In Pennsylvania, the Workers’ Compensation Act does not require a workers’ compensation insurance carrier to “pre-approve” payment of medical treatment, which includes prescription medications.
All too often our Erie, PA workers’ compensation attorneys have seen first-hand the frustration and despair an injured worker experiences when trying to have a work-related prescription filled at their local pharmacy. Customarily, when the local pharmacy receives a prescription that should be covered under a workers’ compensation claim, the first thing the pharmacy will do is call the workers’ compensation insurance carrier. The pharmacy will only fill the prescription if the workers’ compensation adjuster confirms that it will, in fact, pay for the prescription, “pre-approving” the payment of the medical treatment.
As there is no requirement that an adjuster “pre-approve” payment of medical expenses, the workers’ compensation insurance carrier is well within its legal rights not to promise the pharmacy in advance to pay for a prescription before it has been properly billed by the pharmacy. If the pharmacy fails to obtain “pre-approval,” or is unable to even speak with the adjuster, it will not fill the prescription or will only do so if the injured worker pays for the prescription out of pocket and/or the prescription is billed through the injured worker’s personal health insurance, leaving injured workers without the medications they need.
In order to ensure that an injured worker has their prescriptions promptly filled and billed appropriately we recommend injured workers utilize pharmacy companies that specialize exclusively in filling prescriptions for injured workers. These pharmacy companies that specialize in filling workers’ compensation prescriptions do not typically have brick and mortar locations. They will instead have the prescriptions overnighted to your residence. If the prescriptions are time sensitive and having them overnighted to your residence is not acceptable these companies have relationships with brick-and-mortar pharmacies that will permit you to pick-up your prescription from that pharmacy.
Most importantly, these pharmacy companies know and understand appropriate billing procedures under Pennsylvania’s Workers’ Compensation Act. As such, these companies do not seek “pre-approval” before filling your work-related prescription, instead these companies will promptly fill your prescription and then bill the workers’ compensation insurance carrier.
Who will fill my workers’ compensation prescriptions without pre-approval?
Although, there exists a number of pharmacy companies that specialize exclusively in filling prescriptions for injured workers, our office has worked extensively and have had good experiences with Injured Workers Pharmacy, LLC.
If you are having difficulty with the workers’ compensation insurance carrier not promptly filling or paying for your work-related injury prescriptions, contact our Erie, PA Workers’ Compensation Attorneys for a free consultation to discuss your legal rights and options.
Car Accidents occur suddenly and unexpectedly. They typically result in an individual to respond with their natural acute stress response of “flight or fight.” It is not uncommon for one to act instinctively after a motor vehicle collision without properly considering the future consequences of these initial actions. If you have been involved in a motor vehicle collision, there are some actions you should never take following a motor vehicle accident.
After a car crash, never do these five things:
1. Do NOT forget to call the police to the accident scene
Having a police report is critical to establishing fault for the car accident. Insurance companies rely heavily on police crash reports when making liability determinations. The police should always be called even if nobody appears to be injured.
2. Do NOT leave the scene of the car accident
No matter the circumstances of a crash, you should never leave the scene of a motor vehicle accident before the police arrive and say it’s okay to do so. Even if there appears to be no damage to the vehicles, do not simply drive away!
3. Do NOT admit fault for the car accident
Many people make the mistake of immediately exiting their car and beginning to apologize for the crash even if it was not their fault. It is always best to check if everyone is fine and call the police. Never admit fault after being involved in a collision: just report the facts of the accident to the police. It isn’t uncommon for other witnesses with better vantage points to come forward to demonstrate the accident was actually someone else’s fault.
4. Do NOT provide a recorded statement to any insurance company
You should never give a verbal or written statement to any insurance company, including your own. Insurance adjusters are trained to and experienced at questioning you in an effort to create a record favorable for them and unfavorable for you. The other driver’s insurance carrier will question you with the intent of demonstrating that you were at least partially responsible for the happening of the accident. Your own insurance company will question you with the intent of demonstrating that they should not have to provide insurance coverage for you as it relates to the motor vehicle accident due to a loophole found in the fine print of your motor vehicle insurance policy, typically referred to in your insurance policy as a “policy exclusion.”
5. Do NOT represent yourself in your personal injury claim
There are many complicated legal issues involved in the pursuit of a claim stemming form a motor vehicle collision. Attempting to represent yourself in a claim can result in irreparable harm to your case. We frequently see individuals contact our office after unsuccessfully trying to handle the matter themselves. Typically these individual have said and done things in their efforts that result in negative implications to their case. Some bells just cannot be unrung.
What you should do after a car accident:
Promptly contact one of our experienced car accident attorneys for a free, no obligation meeting to discuss your motor vehicle accident claim.
When you should Hire a Disability Lawyer
Many people wonder if they should hire a Social Security Disability attorney. If your and your family’s livelihood depends on winning your case for disability benefits, it’s not a question of if you should hire a Social Security Disability attorney, it’s a question of when you should hire a Social Security Disability attorney. Unfortunately, many individuals wait too long before contacting an attorney about their claim for Social Security Disability benefits. There are two rules to follow if you are considering or have already applied for Social Security Disability benefits:
Contact an experienced Social Security Disability Attorney before applying for Social Security Disability benefits.
Not every individual needs to have an attorney represent them when making their initial application for Social Security benefits. However, in some cases, retaining counsel at the initial application level can improve an individual’s chances for being approved. Regardless of which category an individual falls into, speaking with an experienced Social Security Disability attorney prior to making the application will allow an applicant to obtain advice in avoiding common pit falls that can result in an initial application being denied. Such pit falls include applying for benefits too soon or too late, failing to allege an appropriate onset date for disability benefits, and applying for benefits before having sufficient medical documentation to support your allegations of disability.
If you receive a Notice of Decision denying your initial application for Social Security Disability benefits, contact an experienced Social Security Disability Attorney immediately.
If your claim for Social Security Disability benefits was denied, not only do you have a limited time period in which to appeal the denial of your initial application for benefits, but it is important to have an attorney review the basis for the Social Security Administration’s denial of your claim as soon as possible. Do not wait until your hearing has been scheduled to seek legal representation. Although it can take up to 24 months or more before your appeal will be heard by an Administrative Law Judge, retaining an attorney right away will ensure that you are taking the necessary steps to further document your medical condition and win your case.
Our experienced Social Security Disability attorneys would be happy to provide you with a free review of your Social Security Disability claim. Call our office at 814-452-6232 for a free consultation!
Should 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:
- The amount of a lump sum payment; and
- 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.
Can you work when receiving Social Security Disability Benefits?
People 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.
How long do I have to wait for a Social Security Disability Hearing?
If 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.
Has the Workers’ Compensation Insurance Company hired you a Nurse Case Manager or a Field Case Manager?
Workers’ compensation insurance carriers will often hire registered nurses to oversee an injured workers’ medical treatment. These nurses are referred to as “nurse case managers” or “field case managers.” If you have a workers’ compensation case and were given a nurse case manager—watch out! Nurse case managers work for the insurance company and they are looking to save the insurance company money at your expense. If you are being called by a nurse case manager, or if you have a nurse case manager trying to attend your medical appointments, you should call our law firm immediately at 1-800-999-0750.
You should immediately contact our workers’ compensation lawyers if you have experienced any of the following situations with nurse case managers:
The nurse case manager has asked me to sign medical authorizations.
Nurse case managers will use signed medical authorizations to obtain and review your medical records unrelated to your work injury. Nurse case managers will share your unrelated medical records with the insurance company. The nurse case manager and insurance company will then use any and all information contained in these medical records as an excuse to refuse paying you the workers’ compensation benefits to which you are entitled. You should never provide a nurse case manager a medical authorization without first consulting with our attorneys.
The nurse case manager attends my doctors’ appointments.
You have a right to obtain your medical treatment and speak to your treating doctor without the intrusion of a nurse case manager. You should never permit a nurse case manager to be present while you are being examined by your treating doctor. It is important that you have an open line of communication with your treating doctor. While the top priority for and your doctor is your recovery from your work injury, the top priority of the nurse case manager is saving the insurance company money and denying your workers’ compensation benefits. Doctors know the nurse case manager’s motives and the obstacles they create. Your doctor will thank you for not allowing the nurse case manager to interfere with your medical care.
Call 814-452-6232 to talk to an attorney about your nurse case manager.
The nurse case manager talks to my doctor outside of my presence.
When you are injured at work, you do not give up all rights to medical privacy and HIPAA rights. While the insurance company has certain rights to your medical records, a nurse case manager does not have a right to your private medical information without your approval. When a nurse case manager talks to your doctor outside of your presence, the nurse case manager is simply trying to pressure your treating doctor to take action that will result in savings to the insurance company regardless of whether such action is in your best interest. For example, nurse case managers will attempt to pressure your doctor to release you back to work before you are ready or to delay important medical testing (e.g. MRIs and EMGs). Make sure it is clear to your doctor’s office that your private health information should not be shared with a nurse case manager.
The nurse case manager chooses the doctors I go to see.
Nurse case managers are familiar with the workers’ compensation system and they know the doctors that are on the side of the insurance companies. If a nurse case manager is selecting the doctor you see, they are likely referring you to a doctor that is on the side of the insurance company. These doctors, just like the nurse case managers, are more interested in saving the insurance company money than they are with your well-being and medical recovery. The Workers’ Compensation Act outlines the rights an injured worker has in selecting their treating medical providers. Know your rights and select a doctor who cares about your health and recovery.
The nurse case manager schedules or cancels my doctors’ appointments.
A nurse case manager has no right to delay or cancel your needed medical care. This is a blatant example of a nurse case manager caring more about the insurance company saving money than you obtaining your necessary medical care. Often times nurse case managers will reschedule your physical therapy or doctor’s appointments to coincide with insurance companies efforts to conduct video surveillance of your activities. This allows the insurance company’s private investigator to know exactly where you are going to be at a specific time. This makes recording you very easy. Typically the private investigator will arrive at the appointment before you do so that they can begin recording you upon your arrival. They will then follow you in their vehicle after the appointment to video your activities until you have returned to the comforts of your home.
Our lawyers can help.
If you have a workers’ compensation injury and your medical treatment is being sabotaged by a nurse case manager, our workers’ compensation lawyers can protect your rights and prevent the nurse case manager from interfering with your recovery. From our offices in Erie, PA, and Smethport, PA, we protect injured workers throughout Pennsylvania. We offer free consultations and don’t charge a fee without a recovery. Cal 814-452-6232 for a free consultation.
Do I have to go to an IME or an Independent Medical Examination?
Whether you were injured in a car accident or have a workers’ comp injury, insurance companies will often try to send you to an “independent medical examination” or an IME, which is a medical examination by a doctor the insurance company has hired. Within certain bounds, insurance companies have a right to have you examined by the doctor it selects in order to refute the injuries or continuing problems you are having as a result of a car crash or a work injury. This compulsory medical examination is referred to by insurance companies as an Independent Medical Examination” or “IME.”
Don’t be fooled: there is nothing about these examinations that is “independent.” The doctors that perform IMEs are paid generously by the insurance companies to provide medical opinions that favor the insurance companies; they’re essentially paid mercenaries. The doctors that perform these examinations are going to issue one of two opinions:
- You are exaggerating, malingering, magnifying your symptoms and/or just pretending; or
- Your medical condition and symptoms are unrelated to the accident or work injury.
Regardless of which one of the two possible opinions outlined above are provided by the insurance company’s doctor, the insurance company will use the doctor’s report to challenge you and/or your doctor’s opinion regarding the nature of and/or the extent of the injuries you sustained from the wreck or work injury.
I got a notice scheduling me for an IME
If you have been asked by an insurance company to submit to an examination by one of its doctors, the insurance company is probably getting ready to fight your claim or end your benefits. Call our office for a free consultation to discuss your rights and responsibilities associated with the requested examination so we can help protect you.
I already went to an IME without talking to a lawyer; what should I do?
If you have already undergone an examination at the request of the insurance carrier and the insurance company’s doctor has provided one of the opinions above, know that the insurance company will soon be taking action against you to stop or reduce benefits or monies that you may be entitled to. Do not wait until the benefits have stopped; contact our office today to learn what we can do to fight insurance company’s tactics.
The insurance adjuster asked me to give a recorded statement. What should I do?
Although insurance companies participate in a complex industry involving complicated laws and regulations, insurance companies have a simple business model. Claims paid and overhead expenses are deducted from premiums paid and investment returns to give the insurance company its profit. The insurance industry is big business, with insurance companies making billions in profits.
An insurance company’s biggest expense is insurance claims paid. The less an insurance company has to pay in claims the higher the insurance company’s profit. Insurance companies train their employees to look for loopholes and defenses to valid and legitimate claims in an effort to pay as little as possible on each and every claim. The effort to minimize payment on a claim begins when you initially report your
When you initially report a claim, either to your own insurance carrier or to the insurance carrier of the negligent party, know that the insurance adjuster you are speaking with is very familiar with the fine print of the applicable insurance policy. Insurance adjusters are trained to look for loopholes and exclusions found in the fine print of the applicable insurance policy so they may seek to deny payment of any kind under the policy. Do you really think you know the fine print of your insurance policy better than the insurance adjuster?
Additionally, insurance adjusters are trained to find ways to create a record that allocates blame to someone other than their insured and minimize the injuries of all involved. Insurance adjusters attempt to create this record as soon as they are aware a claim is being made.
You should never, under any circumstances, provide any insurance company with a recorded statement without first consulting with an attorney.
This rule even applies when it is your own insurance company asking for the recorded statement. The sole purpose of obtaining your recorded statement is for the insurance adjuster to create a formal record unfavorable to your claim before you have legal representation and before you may even know the full extent of your injuries. The insurance adjusters are trained to create a record that they can and will use against you.
Do not allow the insurance company to take advantage of your good will and misplaced trust. Contact our office for a free consultation to discuss your rights and responsibilities when communicating with insurance adjusters about your claim.
Have health problems forced you to retire early? You might have other options.
Are you in your 60s and unable to continue working on a full-time basis due to health problems? If so, you need to carefully consider your Social Security Disability benefit options before filing for Social Security Retirement benefits. A failure to properly assess your options can cost you hundreds of dollars per month in Social Security benefits. Over the course of your golden years, the failure to properly assess your options can cost you tens of thousands of dollars. In fact, we have seen individuals cost themselves over $100,000.00 by failing to consider disability over early retirement.
Social Security’s full-benefit retirement age is gradually increasing because of legislation passed by Congress in 1983. Historically, the full benefit age was 65 and early retirement benefits were first available at age 62, with a permanent reduction to 80 percent of the full benefit amount. Now, the full benefit age is 66 for people born in 1943–1954, which will gradually rise to 67 for those born in 1960 or later. Early retirement benefits will continue to be available at age 62, but they will be reduced even more than they already are. When the full-benefit age reaches 67, benefits taken at age 62 will be reduced to 70 percent of the full benefit, and benefits first taken at age 65 will be reduced to 86.7 percent of the full benefit.
If you can’t work because of health problems, consider applying for Social Security disability benefits before taking a reduced early retirement. The disability benefit amount is the same as a full, unreduced retirement benefit. If you’re getting Social Security disability benefits when you reach full retirement age, Social Security will convert disability benefits to retirement benefits.
If you have already elected to take a reduced early retirement instead of applying for disability benefits it is possible—in some instances—to revert those benefit payments from retirement to disability payments to avoid any reduction in your future monthly retirement benefits.
If you can prove your disability began before you began receiving reduced early retirement, you can get a “disability freeze.” A “disability freeze” automatically disregards any low-earning or zero-earning years on your record for the period that your disability prevented you from working (or reduced your earning capacity to below a certain level). This is important because both Social Security disability and Social Security retirement benefits are calculated based upon your earnings: years with no or low earnings on your record would otherwise reduce your benefits without the “disability freeze.” However, you need to apply for disability before you are one year past your full retirement age.
If Social Security decides that you did not become disabled until after you began to receive reduced early retirement, you won’t receive any retroactive payments; instead, your Social Security payments will simply convert to your Social Security disability benefit amount. Once you reach retirement age, your full retirement benefits will be reduced based on how many months you received early retirement.
There are many pitfalls and traps associated with navigating the Social Security process on your own. Additionally, an individual’s work record and personal circumstances impacts the decision-making process; there is no one-size-fits-all approach.
If health problems have forced you to consider early retirement, you should promptly contact an experienced Social Security disability lawyer to discuss your options. To learn more about disability, please see our page about disability benefits and schedule a free appointment with one of our disability attorneys today!