If you live in the Pittsburgh area and are hurt on the job, the good news is you are much less likely to be killed than when the Steel City really was the Steel City.
The bad news is if you are severely injured, you might be in for a fight to get the workers’ compensation benefits you are entitled to.
“Our state does a reasonable job compensating minimally and moderately impaired,” said Pittsburgh attorney Tom Baumann. “The severely impaired … No!”
He should know. Baumann won a landmark case before Pennsylvania Supreme Court in 2017 – Mary Ann Protz vs. Workers Compensation Appeals Board – that voided the use of the Sixth Edition of the American Medical Association’s Guide to Evaluation of Permanent Injuries as a reason to reduce severely injured workers status – and benefits – from permanently disabled to partially disabled.
Employers and their insurance companies freaked out and unleashed their lobbyists on legislators. Just a year after the landmark court ruling, the Pennsylvania General Assembly passed a law reinstating the AMA Guide that the court had ruled unconstitutional.
The legislature did make one concession, reducing the impairment rating level to move people from permanent to partial disability from 50% to 35%.
“It was a partial victory,” Baumann said. “A lot of people who had their benefits unfairly
reduced, saw total disability benefits reinstated. With the subsequent bill reducing the level to
35% impairment more injured workers qualified for total disability benefits and that was a
positive development. You’re always trying to come up with novel ways to help your client and I
think we did that.”
Signs You May Need a Workers Comp Attorney in Pittsburgh
The next time you’re in the company break room or any main meeting area for employees, check the bulletin board. There should be an official-looking notice about what you should do if you’re injured at work.
If there isn’t one, it doesn’t mean your employer is going to give you a hard time if you get hurt. But the lack of a sign is not a good sign.
Employers in Pennsylvania are required to carry worker comp insurance. Ideally, if you are hurt on the job, the state’s system will work smoothly. You get hurt, file a claim, get proper benefits, get well and go back to work.
The hitch is when your employer’s idea of “proper benefits” differs from yours. And that can be a big hitch if you are permanently disabled. But first things first.
“The first thing I tell them is give notice immediately,” Baumann said. “If somebody gets hurt on Friday and reports it on Monday, that claim might be denied because the insurance company will say you got hurt over the weekend.”
You’ll actually have 120 days to report your injury. And once you provide notice, you have three years to file a claim. But it’s highly advisable to do it as soon as possible. Then the ball is in your employer’s court.
You might need to call a workers compensation attorney like Baumann if:
- Your employer doesn’t respond in the allotted time.
- After you give notice of an injury, your employer has 21 days to issue you a Notice of Temporary Compensation Payable and 90 days to accept or deny liability for the injury.
- The settlement won’t cover all your losses or pay all proper medical bills.
- Your employer or the insurance carrier says the injury didn’t happen at work.
- Your employer harasses you or retaliates against you. Such offenses can be subtle, like questioning your work ethic, judgment or making jokes about your situation. Or the employer could increase your workload without increasing your pay. Remember, it’s illegal to fire employees who are simply exercising their employment rights.
- Your claim is denied. The appeals process involves judges, legalese, deadlines and a myriad of other issues. You can try to build and argue a case, but it’s better left to somebody who does that for a living.
What Does a Workers Comp Lawyer in Pittsburgh Do?
The workers compensation system can turn into a muddled mess that controls your life. A lawyer’s job is essentially to guide you through the many potential pitfalls. For instance, Pennsylvania requires injured workers to be examined by a doctor chosen by the employer if they want to be covered by insurance.
There’s a panel of six doctors to choose from in the first 90 days. Even if you are severely
injured and get through the initial phases, a doctor must attest that your entire body is at least
35% or more impaired in order to receive permanent benefits.
The problem is there’s an inherent conflict of interest when doctors selected by employers are essentially in charge of deciding whether you get paid.
“They are chosen for their friendliness and not their competence,” Baumann said. “Most people on the panel I would not want my family treated by. There are exceptions, but if a competent doctor calls it the way he sees it too many times, that doctor is removed from the panel.”
A workers compensation lawyer acts as a watchdog over that process. They handle everything
from adversarial hearings to the basics of the legal system, such as:
- Taking depositions
- Lining up expert witnesses Conducting settlement negotiations
- Cross-examining witnesses
- Filing case paperwork properly and on time
- Pursuing appeals all the way to the Pennsylvania Supreme Court, if that’s what your case warrants.
The ultimate goal isn’t just to get you paid, it’s to give you peace of mind along the way.
“I tell clients the best thing is I can do is to help you maintain control over your life,” Baumann said, “because carriers will control them.”
How Much Does a Workers Comp Attorney in Pittsburgh Charge?
Workers compensation attorneys in Pennsylvania are paid on a contingency basis, meaning the attorney only gets paid if he/she wins the case.
In other words, it doesn’t cost the injured worker anything to hire a workers comp lawyer. The worker can consult with an attorney and watch as the attorney prepares the case … and it won’t cost the worker a thing.
Workers should be aware that there are expenses involved in preparing a case for mediation or, if it gets that far, in front of a judge. Witnesses have to be deposed, documents have to be ordered and examined, evidence has to be collected, etc.
The attorney bears the cost for all of those things. If the worker wins the case, the insurance company will pay the costs for all that prep work. If the attorney loses the case, it doesn’t cost you anything. The lawyer bears all the costs.
And judges must approve all attorney fees.
“My clients tend to be a little overwhelmed by the system,” Baumann said. “A smart person willing to do their homework on an uncomplicated case might be able to do it, but I do not think most people have the ability to handle a case on their own.”
Handling a Workers Comp Case on Your Own in Pittsburgh, PA
The first step in a workers comp case is to notify your employer. That will kickstart the process of filing a workers compensation claim. If your claim is denied, you have the option to appeal the decision.
Filing a Workers Comp Claim in Pittsburgh
You have 120 days from the date you were injured to tell your employer. Do not wait that long.
Notify your employer of your injury as soon as possible. You can receive workers comp benefits from the date you were injured, but only if you report the incident within 21 days of its occurrence. If you wait more than three weeks to report it, you’ll receive benefits from the date you reported the injury.
Employer’s Responsibility for Filing Claim
Once you have lost a day, shift or turn of work, your employer has three days to file a First Report of Injury with the Pennsylvania Bureau of Workers Compensation. Your employer has to report your injury to its insurance company within 21 days of being notified of the incident.
Insurance Carrier’s Responsibility with Claims Form
If your employer’s insurance company accepts your claim, you’ll be issued a Notice of Compensation Payable and start receiving benefits. In some cases, the company will issue a Notice of Temporary Compensation Payable.
That means it hasn’t made a decision on your claim, but will pay benefits until it does. If the insurance company rules in your favor, it can still reverse its ruling within 90 days and stop paying benefits.
If your claim is denied, you’ll be issued a Notice of Workers Compensation Denial. Then you have the right to file a claim petition with the Bureau for a hearing before a workers compensation judge. You have three years to file such an appeal.
How to Appeal a Workers Compensation Claim in Pittsburgh
If your benefits are denied, you have three years from the date of your injury to file a Claim Petition (LIBC-362). This is where an attorney could come in handy collecting information and presenting your case.
The case gets assigned to a workers comp judge, who will hear evidence from both sides during a hearing.
The judge will then schedule the case for mediation. During mediation, the two parties will try to negotiate a settlement.
If they aren’t able to reach an agreement, they may ask for an informal conference or settlement conference with the judge, who will issue a ruling.
Directions to the Workers Compensation Hearing Site in Pittsburgh:
If the ruling goes against you and you choose to pursue your case, you can file an appeal with the Workers Compensation Appeal Board within 20 days of the judge’s decision.
Odds are the Appeal Board will not reverse the judge’s decision, since it gives judges a lot of discretion in deciding cases.
If the Appeal Board rules in favor of your employer, that decision can be appealed to the Commonwealth Court of Pennsylvania. Unlike the Appeal Board, the Commonwealth Court is not required to hear all cases. It takes cases with compelling legal issues, which amounts to about 10% of all appeals.
Henderson, T. (2018, December 12) The Mystery of Pittsburgh: How Some Shrinking Cities Are Thriving in the New Economy. Retrieved from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/12/12/the-mystery-of-pittsburgh-how-some-shrinking-cities-are-thriving-in-the-new-economy
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N.A. (2016, January, 6) Protz v. Workers’ Comp. Appeal Bd. Retrieved from https://casetext.com/case/protz-v-workers-comp-appeal-bd-1
N.A. (ND) Workers’ Compensation. Retrieved from https://www.dli.pa.gov/Businesses/Compensation/WC/Pages/default.aspx