IMPORTANT TIPS FOR EVERY INJURED WORKER
1. Treat the Employer As Your Enemy, Unless Proved Otherwise.

Many employers, even good ones, turn into your enemy after you are involved in a work injury. Even if you have been working at the same company for 10 or 20 years without ever having an accident, your employer may not believe you when you and your doctor say you cannot return to your pre-injury job after a work injury. This comes as a great shock and disappointment to many workers, but it is a fact that needs to be faced.

2. Learn Your Rights Regarding Medical Treatment From the Beginning.

Many employers give their workers inaccurate information about their rights and obligations. For example, the law requires that employers provide their workers with a list of 5 doctors that they can see for the first 90 days after a work accident. If they don't give the worker a list of five doctors, the worker is free to choose any doctor he wants to see. However, many employers simply tell the worker where to go and do not advise them of their rights. The only way to avoid acting on false information is to consult with an attorney who specializes in handling workers' compensation matters. As a result of the passage of Act 44 and Act 57, workers' compensation law is changing rapidly. Almost every week brings with it new case law interpreting these new laws. Sometimes, the new case law is predictable from a careful reading of the statute and previous legal precedents, but sometimes it is not. Therefore, the only attorneys who can advise you about your workers' compensation rights are those attorneys who specialize in the representation of injured workers and who are making it a point to keep up with the new developments in the law.

3. Make Sure that You Have Notified the Proper Personnel About Your Injuries.

Under the law, you have an obligation to notify your employer about your injury within 120 days of the injury. The law has interpreted that to mean that you must make sure your supervisor knows about the injury - and not just any co-employee. Don't assume that because you have been out of work for some period of time after an injury, that you have satisfied this requirement. Make sure you tell your supervisor, and that your supervisor fills out a form called an Employer's Report of Occupational Injury and Disease. Ask for a copy of that form, and keep it for your records.

4. Do not Let Your Employer Harass You with Phone Calls.

After an injury, your employer may call you on the phone to find out how you're doing. While the first phone call may seem to be out of concern for your well being, at some point it will become clear to you that the employer has other motives. And you will not know what to do because you will be afraid not to respond. This is another place where an attorney can help. The attorney can contact the employer and demand that the employer direct all further communications with you through the attorney's office. This will give you great peace of mind, and allow you to focus on getting medical care and getting better.

5. If the Panel Physician Gives You Advice that You do Not Agree with, Seek Treatment with your Own Doctor.

Sometimes, your employer will refer you to a medical provider who gives you advice that simply seems wrong to you based upon your previous experience with medical providers. For example, you go to the doctor and tell him that your low back is killing you, and the doctor recommends that you take the rest of the day off, but go back to work full duty tomorrow without recommending any diagnostic or medical testing. The doctor may not even have asked you any questions about your job duties. Based upon your experience with other doctors outside a workers' compensation context, you believe this to be false. Or based upon how you are feeling and your knowledge of your job duties, you know you will not be able to walk back onto the job the next day and perform a day's work. Make an appointment to see another doctor. If the employer gave you a list of five doctors, you can go to one of the other doctors on his list or to a doctor of your own choice. However, if you have a list and don't go to a doctor on that list, the doctor you see will not be able to bill the workers' compensation insurance carrier for the office visit. Still, you may have other insurance to cover the visit, and if you don't, in the long run, it will have been worthwhile for you to pay for the office visit yourself, rather than risk having no accurate medical documentation of the extent of your injuries for the first 90 days. And if you do not have a list, the doctor you see will be able to bill the workers' compensation insurance carrier for your office visit, even if it is not the doctor to whom your employer referred you.

6. If the Employer Accepts your Claim with a Notice of Compensation Payable, Review the Document Carefully for Mistakes.

If your employer and its insurer accept your claim by issuing a document titled Notice of Compensation Payable, and you start receiving benefits, you may be tempted to ignore the language in the Notice of Compensation Payable. That may be a big mistake. Before you can safely conclude that the Notice of Compensation Payable is accurate, you must review it very carefully for the following information:

Did the employer accurately calculate your wages for purposes of establishing your compensation rate?

Did the employer accurately state the areas of your body that were injured, and list all of the diagnoses related to your work injury?

Did the employer correctly state the date of injury?

If these pieces of information are incorrect on the Notice of Compensation Payable, an attorney specializing in workers' compensation injuries can get them corrected. Often, the attorney can write to the insurer and get the information corrected without drawn out legal proceedings. Other times, legal proceedings will be necessary. However, you will do yourself a great disservice in the long run if you ignore the mistakes because you do not feel that they are causing you any harm. The most common such mistake is when an employer issues a Notice of Compensation Payable, but doesn't list all of the areas of injury. Under such circumstances, the employee may be getting his work loss benefits and his doctors may be getting paid for their office visits and physical therapy. However, as soon as the doctor recommends surgery, the insurer may refuse to pay for the treatment, claiming it is not related to the workers' compensation injury that they agreed to pick up. The only way to avoid being in either of those circumstances is to seek legal representation as soon as you notice that the Notice of Compensation Payable does not list all of your injuries.

7. If the Employer Issues a Notice of Compensation Denial and You are Injured, Seek Legal Representation Even if the Employer Has Permitted You To Return to a Light Duty Job.

Sometimes, an employer will issue a Notice of Compensation Denial, while at the same time, allowing the worker to work in a light duty capacity and paying for medical treatment. Under such circumstances, it may be tempting to not want to "rock the boat." If you are injured and hurting and cannot perform your pre-injury job, this is a mistake. Why? Because if your employer decides down the line to terminate your employment without cause (which the law permits under most circumstances since most Pennsylvania employees can be hired and fired "at will"), you will not be able to collect workers' compensation benefits. Also, if your employer decides not to pay for your medical treatment, you will have no legal recourse. Often, employers will pay for medical treatment that is not costly, even though they have issued a Notice of Compensation Denial, but as soon as the doctor recommends surgery, they refuse to pay for the treatment. The only way to avoid being in either of those circumstances is to seek legal representation as soon as the Notice of Compensation Denial is issued.

8. Do Not Go Alone to a Physical Examination.

If you are out on workers' compensation for any extended period of time, your employer or its insurer will at some point ask for you to be examined by a doctor of their choice. Often, they will refer to this examination as an "Independent Medical Examination," which may mislead you into assuming that the doctor who examines you is truly independent and unbiased. That would be a false assumption. These are commonly referred to by lawyers who represent injured workers as "defense medical examinations." In many instances, the doctor performing the examination receives a sizable percentage of his income from examining injured workers on behalf of insurance companies. It stands to reason that if the insurance company chooses that doctor in particular to perform the "independent" medical examination, it is because they have reason to believe that they will get an opinion favorable to them. This is not always the case; however, there is no way for you to know going into the examination whether that particular doctor is one who would allow his biases or loyalties to the insurance company to overshadow his obligations as a doctor. If a doctor wants to support the insurance company's position at the expense of the worker, he may misrepresent the information you provide in your history or in his report of your physical examination. Sometimes, this is done by asking misleading or incomplete questions. The only way to protect yourself is to be sure that you have a witness to the examination. The practice in our offices is to send someone with our clients to almost every physical examination. Other offices may rely on you to bring your own witness. Either way, it will be your word against the doctor's word if you claim later on that you did not tell him something, or that he did not do a certain test that he claims to have done. A witness can go a long way to preventing such an occurrence.

9. Do Not Settle Your Claim without First Seeking the Advice of a Workers' Compensation Attorney.

Sometimes, an insurance company may offer you some amount of money in settlement of your claim, even if you do not have a lawyer. In our opinion, it is never a good idea to settle a case without a lawyer - primarily because you will not know what it is you are giving up unless a lawyer has carefully reviewed your medical records, your pre-injury job, your prior job experience, the sequence of events from the time you were injured up to the present, and evaluated them in light of current law. So do yourself a favor, don't get seduced by the fact that someone has offered you what seems to be a sizable amount of money. Review all of the facts with an attorney who specializes in the representation of injured workers before you take the next step. If the offer was a fair one, the insurer should have no problem holding the offer open until you have had an opportunity to consult with an attorney. And if they tell you they won't hold the offer open, well, you can draw your own conclusions.

THE NEW WORKERS' COMPENSATION LAW: WHAT ACT 44 AND ACT 57 HAVE DONE TO WORKERS' RIGHTS
In 1995, and then again in 1996, a conservative Pennsylvania legislature, allegedly concerned about the high costs of doing business in Pennsylvania, passed a new workers compensation law that greatly curtailed the rights of workers with respect to both their medical treatment and their long term benefits. It would appear that the primary beneficiaries of the new law have been the insurance companies, since employers do not report substantial reductions in their insurance premiums. Nevertheless, Pennsylvania workers are stuck with the new law, and will continue to be stuck with that law until a more progressive legislature is elected and makes workers' compensation reform a priority. From my perspective, as a person who represents workers who have been seriously injured in work-related accidents, the worst parts of the new law, which apply to all persons who sustained work related injuries since June 24, 1996, are the following:

First, under the new law, if a person has been injured in a workplace accident, the insurer will only pay for his medical treatment for the first 90 days after the injury if he treats with one of five panel physicians that his employer, or its insurance carrier, have chosen for him. These are not necessarily the best doctors, and worse, they may have undisclosed ties to the employer or insurer that result in the doctor trying everything in his power to minimize the workers' injuries in his reports and recommendations. For example, it is typical for panel physicians to see a person once, and return him to full duty the very next day without ordering any medical or diagnostic studies or tests.

Second, under the new law, an insurer has 90 days to decide whether or not it will accept the claim as compensable. What that allows the insurer to do is to wait 90 days, all along paying for treatment with the panel physicians, but then, if there are signs that the person is still injured and can't return to his pre-injury job, the insurer will deny the claim, forcing the injured worker to file a claim. Even if the worker wins the claim in the long run, he may have to wait several years for that result, and will not have any income while the litigation is pending. Many workers simply do not have the financial resources to wait for the courts to resolve their claims, and will be forced into some type of settlement rather than wait the time necessary to get a court ruling that vindicates these rights.

Third, under the new law, if a person is out of work for more than two years, the insurer can hire a vocational expert to prove that there are jobs out there in the marketplace that the person would be capable of doing, and based upon that evidence, his work loss benefits should be limited or even extinguished completely. This evidence may persuade the Workers' Compensation Judge to cut down or cut off the worker's benefits, even if the insurer made no effort to tell the worker about the jobs that he found (jobs the worker most likely never knew about because they are advertised in places he's never heard of). This is a dramatic change from the old law, under which the insurer could only get out of its responsibility to pay work loss benefits if they referred the worker to an available job for which he had been cleared by a medical professional and the worker refused to go to work.

If you have been injured as a result of a work injury, please call us at (610) 660-7760 or e-mail a completed General Case Inquiry form to us. Once we have had a chance to review your submission, we will contact you and will provide you with a confidential consultation at no charge.

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