YOUR PROVIDERS? THINK AGAIN…
As published in the November/December issue of Hempfield Suburban News
Pennsylvania’s Workers’ Compensation Act is a unique creature. While fault for a work injury is most times irrelevant—meaning, even if you cause the accident, you will be entitled to benefits—these benefits are limited in nature and scope.
For instance, your indemnity benefits, resulting from a loss of earnings arising out of the injury-related disability, are limited to two-thirds (66 2/3%) of your average weekly wage (for an AWW of $552.77 and below, it is 90%), up to a yearly state-imposed maximum—for 2017, it is $995.00. Scarring and disfigurement are separately compensable, but only to the head, face and neck areas, as is the loss of a body part—meaning, it is either separated from the body, or, if not, the part is of no use “for all practical intents and purposes.”
But, non-economic losses, like “pain and suffering” and “loss of life’s enjoyment,” are not compensable. This means that, no matter how much pain and suffering you and your family endure as a result of a work injury, you and/or your spouse are not entitled to any benefits on that basis (unless there is a viable third-party claim).
The last type of benefit, and the one I want to discuss today, is your right to medical treatment that is reasonable, necessary and directly-related to the work injury. While this sounds good, in theory, medical benefits through the workers’ compensation system in Pennsylvania are a far cry from limitless and restriction-free.
Upon sustaining a work injury, you are obligated to treat with a medical provider on your employer’s “panel list” for 90 days. Many times, employers tell injured workers that they have to see one of the “medical factories” around, but this is not the case. You have a right treat with any provider on the list; and, if the medical specialty you need is not on the list, you may choose your own provider from the relevant discipline. Again, the standard is that the care must be reasonable, necessary and related to your work injury.
The control doesn’t end there, though. Your employer (and its insurance company) can also compel you to attend two “independent” medical examinations during any 12-month period. And, “independent” in this context usually means anything but—I just cross examined a doctor who makes over $1 million annually performing these examinations and testifying for insurance companies.
As a lawyer who only represents injured workers, I take the position that the 12-month period begins after the 90 days are up. However, I see more and more employers and insurance companies trying to schedule IMEs within the 90-day window, trying to get as many bites at the apple as necessary to obtain a medical opinion in their favor.
So, when it comes down to it, you really don’t have that much control over your medical treatment for a work injury. However, it is critical to know what your rights and obligations are, so that your claim is postured as well as it can be. Call us anytime to set up a time to talk about your options and claim, free-of-charge.