Injured at Work: “Accidents that occur due to work are considered an accident at work. According to the laws of a region, any injury that a person suffers suddenly and violently due to or on the occasion of work, and that causes disability or death and also those that occur between the worker’s home and the workplace, always and when the injured person does not modify or alter the route for reasons unrelated to work”.
In such a way that the accidents occurred “due to work” have their immediate and direct origin in the work itself, in such terms that they are framed in the tasks that the worker performs in the place and in the hours in which they must be carried out, in On the other hand, those that occur “on the occasion of work”, are those that, without being suffered in the workplace or during the work day, have an indirect or mediate relationship with the work performed, but in any case undoubted, as for example the case of an accident suffered by a union leader in the exercise of his trade union activities.
In turn, they are commuting accidents and therefore work accidents, “Those that occur on the direct journey, going or returning, between the room and the workplace, and those that occur on the direct journey between two places of work , even if they correspond to different employers”. All occupational diseases that occur as a consequence of carrying out work tasks must also be taken into account.
Accidents that occur to workers when they move between the workplace and the room or vice versa, with the precise purpose of having lunch, must also be understood as commuting.
To deal with these accidents, the Occupational Risk Insurer (ART) is in charge of providing all the medical and monetary benefits provided by law, immediately after being notified of the accident at work or occupational disease, but that depends on the regulations of the region or company where the event occurred because there are other companies that handle these events by the Department of Human Resources or Department of Risk Prevention, so that they immediately refer you to the health care establishment of the organization to which the company is affiliated.
The first thing is to report the work injury to the supervisor or authorized personnel. The authorized or supervisory personnel must give notice to the company in the days after the injury that are established according to the law of the region where the company is located in which the event has occurred. It is necessary and important to give notice of any accident at work, no matter how minor, and it must be detailed and include a description of the injury suffered at work along with the time and place of the injury.
ACCIDENT REPORT
The employer is obligated to report to the Insurer or corresponding Organization, any accident at work or occupational disease suffered by its workers. The complaint may also be made by the worker himself, his successors or any person who has had knowledge of the work accident or occupational disease.
The complaint will be addressed to the Insurer, but may be filed with the service provider that it authorizes for this purpose.
When the complaint is filed directly with the Insurer, it must take the necessary precautions so that the worker immediately receives benefits in kind.
In the event that the worker, his successors or any person who has had knowledge of the work accident submits a written complaint to the Insurer or ART Organization, it must contain a list of the facts, the identification of the parties (Worker / Employer) and the signature of the complainant.
MEDICAL BENEFITS
The corresponding body that handles the complaint has the obligation to provide, in case of contingencies provided by law, the following benefits in kind:
Medical and pharmaceutical assistance.
Prosthetics and orthopedics.
Rehabilitation.
Personal requalification.
Funeral services.
Medical and pharmaceutical assistance, prostheses and orthopedics, and rehabilitation must be granted while the symptoms persist or until they are completely cured.
Under Workers’ Compensation Laws, if the company has a list of approved doctors, the injured worker is required to treat with a doctor on the list for the first 90 days of treatment. The injured worker may treat with a non-listed doctor, however, he/she will be responsible for paying the bills.
If the company does not have a specific specialty covered on the list, the injured worker can go off the list to a doctor in that specialty. The company cannot force the injured worker to
try a doctor who is not on the list.
MONEY BENEFITS
The Insurer must provide the worker with a monthly cash benefit until he is discharged or until one year after his accident. During the first 10 days of absence of the worker, the cash benefits will be paid by the employer.
HIGH
The discharge must be granted in writing and notified to the worker. Upon discharge, the worker must report to his employer to resume work.
In the event of disagreeing with the discharge granted, you must inform your employer so that he or she may request a reinstatement to the company, or else directly request reinstatement to the company. If a satisfactory response is not obtained, the worker can initiate a procedure before the corresponding Medical Commission for discrepancy in the discharge.
DISABILITY PERCENTAGE
In case there was a sequel product of the accident. The percentage of disability will be estimated and notified by the insurer or organization after discharge from work or one year after the accident (whichever occurred first). The worker may accept the percentage granted by the agency or reject it.
In the event that the proportion is accepted, an agreement may be signed, which will then be approved by the insurer or authorized bodies. If it has not been agreed, the worker can initiate a procedure before the closest medical commission to his domicile.
HOW DO I KNOW IF MY INJURY WAS ACCEPTED?
Once the injury is reported, the insurance company must accept or deny the claim through one of the following documents:
Notice of Compensation: This document provides the injured worker with the greatest protection and stipulates the payment of lost wages and medical benefits. Once the notice is filed, the insurance company cannot stop payment of lost wages or medical benefits without a court order. At the time a notice is issued, the injured worker must also receive a Statement of Wages describing the calculation of the injured worker’s Average Weekly Wage and rate of remuneration.
Temporary Severance Notice: This document provides for the payment of lost wages and medical benefits. However, the notice may be revoked within 90 days and the request may also be denied.
WHEN WILL I START RECEIVING LOST WAGE BENEFITS?
The amount of your compensation is calculated according to the percentage of disability that has been set for you.
If the disability extends for seven (7) days or less, there will be no payment for benefits for lost wages under the Pennsylvania Worker’s Compensation Laws. If the disability extends from eight (8) to thirteen (13) days, benefits are paid only for the specified period of time. Benefit payments will be retroactive to the first day if disability extends fourteen (14) days or more. The first payment of benefits must be paid within twenty-one (21) days from the notification of the injury to the employer or from when the employer became aware of his or her disability.
HOW MUCH WILL A LAWYER CHARGE ME FOR REPRESENTING ME?
In a workers’ compensation case, you work on a contingency fee basis, which means attorneys’ fees will not be paid unless the attorney secures a settlement or wins the case. In addition, the workers’ compensation judge must approve the attorney’s fees. Consequently, there is no fee to monitor a case that is not yet in litigation.
Importance of the presence of a labor compensation lawyer in the previous administrative phase of a case are:
Insurance company or rehabilitation medical personnel may not have direct contact with a person represented by an attorney. The attorney acts as a go-between and makes sure that the injured worker does not make mistakes that lead to litigation.
Your attorney will review all legal documents and counsel the injured worker before signing a document that could ultimately negatively impact workers’ compensation benefits.
Your attorney will review the Statement of Wages to ensure that the injured worker is receiving the correct wage rate.
Your attorney can negotiate a Lump Sum Settlement for the injured worker.
How much money will I receive, while I am in workers’ compensation for an accident suffered at work?
This will depend on the answers given to the following questions:
Is the worker’s disability total or partial? How long have they been working at the company? Was the worker working for more than one employer at the time they were injured? What is their regular salary and is this a Fixed amount per week/month/year? Or another term to receive the salary?
The answers to these questions will help determine how to calculate the Average Weekly Salary. Once your Average Weekly Wage is determined, partial and total disability benefits can be calculated. The organization in charge of the company recognizes a maximum rate of compensation, which determines the maximum amount that you can receive. In any case, the basic way to calculate the maximum compensation rate is the Average Weekly Salary. This Average Weekly Salary is determined annually by the agency corresponding to the jurisdiction where the company is located.
How should compensation for an accident suffered be paid?
Compensation must be paid in the same pay periods the worker was paid before the injury. An insurance company can be fined for failing to comply with these regulations to pay the injured worker regularly and on time.
TOTAL PAYMENT AGREEMENT
A Lump Sum Payment Agreement is a one-time payment made by the company to the injured worker in exchange for the injured worker waiving his/her rights to workers’ compensation benefits. This results in a payment agreement that is commonly known as a “commitment and release agreement.” The settlement may include settlement of lost wage benefits and/or medical benefits.
Once the settlement is approved by the Workers’ Compensation Judge, the settlement is final. An injured worker will not be able to request that his/her case be reopened for additional benefits, even if his/her injury worsens in the future.
Once the settlement is approved by the Workers’ Compensation Judge, the settlement is final. An injured worker will not be able to request that his/her case be reopened for additional benefits, even if his/her injury worsens in the future.
WHAT SHOULD BE DONE IN CASE OF NOTIFICATION TO MODIFY, SUSPEND OR TERMINATE THE BENEFITS?
If this happens, you should seek the advice of a lawyer. This is an effort by your employer to have your workers’ compensation benefits reduced or eliminated. Your case will go before a Workers’ Compensation Judge. The Judge will hear the medical evidence and testimony and then make a decision regarding the pending petitions.
A modification request alleges that the injured worker can work with a loss of income. If granted, this petition would change the injured worker’s disability status from full to partial. The injured worker will be entitled to 2/3 of the difference between his Average Weekly Wage and the Presumed Earning Capacity. Partial Disability has a maximum limit of approximately one and a half years. Medical benefits continue indefinitely.
A stay request is based on the injured worker being able to return to work without loss of wages. If granted, this request stops wage benefits, however, medical benefits will continue indefinitely.
A termination notice alleges that the injured worker has fully recovered from the on-the-job injury. If this request is granted, the
lost wages benefits and medical benefits
WHAT IS CALLED NOTICE OF ABILITY TO RETURN TO WORK?
The Notice of Ability to Return to Work is a document that the insurance company is required to provide, informing the injured worker that he/she has been released to return to work. This document may be based on the opinion of the injured worker’s treating physician or an independent treating physician.
Based on the Notice of Ability to Return to Work document, the company will likely begin the vocational training process in an attempt to provide job references to available positions or provide proof of your earning ability. Such earning capacity is established by opinion testing, which is based on available positions provided by department agencies, private job search agencies, and job postings in the regular employment area.
Accordingly, the employer may suspend her benefits based on professional expert testimony that there are jobs within the work area that you may pursue. The company is not required to send you to job interviews.
If you receive a Notice of Ability to Return to Work, contact a workers’ compensation attorney immediately.
WHAT SHOULD I DO IF THE INSURANCE COMPANY STOPS PAYING THE BILLS?
Payment to healthcare providers for treatment rendered must be made within thirty days of receipt of invoice, unless the business/insurance questions the reasonableness and necessity of the treatment. If the bill in its entirety is not disputed, the account must be paid within thirty days of receipt of the bill.
If the insurance company refuses to pay the bill, it is up to the health care provider to challenge the non-payment by filing a fee review request. This review must be submitted within thirty days of notification of a disputed treatment or, within ninety days of the date the original bill was received.
If the company or insurance refuses to pay the bills based on the allegation that there was a lack of reasons for the medical treatment, then a Workers’ Compensation Judge has to intervene. The Workers’ Compensation Judge will have to determine if these bills are casually related to the work injury.
The Workers’ Compensation Judge may authorize the payment of up to 50% of the total outstanding invoice as a penalty, if the Judge considers that the company violated the Workers’ Law due to non-payment. Note: If the insurance company refuses to pay your medical bills, you should immediately consult with an attorney.
SHOULD I SIGN A SUPPLEMENTAL AGREEMENT?
A supplemental agreement is a form used to make an adjustment to the amount or length of payment of compensation benefits. This supplemental agreement can modify, suspend or terminate the payment of benefits to an injured worker. In this case, the advice of a lawyer is recommended before signing any binding contract, to ensure that you are not giving up any of your rights or benefits.
SOCIAL SECURITY DUE TO DISABILITY
This is an individual decision that must be based on the facts of each particular case. If you are receiving lost work compensation benefits, your Social Security benefits should be offset by Workers’ Compensation benefits. It is advisable to seek advice from a lawyer specializing in compensation and social security for disability.
SHORT TERM DISABILITY
In some cases, the company tells an injured worker to apply for Short Term Disability instead of filing a Workers’ Compensation claim. But the employer may be intent on limiting its risks with respect to workers’ compensation insurance premiums.
However, Short Term Disability offers several disadvantages to an injured worker:
Short Term Disability is taxable, workers’ compensation benefits are not. Most Short Term Disability plans only offer benefits for a short period of time, usually less than a year. Compensation benefits may continue indefinitely. If an injured worker waits until Short Term Disability benefits expire to file a workers’ compensation claim, he or she may bypass the 120 days available for such a claim and be barred from receiving workers’ compensation benefits. In the cases of Short Term Disability, only the total disability is compensated. Workers’ compensation benefits provide benefits for partial disability.
PERFORMANCE CHARGE WHILE RECEIVING COMPENSATION FOR ACCIDENT SUFFERED AT WORK
An employee may receive unemployment compensation as well as Worker’s compensation, as long as the employee notifies the Unemployment Compensation Department of his or her ability to work and also reports the unemployment compensation receipt to the Workers’ compensation insurer. In this case, a credit will be applied against your compensation, based on what you have received from unemployment. Severance pay benefits are generally preferable to unemployment compensation. Workers’ Compensation benefits are not taxed, but unemployment compensation is taxed. Additionally, Worker’s Compensation benefits are indefinite, while unemployment benefits are capped.
IS COMPENSATION FOR WORK ACCIDENT AT WORK AFFECTED BY RECEIVING RETIREMENT OR UNEMPLOYMENT?
Receipt of pensions or severance pay due to layoff may affect workers’ compensation benefits. The company responsible for the payment of the indemnity is entitled to the credit equivalent to the contribution that the employer makes to the pension plan or the liquidation due to dismissal. It is advisable not to withdraw any pension receipts or severance benefits before seeking the advice of an attorney.
WHAT ADMINISTRATIVE RESOURCES ARE THERE IN CASE THE ACCIDENT IS NOT CLASSIFICATED AS LABOR?
If the Insurance Company refuses to accept the injury suffered by the worker, lost wages and medical benefits will not be paid. The injured worker must file a petition to claim benefits and claim the case before a judge designated for that purpose.
Being the first instance of claim before the Insurance Company or Organization, in that order, the affected party may request the same instance that issued the resolution, to modify it or render it null and void, and thus the interested party may request the administrative body that issued the resolution. , that they study the background of the case again – in fact or in law – whether they think that some point of view was not considered or that some background was not taken into account or that some legal or complementary provision was misinterpreted, thinking that, had they been taken into account, the agreed resolution would have been another.
This situation is common in cases of commuting accidents. By, the pertinent body, can indicate that an accident suffered on the way to work is not classified as an accident at work because there is a difficulty on the way. A characteristic case is the situation of workers who are going to leave their children at the study sites. In this case, it is necessary to demand the qualification in view of the fact that the current legislation has estimated that said interruption is due to the real needs of the workers.
Other characteristic cases are accidents suffered during company festive activities or when visiting clients. In this case it is very important to attest to the immediate eventuality between the work and the activity explained. This is how, in cases of activities planned, financed and paid for by the employer, it has been decided that it is definitely the product of a work accident.
Another important situation occurs in the case of the union leadership, it is necessary to certify that the affected person was certainly carrying out a union activity.
It is necessary to point out that the proof of accidents according to the current administrative law is very broad, and can be complemented by any other means of proof, such as: witnesses, photographs, reports from private doctors, etc.