choice but to take it. Call our Erie, PA car accident lawyers for a free consultation; if we don’t think we can get you a better offer and more than pay for ourselves, we’ll let you know.

My doctor has told me I’m disabled; does that mean that I can get Social Security disability benefits?

Am I automatically entitled to Social Security Disability benefits if my doctor says I’m disabled?

Social Security DoctorIf a doctor has said that you are disabled, you might be thinking you have an “easy” Social Security Disability case.  Perhaps your doctor has filled out a form for Medicaid (insurance through the Department of Public Welfare) that states you’re disabled.  But, despite all of this, it does not mean that you are automatically entitled to Social Security disability benefits and it does not mean you have an “easy” case.

Instead, it is important to understand that “disability” under Social Security is a legal determination that must be made by Social Security, often by an administrative law judge (also known as an “ALJ”).  This ALJ is a Social Security Judge who will ultimately determine whether you are disabled or not.  And in making that determination, the ALJ looks to the rules and regulations that Social Security has issued in order to make the decision.  As part of the decision, the ALJ will look to medical opinions and medical records from treating sources such as your doctor.  But, it is important to understand that this is only one area that the ALJ takes into consideration.  It is vital to have an experienced Social Security disability attorney, one who understands the Social Security’s rules and regulations on disability, aid you in the process of obtaining benefits—particularly at the appeal stage.

Alternatively, if you have visited a doctor and the doctor has expressed an opinion that you are not disabled, you still may be able to qualify for Social Security disability benefits.  Because disability under Social Security is a legal determination, it is possible to obtain benefits for disability even when the doctor does not believe that you are disabled.  For example, Social Security’s rules contain the Medical/Vocational Guidelines, often referred to as the GRID rules, which contain different standards for individuals based on their age, work history, and education.  These GRID rules are typically used for individuals over the age of 50 because at that point, the standards for disability are often relaxed.  Because of this, an individual whose doctor does not believe that the person is disabled may very well be found to be disabled under the legal rules and regulations set for by Social Security.

It is vital to retain an experienced Social Security disability attorney when considering whether to apply for disability.  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.

What happens when both drivers in a car accident are insured with the same insurance company?

What do I do after a car accident if the other driver uses the same insurance company as me?

Car Insurance PaperworkBoth drivers in a car accident being insured with the same company is not as uncommon a situation as one might expect.  In Erie, Pennsylvania, there are several large companies which have significant shares of the insurance market.  Hence, it is not that unusual for the same car insurance company to provide insurance coverage to both vehicles in a two-car accident.  How does that change the normal policy processing of the claims?

Auto Insurance carriers are sensitive to the pitfalls in this scenario.  An insurance company contractually owes a fiduciary obligation to protect its insured.  A fiduciary obligation is an extremely high duty of good faith and loyalty and it is one of the highest duties under the law.  This creates difficult conflicts where an insurer insures both parties in an accident.  After all, if the situation is contested, and it takes the position of one insured, it usually damages the interests of the other insured.

In these situations, it is extremely important to document everything.  The insurer will assign separate adjusters to handle the claims of each insured and those files are supposed to be maintained separately from access by the opposing adjuster.  In a disputed accident, the carrier will frequently refer the matter to an independent arbitrator to determine fault.  That is not a perfect system, though, because the arbitrator’s decision will be based upon the evidence submitted.  Keep in mind that while the arbitration can prove helpful, it does not absolutely bind the insured.  Hence, even if an insured is determined to be at fault, he or she could still have rights to sue.  Eventual success may depend upon carefully documenting the situation.

The scenario can be extremely confusing for the typical client.  I had a case a few years back where a client was rear-ended by another vehicle and both vehicles were insured by “A” Insurance.  An adjuster was assigned and contacted the client after her release from a hospital.  He arrived at her house, took a recorded statement and offered her “gas money” to help her with the expenses of treatment.  She signed a “receipt” on a clipboard and when she contacted the adjuster a month later after a week in a hospital to seek additional funds, she was advised she had settled the claim.  After contacting us, we discovered the adjuster had never disclosed he was the “enemy” adjuster for the other driver.  He had tricked her into settling her claim for a pittance.  She had assumed he was her adjuster.  We demanded the release be set aside and that request was refused.  The events precipitated several years of litigation that resulted in a significant recovery for our client, but the situation could have been averted by contacting counsel at a much earlier stage of the controversy.  If you are involved in such a situation, be sure to get a lawyer as soon as possible.

How do I file a Workers’ Compensation Claim in Pennsylvania?

How do I file a Pennsylvania Workers’ Compensation Claim?

As workers’ compensation lawyers, injured workers frequently ask us “how do I file a workers’ compensation claim?” Normally, the reason they’re asking is because either their employer failed to report the injury to their insurance company or because the insurance company denied their claim, asserting that the injury wasn’t “work related.” If this happened to you, you need a lawyer.

You need a lawyer to help file your workers’ compensation  cFiling a Workers' Compensation Claimlaim.

It’s important to realize that “making a workers’ compensation claim” isn’t as simple as, for example, reporting a fallen branch on your roof to your homeowner’s insurance carrier. Making a workers’ compensation claim is more similar to litigating a personal injury claim in real court, as it involves multiple hearings, cross-examination of witnesses, and medical depositions. This is neither cheap nor simple and it is not something you should try to do without an experienced lawyer.

When I get involved in a situation where a claim needs to be filed, I file what’s called a “Claim Petition” with the Pennsylvania Bureau of Workers’ Compensation. This is just the beginning of the process. Soon thereafter, I am required to pay for and submit expert narrative reports, medical records, and conduct depositions of the treating doctors. This is both time consuming and expensive. It is not unusual to spend $4,000.00 litigating a workers’ compensation claim petition from start to finish.

We can help file your workers’ compensation claim.

When our office represents an injured worker, we work on a contingent basis and we pay all litigation expenses. We know that, when you’re out of work, you can’t afford to pay a lawyer’s retainer or be expected to spend $3,000.00 on a medical deposition. Importantly, in workers’ compensation claims, we never charge these expenses to our clients—we either get paid back by the employer or we don’t get paid back at all. We take the risk so you don’t have to.

If you’re wondering how to file a workers’ compensation claim in Erie, PA, Bradford, Smethport, or in Northwestern Pennsylvania, we encourage you to contact our office for a free consultation. If we can’t help you, we can at least point you in the right direction.

I’ve been named Executor in a Will. What do I do now?

What do I do if I’ve been named “executor” in a will?

What's next after being named executor in a willWhat should you do after being named executor in a will? The first answer to this question should be another question: “do I want to serve as executor?” No one is required to accept this responsibility. Should you wish to decline, you can sign a document called a “renunciation.” This would enable either an alternate executor named in the will to serve, or to allow another authorized party to petition to become the administrator of the estate.

What is an executor and what are his or her duties? First, the term “executor” typically refers to a male; “executrix” is the female form. The more modern term is “personal representative,” which generically refers to an executrix, executor, administrator or administratrix. The term executor simply refers to a person appointed in a will; for persons who die without a will, the term “administrator” is used.

The duties of a personal representative are essentially to gather the assets of the deceased, convert them to cash if appropriate, and pay the decedent’s debts and inheritance taxes. Finally, the personal representative will distribute the balance to the beneficiaries named in the will, or if no will, to the decedent’s heirs as set forth by law.

While it is not necessary to have a lawyer assist the personal representative in administering an estate, it is certainly advisable. There are many ways that an attorney’s advice can save the estate money, and protect the personal representative from the many pitfalls in administering an estate.

As a few examples of the type of issues facing a personal representative, the first is providing notice to the beneficiaries. The law requires certain persons to receive notice of the administration of an estate, and a lawyer can determine who needs to receive notice. Failure to provide notice could potentially expose the personal representative to liability in the future.

Next, a decision needs to be made as to whether or not to advertise the estate. While not strictly required by law, advertising is beneficial because the purpose of the advertising is to cut off claims of creditors. However, in some situations, typically where there is a sole beneficiary who perhaps had a power of attorney for a parent and is very familiar with their affairs, the cost of the advertising can be saved.

It is the personal representative’s responsibility to file and pay any inheritance taxes due. There are many issues dealing with inheritance tax that most people are not able to handle on their own. Just as an example, in Pennsylvania, there is a 5% discount to the extent that inheritance taxes are paid within three months of death. This may not be possible if there are not sufficient liquid assets, but an attorney can assist in estimating the tax, which can result in significant savings to the beneficiaries.

There are many other issues facing a personal representative. One of these issues is whether or not to take a fee. The personal representative is entitled to be paid from the estate for their services. However, this is not always advisable because the personal representative will need to pay income taxes on their fee, which could be greater than the savings in inheritance taxes to the estate.

Other issues confronting a personal representative are whether or not to make an “at risk” distribution. This is any distribution made before one year has passed from the advertisement of the estate. Such a distribution is “at risk” because if claims of creditors later arrive, the personal representative may have personal liability for these claims.

One of the more difficult issues to deal with is that of an insolvent estate. This is where the debts are greater than the assets. It is still necessary to file an inheritance tax return even though no tax will be due. It is also important that no debts be paid until all debts are known. This is because, by law, certain classes of debts have greater priority than others in being paid. It is the personal representative’s responsibility, with advice from their attorney, to only pay those creditors that are entitled to payment.

At Bernard Stuczynski & Barnett, we would be pleased to discuss your situation. In most cases, it will benefit a personal representative to have representation by a skilled attorney.

Can I file a Workers’ Compensation Claim in Pennsylvania if I was hurt in another state?

If I live in Pennsylvania, but I was hurt in another state, can I still file a workers’ compensation claim in Pennsylvania?

out of state workers' compensation claimWe often get asked by Pennsylvania residents—hurt in other states—if they can file their workers’ compensation claim in Pennsylvania. The answer to this question is “maybe.” Pennsylvania (and most states) provide that you may file a claim if you were hurt while working here or if you were hired here. So, for example, if you live in Pennsylvania, but were hired by a factory in Ohio and commute there every day, the answer is that your claim must be filed in Ohio.

However, if you were hired by a construction company and are injured while working on a project in New York, you can (and probably should) file your claim in Pennsylvania. Generally speaking, Pennsylvania benefits are better than both those of Ohio and New York. Of course, individual circumstances may vary.

Thus, the general rule is that if you were hired in Pennsylvania, and were injured in another state, it is necessary to examine the benefits in that state to determine if you should file in Pennsylvania or where the injury occurred. Please note also that some employers, notably trucking companies, often have employees sign agreements to file compensation claims in a certain state, often Indiana, which has laws that are very unfavorable to injured workers.

While these agreements are generally valid, we are happy to review your case to determine if there is some reason that it may not be enforceable. Any time there is a difference between the state of hire and the state where the injury occurred, it makes sense to seek legal advice to determine how best to proceed. At Bernard Stuczynski & Barnett, we are happy to review your injury claim with no cost or obligation. Give one of our experienced workers’ compensation attorneys a call at 814-452-6232 for a free sit-down consultation!

Why can’t I sue my employer if I was hurt at work?

Can I sue my employer if I was hurt at work?

LawsuitIf you have been injured at work in Pennsylvania, you are normally unable to bring a personal injury lawsuit against your employer—even in cases where the employer was negligent and caused you to suffer an injury. Instead, the only possible recovery for a work injury is through the workers’ compensation system. Why is this case? To understand why, it is best to understand the history of worker’s compensation and how the system was created.

A brief history of Workers’ Compensation

Prior to the introduction of workers’ compensation statutes, any worker who was injured on the job had to prove in court that the employer’s negligence was responsible for the injury in order to receive compensation. This was often a long and costly process for any worker to undergo. And, there were many defenses that employers could use to avoid liability for injuries including contributory negligence which prevented recovery if the employee was even slightly at fault for the accident, the fellow-servant doctrine which could allow employers to avoid liability if another employee was the cause of the injury, and the assumption of the risk doctrine which prevented recovery if the employee was aware of and assumed the risks and dangers of the workplace. Due in large part to these defenses, many injured workers recovered no compensation in the event that they were hurt while at work.

But, despite the low odds of recovery, employers also faced their own risks. The system of proving employer negligence often led to court costs and judgments that employers could not predict and they faced rising workplace liability insurance premiums.  Thus, the system provided significant incentives for reform from the perspective of both the worker and the employer. These reforms began first in Europe, starting in Germany in 1884. These workers’ compensation laws soon spread quickly to the United States, with Wisconsin passing the first law in 1911. Soon, the other states began to follow and each began to pass their own individual workers’ compensation laws. Pennsylvania passed its first Workers Compensation Act in 1915. By 1921, all but six states had replaced the old system of requiring a worker to sue to recover for an injury with a modern workers’ compensation system.

Workers’ compensation is often described as a “grand bargain” between workers and the employer. Under workers’ compensation, workers have relinquished the right to sue employers for any injuries that may be suffered in exchange for no-fault occupational injury insurance from the employer. Unfortunately, Pennsylvania’s workers’ compensation is a complex and difficult system to navigate; if you have been injured, it is best to contact an attorney who understands workers’ compensation in order to ensure that you are properly compensated for your injury and that your rights are protected.

Social Security Disability Hearing Wait Times

How long do I have to wait for a Social Security Disability Hearing?

Disability hearing wait timeIf after initially applying for Social Security Disability benefits you receive a letter denying your claim, you may appeal the Social Security Administration’s initial determination by timely requesting a “Hearing by an Administrative Law Judge” (ALJ).  Statistically, an individual stands a better chance of having their case approved following a hearing by an ALJ then they do at initial application process.

Unfortunately, there is a lengthy wait time between the time that you request a hearing by an ALJ and the time your hearing actually takes place.  Here is a link to the Social Security Administration’s website documenting the average wait time at each hearing office.

For quick reference, as follows are the current average wait times for the hearing offices in which our clients most frequently appear:

Hearing Office                        Waiting Time

Seven Fields                           20 Months

Buffalo                                   26 Months

Pittsburgh                              21 Months

Cleveland                               15 Months

Johnstown                              20 Months

Again, the wait time identified above is not the wait time between the initial application and the hearing by ALJ, but the wait time between the request for the hearing by ALJ and the actual ALJ hearing.

We recommend consulting with an experienced Social Security Disability attorney prior to filing your initial application.  However, if you have not consulted with an experienced Social Security Disability Attorney prior to filing your initial application, it is vital that you consult with an attorney immediately after receiving the very first letter denying you benefits.  The sooner our office becomes involved in the case, the sooner we can begin strengthening your case and increasing your chances of obtaining a favorable outcome.

Our attorneys and staff recognize that our clients’ lives are not placed on hold while they wait for their Social Security Disability hearing.  We understand that bills still have to be paid and medical care must continue to be received.  We realize this long wait time occurs while an individual has significantly reduced or no income. This obviously results in significant financial hardship.

Our office will do everything in its power to move your case through the Social Security Disability appeal process as expeditiously as possible while guiding you through this difficult time. Contact one of our attorneys today for a free consultation.