Today we will be talking about workers’ compensation law and who is eligible to make a claim. My guest is workers’ compensation attorney Bill Kovalcik and he is going to talk with us about this topic. So Bill thanks for being here today.
Bill: Well thank you for having me.
Interviewer: Bill, who is eligible for worker’s compensation benefits?
Bill: The Pennsylvania workers’ compensation system protects injured workers. So that means if you are employed, that employer is obligated by law to have insurance for workers’ compensation matters. Every insurance company who covers an employer then is obligated to pay your benefits. Now there is a distinction. There are some people who think they might be employed by a particular employer when in fact they are an independent contractor. This is a difficult question that needs to be analyzed by an attorney. So if you’re hurt and you’re not sure where you’re going to get your benefits from, you need to seek an attorney’s advice about this. Now, the other thing I would like to point out is that some employers don’t have any insurance, they are violating the law. If you get hurt working for them that doesn’t mean you’re out of luck. There is a fund called the uninsured employers guarantee fund in Pennsylvania and that fund will pay your claim if your employer doesn’t have insurance.
Interviewer: Okay and if I am injured at work how is my claim decided?
Bill: If your claim has been denied, for instance you get hurt and the insurance company doesn’t voluntarily pick it up, that means you’re going to need an attorney. You come to us and here is what we will do for you. We will file what is called a claim petition. This petition is filed with the Department of Labor and Industry, Bureau of Workers’ Comp in Harrisburg. Once it is filed it will be assigned to a judge in a jurisdiction near your home. That judge will schedule hearings, there will be depositions of doctors, and the injured worker will have to testify. This process is long and tedious and sometimes takes 9 to 12 months before a judge will actually make a decision. This scares a lot of people away but keep in mind that we settle a lot of these cases along the way. A lot of our clients can’t wait 9 to 12 months to have an income once again. So we can settle them sometimes for a lump sum or just resolve them in a way that provides the injured worker with income.
Interviewer: And how are lost wage benefits calculated?
Bill: When you’re hurt at work the insurance company is obligated to calculate what is called the average weekly wage. Under the law, that requires that they go back one year in time from your date of injury and calculate all the wages you had on a gross basis, come up with an average, and that number is your average weekly wage. Your compensation rate, which you actually get, is usually two thirds of that. Usually people in the lower income brackets get the benefit of 90%, so their average weekly wage is multiplied by 90% and that’s their compensation rate.
Interviewer: Okay and how is workers’ compensation paid out? Is it weekly, bi-monthly or a lump sum?
Bill: That’s a good question. The benefits under the law for wage loss are to be paid the same way you got paid at work. So an individual who gets paid every week, he gets hurt, he goes on workers’ comp benefits, he is supposed to get a check then every week. Same with bi-weekly. If you were paid bi-weekly, that’s how you’re going to get your workers’ comp benefits. The other way you get wage loss benefits is in a settlement. So if, for instance, you’ve been on workers’ comp benefits for a while and the insurance company has a desire to stop paying those benefits, they may offer you a lump sum. So that money is paid all at once after your attorney’s fees of course, and that lump sum is called the compromise and release. Not everybody gets these. Just because you get hurt at work it doesn’t mean you’re ever going to get the money in a lump sum. Some cases it’s appropriate, and some it isn’t. The attorney can advise you as to which category you’re in.