Is there a right to lump sum workers’ compensation settlements?
In general, there is no right to a lump sum settlement for a workers’ compensation injury in Pennsylvania. Settlements are typically the product of negotiation or, in some cases, mediation with a workers’ compensation judge. This is unlike in some other states where there is a right to a lump sum settlement based upon one’s degree of permanent bodily impairment.
What is specific loss? Am I entitled to a lump sum for an amputation?
The one exception to the general rule in Pennsylvania is the area of the law known as “specific loss.” Specific loss simply refers to a “schedule” of benefits for the loss of a body part. This could be a finger or a part of a finger, an eye, or an entire limb (such as an arm or a leg). This “schedule” of benefits is expressed in the number of weeks of compensation to which the victim is entitled. Thus the higher the worker’s compensation rate, the greater his or her compensation will be for a specific loss.
It is important to understand that an actual amputation is not necessary in order to be entitled to a lump sum. If there is medical evidence that the worker has lost the use of the body part “for all practical intents and purposes” it may be possible to obtain specific loss benefits.
Workers’ Compensation for Scarring and Disfigurement
Specific loss also includes disfigurement of the head, face or neck. To be compensable, the disfigurement must be permanent and unsightly. This is one type of injury that is not covered in the schedules. If the parties are unable to reach a settlement, a workers’ compensation judge will view the disfigurement and award a number of weeks of compensation which the judge feels is appropriate.
It is also important for a worker who has suffered a specific loss to understand that it is referred to as a “sword and shield” under the law. While specific loss benefits might at first seem attractive, often an injured worker’s disability is far more extensive than the schedule of benefits allows. In some cases, the insurance company will use the specific loss as a “shield” and argue that their obligation is limited to the specific loss rather than ongoing weekly benefits.
Do I need a lawyer?
Depending on the facts of your case, it may be possible to establish that disability arises from a condition other than the specific loss, thus maximizing benefits. Proper evaluation of a claim involving a specific loss is essential in order to make certain that the client receives the benefits to which they are entitled by law. We are always happy to discuss your claim at no cost or obligation. We will tell you if we think a lump sum settlement is possible. The major factors that affect the value of a settlement are the age of the claimant, the seriousness of the injury, the extent or permanence of the disability, and the compensation rate. Call our office for a free consultation to discuss whether or not you should get a lump sum.
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.
Why can’t I sue my employer if I was hurt at work?
Can you sue your employer if you were hurt at work? The short answer to this question is “probably not.” In Pennsylvania, and most, if not all, states, when you are hurt at work, you are limited to the recovery of workers’ compensation benefits: lost wages, medical bills and, in some cases, a lump sum award. This is the result of what is known as the great “bargain” that was crafted during the Industrial Revolution. Before workers’ compensation laws, an inured worker was limited to filing suing the employer for his or her injuries. The problem was that the inured worker had to prove negligence. It was, and remains, very difficult and time-consuming to prove negligence on the part of the employer. Injuries were often caused by the negligence of a fellow worker or even the injured worker himself. Unfortunately, filing suit against a co-worker would not be fruitful as the judgement against them would probably not be recoverable.
Workers’ Compensation laws were the original form of no-fault legislation. The historic bargain is that employees give up the right to sue their employer (and co-workers) in exchange for quick payment of lost wages and medical bills without regard to the cause of the injury, without the need for lengthy litigation. There are very narrow exceptions to this.
Exceptions to Immunity
In Pennsylvania, an employee who causes intentional injury to himself or herself is not entitled to compensation. A co-worker may be sued for intentionally causing an injury. If an employer illegally fails to have workers’ compensation insurance in place, the worker has the option to sue in tort or to proceed against the Uninsured Employers’ Guaranty Fund.
In very rare cases an employer who intentionally causes injury to an employee may be sued. The classic example of this is where a battery manufacturer intentionally concealed toxic levels of lead in the blood of its employees.
Lawsuits against other “third” parties
Another very important thing to keep in mind is that if the injury is caused by a third party, they are not covered by the limited immunity provided by workers’ compensation laws. The most common examples of this would be a professional driver who is injured by the negligence of another motorist, or a worker who is injured by a defective machine. In instances such as this, it may be possible to bring what is known as a “third party tort action” against the other driver or manufacturer of the machine. Our Erie, PA workers’ compensation lawyers always evaluate the possibility of third-party claims when we represent injured workers.
All of these are complex situations and require expert analysis by a local, experienced personal injury attorney. If your injured at work, we will be happy to discuss your claim with you with no cost or obligation. We have law offices in Erie, PA, and Smethport, PA.
Who is the Best Lawyer in Erie, PA?
When hiring an attorney, you understandably want to hire the best. But who is the best lawyer in Erie, PA? Or Smethport, PA? Or anywhere? Before you can answer this question, you need to figure how you define “best lawyer.” Is the best lawyer the one who wins the most trials? The lawyer who settles cases for the most money? The lawyer who knows the most laws? Or how about the lawyer who spends the most time with his or her clients and listens to what they have to say? As you probably guessed, there is no “best” attorney for every person or for every case. The right question to ask is “who is the best attorney for me and my case?”
Your personal injury case is unique. There is no one-size-fits-all strategy for handling personal injury cases and there is no best lawyer for every case. When picking a lawyer for your car accident, your work injury, or your disability appeal, you need to perform your due diligence into what matters to you. Before agreeing to meet, read the lawyer’s website and see what he or she is all about. What is their philosophy? Are they local? Will the attorney you call even be the actual attorney you meet with, or will you be pawned off onto somebody else you’ve never met?
I certainly cannot speak for all lawyers in Erie, PA, but at Bernard Stuczynski Barnett & Lager, what you see is what you get. If you hire one of our four lawyers whose pictures are on the front page, the lawyer you meet with will be your lawyer. He will be the lawyer who answers your calls, meets with you, and represents you at trial. We’re local to Erie, PA, and to Smethport, PA. We aren’t an “injury mill” from Pittsburgh and your case isn’t being handled by any non-attorney paralegals.
Additionally, each of the lawyers in our Erie, PA, and Smethport, PA law firm limits their practice to Personal Injury, Car accident, Workers’ Compensation, and Social Security Disability law. We don’t dabble in areas in which we’re unfamiliar. If you hire one of our lawyers for your personal injury case or workers’ comp case, you can be confident that we know exactly what we’re doing. Just as importantly, you can be confident that the insurance company knows that we know exactly what we’re doing.
If you need an Erie, PA lawyer or a Smethport, PA lawyer, call our law firm and schedule a free consultation. If you still aren’t sure who to hire—call our firm and schedule a free consultation anyway! There are no tricks and the meeting is free. If after meeting with us you still don’t think we’re the right lawyer for your case, we completely understand and you won’t be billed for anything.
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.
Can I get Workers’ Compensation for Carpal Tunnel Syndrome or for other Repetitive Motion Injuries?
People frequently ask us, “Can I get workers’ compensation for carpal tunnel syndrome?” The most common work injury scenario goes something like, “I was lifting a box and my back went out.” That type of injury is a readily identifiable distinct event. For carpal tunnel syndrome, the story changes. Maybe you’ve just been typing all day, every day, for thirty years.
However, many injuries can’t be traced to a specific event. It is well known medically that performing the same, repetitive tasks for weeks, months, or even years can cause excessive wear on body parts. The most common example is carpal tunnel syndrome, which is a painful condition involving the wrist. We have seen this work injury in a wide variety of settings including such diverse occupations as sorting clothes in a laundry or operating a coil winding machine in a shop.
One of the most confusing questions involving repetitive motion injuries is what date your injury occurred.
While workman’s comp insurance companies will often assign an injury date based upon when the injury was reported, this is not proper in the case of a repetitive motion injury. Under Pennsylvania law, each day of work is considered a new injury; the date of injury is the last day of work. This date is sort of a legal fiction, seeing as repetitive motion injuries occur over time—not on a specific date.
This can be extremely important in the typical case where the employee thinks “I can just work through this” and never reports and injury. Then, one day, the pain becomes so severe that they are unable to work and perhaps surgery is even necessary. Since by law in Pennsylvania a worker has 120 days from the date of injury to make a report, establishing the date of injury as the last day of work can be very important in assuring that the reporting requirement has been adhered to.
What if I notice the pain at home instead of at work?
One interesting aspect of repetitive motion injuries or overuse injuries is that the actual disabling event need not occur at work to be compensable under workers’ compensation. While carpal tunnel syndrome may be the best known example of repetitive motion injuries, there are many others. We have seen a number of cases over the years where a worker who engages in heavy lifting over a long period of time suffers a herniated disc at home. Of course the workers’ compensation insurance company will deny a claim such as this on the basis that it did not occur at work. However, with the proper development of medical evidence and an experienced workers’ compensation lawyer, it may be possible to obtain workers’ compensation benefits (including benefits for lost wages) for injuries which seemingly occurred at home, but were caused by repetitive work activities.
Will I need a lawyer to get workers’ compensation for my carpal tunnel?
This short article can’t possibly cover every situation. If you’re suffering from a repetitive motion injury like carpal tunnel, and you believe it’s from your work, you need a lawyer. That is why we are always happy to discuss the circumstances of your work injury with no cost or obligation. Contact our office to talk to a lawyer about your work injury. If you’re not sure and want to learn more, read our other articles about work injuries and workers’ compensation.
What is a Personal Injury Claim or a Personal Injury Lawyer?
When watching commercials and browsing the internet, you’ve probably heard the phrases “personal injury claim” and “personal injury lawyer,” but what is a personal injury? What does “personal injury” mean? Oddly enough, it’s a phrase used more often by attorneys than anyone else, but it encompasses several different—but related—areas of law.
The phrase “personal injury” is typically used to refer to the variety of legal issues that arise out of injuries resulting from negligence, including car accidents and slip and falls. When a person becomes badly hurt, a large number of people can be affected. From the families that lost their only source of income and the business that lost its best employee to the paramedics that gave life-saving care on the scene. With so many people whose lives have become disrupted, multiple areas of law come into play.
Personal injury claims include car accident and auto accident claims, dog bites, and even slip and fall lawsuits. Some attorneys even include workman’s comp claims under the umbrella of the phrase “personal injury.” In short, “personal injury” includes the cases that arise out of any injury, whether it occurred at work, on the road, or on the sidewalk. If someone gets hurt through no fault of their own, a personal injury attorney will work to see that the injured person and their family is compensated for missed work, lost wages, medical bills, and pain and suffering.
While some personal injury firms only handle car accidents, our firm handles it all: more often than you might think, a significant injury crosses over multiple areas of practice. We’ve had many clients in Erie, Smethport, and everyone in between, whose car accident cases turned into workers ’s comp claims and then Social Security Disability appeals. Given how common this scenario occurs, it’s important that your personal injury lawyer handle all three of these areas. If not, you can be shuffled around between three different law firms all at once—if they don’t miss one of your claims entirely. The more lawyers that are involved for the same injury, the greater the chances of miscommunication and mistake. When we handle every legal claim arising out of your injury, we’re able to make sure each claim builds upon the others to maximize your settlements and minimize mistakes.
If you or a loved one is looking for a personal injury attorney in Erie, Meadville, Bradford, Smethport—or anywhere in Northwestern Pennsylvania, call one of our offices to schedule a free consultation; we’ll show you how we can help.
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.
Life becomes stressful after an injury
After suffering an injury at work, your life can be turned upside down. You’re in pain, you can’t work, you’re worried about how you’re going to pay your mortgage, your medical bills are piling up, your boss and coworkers are looking at you suspiciously, and now you’re repeatedly being called by an insurance adjuster who “just wants to ask you a few questions about your accident” and have you “sign a few papers.” What will you do? More importantly, what should you do? What if you do the wrong thing? Should you sign those papers? We frequently hear the question, “When should I hire a workman’s comp lawyer?”
You need representation
Many injured workers struggle with the decision as to when they should hire a lawyer. Some even wonder if they should hire a lawyer at all, worrying that getting a lawyer involved might hurt their employment. In this article, we hope to clear up some misconceptions and ensure your rights are protected.
It’s important to realize that while your friends and union representatives are knowledgeable and are trying to help by giving you advice, they aren’t lawyers—and they aren’t workers’ compensation lawyers. Workers’ compensation is a complex legal minefield waiting for you to slip up just once. Many people get a lawyer involved too late after they’ve done something to cause irreparable harm to their case. Hiring a lawyer alleviates a great deal of stress; you can rest easy knowing that you’re not doing the wrong thing.
When to hire an attorney and what it costs
If your claim was denied, it’s obvious that you immediately need an attorney that can file a “claim petition” and litigate your case. But what if you’re receiving benefits and nothing has gone wrong yet? Our firm works on a “contingency” basis, which means our fee is contingent upon getting you a good result. If you are already receiving wage-loss benefits, we do not begin taking a portion of those wage loss benefits unless the insurance company brings you into court and we successfully prevent them from shutting off your benefits. This means it does not cost you a penny more to hire an attorney the day you get hurt than it does to hire an attorney the day before your hearing is scheduled.
With that in mind, since it doesn’t cost anything extra, it’s important to take advantage of having an attorney from day one so we can ensure everything is handled appropriately from the beginning. Your wage loss benefits will not continue forever: the insurance company will eventually haul you into court to shut them off—probably before you and your doctor think you’re ready to go back to work. And when that time comes, you will need a lawyer to gather records, hire expert witnesses, conduct depositions, pay for expert reports, and represent you at the several hearings that will be scheduled in court before a judge. The earlier on you have a lawyer, the stronger your case can be when you’re eventually taken into court. Building a strong case doesn’t happen overnight.
What if I recover and can go back to work without any problems?
Some people don’t hire a lawyer because they think they’ll get better and go back to work without the insurance company ever denying a medical bill or trying to shut off their wage-loss benefits. If you hire us and that happens—no worries! If there aren’t any complications in your case and you go back to work without the insurance company every trying to shut your benefits off (and you don’t want us to negotiate a settlement), we don’t take a fee and we don’t charge you for our costs! While not common, this does happen from time to time and we’re happy to have helped you along the way. We find that our involvement in cases like this early on actually encourages the insurance company to be on their best behavior and not wrongfully shut your benefits off. We’re there and already involved if you need us, and we ensure everything is handled properly if you don’t.
There’s no risk.
Whenever you’re hurt at work, it’s you versus an experienced insurance adjuster (and the insurance company’s attorney) whose job it is to pay you the least amount of money possible. Don’t go it alone. There’s no risk or downside to hiring an experienced workers’ compensation attorney from day one. If you don’t need us, we don’t cost you anything and our advice was free. If you do need us at some point (and you most likely will), you’ll be glad we were there helping from the beginning.
To learn more about workers’ compensation law and work injuries, read our Frequently Asked Workers’ Compensation Questions.
Social Media can ruin your injury claim
Whether you like or not, Social Media has become an integral part of our culture. While it’s a great way to stay in touch with friends and family, you need to be aware of the risks—particularly in regard to your insurance claims and legal cases. Whenever a client hires us to represent them in their accident or workers’ compensation claim, we always explain how much damage even a seemingly simple post can do to their case. Defense attorneys, insurance companies, and judges routinely search social media sites to discover harmful information regarding you and your claim. A good rule-of-thumb is if you’ve posted something online, expect to be cross-examined about it in court.
Anything you post—even if you believe it to be completely irrelevant to your case—could end up being extremely harmful. Don’t post anything on social media related to your case, the accident, your injuries, your state of mind, or even what you’ve recently been doing. In fact, if you are pursuing an insurance claim, we strongly advise that you stop posting on social media sites until the conclusion of your claim or lawsuit. Defense attorneys and insurance companies are quite savvy; they frequently turn posts as simple as you attending a family picnic into key pieces of evidence demonstrating your capabilities following an accident. Regardless of your innocent intentions, anything you post can—and will—be used against you.
In Pennsylvania, if the defense can demonstrate that your profile has information that may be relevant to your case, the court can grant the defense access to your private account, even if it is “locked down” with the maximum privacy settings. There may even be a time when a judge orders you to give the defense your Facebook password. All of your posts, pictures, videos, etc., and even your private messages, can potentially be used against you in open court.
Do Not Delete Anything from your Account
Even though information you have already posted could very well be harmful to your claim, if you anticipate litigation, it is illegal for you to now delete it. Bringing a legal claim against another individual creates a duty to preserve any and all evidence, regardless of whom it favors. Deleting items from your social media page can be classified as the destruction of evidence, otherwise known as “spoliation.” The penalties for destroying evidence are very serious and can lead to you losing your case and being fined by the court.
What you can do
While you are not allowed to delete or deactivate your accounts or posts, you can and should adjust the privacy options to their most restrictive settings, allowing access to only close, trusted friends that you personally know.
To briefly summarize, if you anticipate making an insurance claim, 1) Stop posting on social media websites; 2) Do not delete any information whatsoever; and 3) Immediately set all of your accounts to their most restrictive privacy settings, forbidding access to people whom you do not personally know and trust. Most importantly though, get a lawyer. Not only will we ensure your legal rights are protected—we can keep you from being your own worst enemy.