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How To Use This Section Of Our Wesbite

If you have a question about Workers Compensation or Social Security, you’ve come to the right place.

We have answered hundreds of questions our clients have asked us over the years right on this site.

Just look to the right and you’ll see a section that says “Have A Question?”. Just type your question in the box and click Search.

If we have an answer and other information related to your question on this site, it will show on the screen for you.

If we do not have your answer, it’s okay. Just pick up the phone and call us at 877-291-9675.

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Choose him to get the job done

Thomas has worked on my Social Security Case and a very difficult Workers Compensation Case. I have had the pleasure of him representing me for at least seven to eight years. He always kept me informed on any changes or what to expect on both cases. I trusted him with all my information and it was very relaxing to know that he was knowledgeable of all that needed to be. He also respond at anytime I have called him, and he kept me informed me at anytime. I really would advise clients to choose him to get the job done. He has the ambulation to take on a challenge and to concord it. I would do it all over again if I had to. I’m still involved with Thomas because he said once my client always my client. And until today I can count on him to do or be there for me and my difficult situations that ever arise in my life. Thank You Thomas for all your service. Barbara Harrisburg, PA

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In most cases when an injured worker gets a bill for their workers’ comp injury is a “Balance Bill.” A Balance Bill is when a medical provider charges the injury worker the difference between the provider’s charge and the amount paid by the insurance company. This practice is prohibited by the PA Workers Compensation Act, 34 Pa. Code Section 127.211 (a), titled “Balance Billing Prohibited,” which states:

A provider may not hold an employee liable for costs related to care or services rendered in connection with a compensable injury under the Act. A provider may not bill for, or otherwise attempt to recover from the employee, the difference between the provider’s charge and the amount pain by the insurer.

The problem with “Balance Billing” lies with how the Pennsylvania Workers Compensation Act was written. There is a gap in the law when it comes to Pennsylvania Medical Provider as compared to out-of-state medical providers.

Most Pennsylvania medical providers are aware of the law that prohibits them from balance billing. However, when you are dealing with an out-of-state medical provider they may not be aware because Workers Compensation laws vary widely from state to state.

An out-of-state medical provider may not be aware or disregard the PA Workers Compensation laws. To further complicate this, the Workers’ Comp Act doesn’t specifically state in the section referring to Out-of-State medical treatment that Balance Billing is prohibited from these providers.

The PA Workers Compensation Act, 34 Pa. Code Section 127.129, titled “Out-of-State medical treatment,” states in part that:
When you treat with out-of-state medical providers who are not licensed by the Commonwealth to provide health care services, the amount that the workers compensation insurance company shall pay for medical treatment is capped.

The medical fee cap is based off of the Medicare reimbursement rate applicable in Harrisburg, Pennsylvania.

This amount may not cover the full amount of the cost of treatment from the provider and the out-of-state medical provider sends you a balance bill. The Act doesn’t specifically state that this action is prohibited for an out-of-state medical provider. In addition the Pennsylvania Workers Compensation website’s FAQ warns; “If you seek treatment outside Pennsylvania, you may be subject to the risk of balance billing by the medical provider.”

Thus leading to the “gap”, in which out-of-state medical provider can attempt to collect the balance from an injured worker.
You should immediately take action when you get a bill from a medical provider for your compensable Pennsylvania workers compensation injury. Whether the bill is from an out-of-state medical provider or a Pennsylvania medical provider, this is the first sign that there may be a problem with your PA Workers’ Compensation Claim.

The law firm of Calhoon & Associates represents injured workers and Social Security Disability applicants throughout Pennsylvania, including (but not limited to): Allentown, Altoona, Bellefonte, Bethlehem, Bloomsburg, Carlisle, Chambersburg, Easton, Enola, Fayetteville, Gettysburg, Harrisburg, Hazelton, Hollidaysburg, Huntingdon, Lancaster, Lebanon, Lewisburg, Lewistown, McConnellsburg, Mechanicsburg, Mifflintown, Millersburg, Milton, New Bloomfield, Newport, Philadelphia, Pittsburgh, Pottsville, Reading, Scranton, Shippensburg, State College, Sunbury, Uniontown, Washington, Wellsboro, Wilkes-Barre, Williamsport, York and all cities and towns in Adams County, Allegheny County, Berks County, Blair County, Bucks County, Centre County, Chester County, Clinton County, Columbia County, Cumberland County, Dauphin County, Fayette County, Franklin County, Fulton County, Huntingdon County, Juniata County, Lancaster County, Lebanon County, Lehigh County, Luzerne County, Lycoming County, Mifflin County, Montgomery County, Northumberland County, Perry County, Philadelphia County, Schuylkill County, Tioga County, Union County, Washington County and York County, Pennsylvania.

Calhoon & Associates
2411 North Front Street
Harrisburg, PA 17110
1-877-291-9675

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The short answer is Yes, but be cautious. There may be problems with paperwork and billing. Pennsylvania Workers Compensation law says any doctor that wants to get paid by the workers’ comp insurance carrier must file a Pennsylvania form called LIBC-9 and monthly thereafter plus an HCFA 1500 form, their bill and copies of office notes. Failure of the doctor to do this means that the Workers Comp Insurance Carrier does not have to pay the bill in most circumstances. Workers’ Compensation laws are completely different from state to state with different forms and procedures. Thus, an out-of-state doctor is not going to know how to follow the PA Workers Compensation rules and may be unwilling to learn. We can email him or her our book on how to get work related treatment bills paid and it contains all the forms they need. It is easy to see how there can be problems with billing and payments when an out-of-state doctor is treating a PA WC injury.
Pennsylvania law says that a doctor can’t hold an injured worker with a recognized PA Workers Compensation claim responsible for payment of Workers Comp related medical billing. Also, a doctor is not allowed to “balance bill” a claimant, ie, charge the injured worker the difference between the face amount of the bill and the lesser amount that Workers Comp pays under the PA fee schedule. This rule can be difficult to enforce against PA doctors and is even more difficult to enforce against an out-of-state doctor. Thus, PA injured workers with PA Workers Compensation claims who treat with out-of-state doctors may find themselves being held responsible for payment of work related medical bill.

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The Pennsylvania Workers Compensation Act was signed into law in 1915. Many people ask why and what was its purpose? There were two main reasons: 1) employees were beginning to sue employers for negligence and winning; and 2) social reformers thought something to be done to help injured families at a time when there was no welfare, unemployment or Social Security. The Workers’ Compensation Act was seen as a compromise deal. Workers’ Compensation was created to give the injured workers a prompt and non-technical source of benefits but injured workers gave up their right to sue over workplace negligence.
Pennsylvania Workers’ Comp has been changed many times over the past 100 years, sometimes in favor of injured workers and sometimes in favor of employers. In 1972, Pennsylvania modernized and liberalized its Workers Compensation law because it was too strict and too slow. Since the 1990’s, two major changes to the law favored employers in significant respects. Some of these changes significantly reduced the amount of Workers Compensation benefits paid to injured workers and for how long those benefits would be paid. Also, the practice has become hyper-technical.
Why did this happen? First, the rapid decline of Unions in Pennsylvania in the 1980s and 1990s meant there was no one with any clout speaking about and advocating for injured workers. Second, the legislators and so called “experts” came to view Workers Comp as an insurance payment system to be managed rather than a grand bargain between employers and employees; whereby injured workers gave up their right to sue employers over work place negligence. Pennsylvania Courts have generally upheld the bar against suing employers over workplace negligence.
In some states, the bar against suing employers over work place negligence is beginning to weaken. The Courts recognize that some states Workers Comp laws have become too restrictive and thus become unfair to injured workers. In essence the injured worker’s rights have been “managed” out of existence by bureaucrats who don’t know or don’t care about the tremendous savings reaped by employers who enjoy immunity from negligence-based lawsuits. This may start in happen in Pennsylvania as well. Stay tuned. In the meantime, workers’ compensation is the sole and exclusive remedy against one’s employer for damages caused by a work injury. That is why it is so important, to hire a great workers’ compensation attorney for any serious injury.
The law firm of Calhoon & Associates represents injured workers and Social Security Disability applicants throughout Pennsylvania, including (but not limited to): Allentown, Altoona, Bellefonte, Bethlehem, Bloomsburg, Carlisle, Chambersburg, Easton, Enola, Fayetteville, Gettysburg, Harrisburg, Hazelton, Hollidaysburg, Huntingdon, Lancaster, Lebanon, Lewisburg, Lewistown, McConnellsburg, Mechanicsburg, Mifflintown, Millersburg, Milton, New Bloomfield, Newport, Philadelphia, Pittsburgh, Pottsville, Reading, Scranton, Shippensburg, State College, Sunbury, Uniontown, Washington, Wellsboro, Wilkes-Barre, Williamsport, York and all cities and towns in Adams County, Allegheny County, Berks County, Blair County, Bucks County, Centre County, Chester County, Clinton County, Columbia County, Cumberland County, Dauphin County, Fayette County, Franklin County, Fulton County, Huntingdon County, Juniata County, Lancaster County, Lebanon County, Lehigh County, Luzerne County, Lycoming County, Mifflin County, Montgomery County, Northumberland County, Perry County, Philadelphia County, Schuylkill County, Tioga County, Union County, Washington County and York County, Pennsylvania.

Calhoon & Associates
2411 North Front Street
Harrisburg, PA 17110
1-877-291-9675

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GREAT NEWS: RECENT CHANGES MEAN WORKERS’ COMPENSATION WAGE LOSS BENEFITS NO LONGER COUNT AS INCOME FOR MEDICAID

Medicaid is a public health insurance program provided by the state for individuals who meet certain income, resource and eligibility requirements. Specifically, an individual must be a resident of Pennsylvania, have qualified immigration status (if applicable), and meet the income and resource limits for medical assistance. Both children and adults can be eligible for Medicaid. More information on Medicaid benefits and eligibility requirements can be found at www.phlp.org.

To the benefit of Pennsylvania (PA) injured workers receiving workers’ compensation wage loss benefits, beginning in January, 2015, workers’ compensation wage loss benefits no longer count as income when applying for medical assistance benefits under Pennsylvania’s Medicaid Expansion Program.

Medicaid applications can be filed online at www.compass.state.pa.us or www.HealthCare.gov (may take longer), by calling (866) 550-4355, or by visiting your local County Assistance office.

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My Cousin Vinny. Remember the movie?

Two boys are mistakenly accused of murder while on a road trip in the south. They are thrown into a small-town jail, and they cannot afford a lawyer. One boy remembers, “My cousin Vinny’s a lawyer!”

Enter Joe Pesci as a brash New Yorker with a brand new law degree. In spite of himself, Vinny wins the case, exonerates the boys, and gets the girl.

But that’s Hollywood.

In the real world, the success of your case may very well depend on your selection of the right attorney, or at least on your avoidance of the wrong one. Before we examine the various methods of finding an attorney, let’s make one thing crystal clear:

You Need A Specialist!!

This simple assertion seems obvious, but surprisingly, it is frequently ignored or not even considered. If you broke your leg, you would not seek the services of an OB/GYN, right?

You know by now that the world of workers’ compensation law is multi-faceted and convoluted. Thousands of workers’ compensation claims are filed in Pennsylvania every year. Consequently, just like wills and trusts, corporate law, divorce and bankruptcy, workers’ compensation law has become a major area of specialization in the legal world. There are many of us out there. Here are some tips on finding the right workers’ compensation attorney for you. . .

Yellow Pages. . .

This can work, but keep in mind:

• Not all attorneys advertise in the Yellow Pages.
• Beware of the ads that claim to practice in all facets of the law. No one is good at everything.
• Be wary of the splashy full-page ads. They may draw too many frivolous cases that tie up the attorney’s time. You will not find us in the Yellow pages. For the same reasons, you will not find us doing TV commercials.

Ask a Friend . . .

If your friend filed a workers’ compensation claim and was happy with his legal representation, definitely put that attorney’s name on your list. There is nothing better than a recommendation from a satisfied customer.

Call the Bar Association. . .

This, too, can work. Just be aware that attorneys pay to be listed in these referral databases. Nevertheless, if you find the name of a workers’ compensation law specialist from a referral database, by all means, add his or her name to your list.

Ask a Lawyer. . .

If you have had a good experience with an attorney in another field of law, or if your family has a lawyer that you trust, ask him or her for a referral to a workers’ compensation attorney.

Check Lawyer Reviewing Sites. . .

Attorneys are rated by their peers. To see some attorneys ratings, as well as client reviews, go to www.superlawyers.com/pennsylvania and www.avvo.com. What other attorneys and former clients think of the attorney is a pretty good indication of that attorneys skills and efforts.

Accreditation: make sure the attorney is certified as a workers’ compensation specialist by the PA Supreme Court.

With this information, you are on your way to finding the right legal representation for your claim. However, you are not done yet! In our next correspondence, we will look at selecting your best alternative from the list you have compiled. Get busy, do your homework, and please do not call your cousin, Vinny!

Of course, you can come in for a free consultation. We will listen to your case, advise you on its merit, and help you to keep the system working for you. The road to protecting your rights under the law starts with Calhoon & Associates, P.C.

Find out if we’re right for you.

Call Us Today: 877-291-9675

Serving injured workers throughout Pennsylvania.

FREE CONSULTATION • FREE CASE MANAGEMENT • NO RECOVERY, NO FEE

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Wrong. Very wrong. A PA Workers’ Compensation Judge does not have the power or authority to tell an injured worker worker that the settlement being offered by an insurance company is too low or is a bad idea. Thus, an injured worker can accept a settlement of $10,000 for a case worth $1,250,000.00 and the Workers’ Compensation Judge can’t disapprove it as long as the injured worker says he understands it.
The result is that many workers’ compensation cases settle for far less than they are worth since the workers compensation insurance company will press for the deal that suits them, not the injured worker.
A good example of this is medical coverage. WC insurance companies commonly demand “closed medical” no more medical bills being paid by the WC insurance carrier) even though the injured worker is entitled to life time medical coverage and pay no additional consideration to settle the medicals on top of an unfair settlement of the wage loss liability. There is no requirement that the adjuster tell you the truth about what your future rights and entitlements are! Most workers’ comp attorneys will review a settlement offer for free and give free legal advice whether the settlement being offered is fair and reasonable. Feel free to contact us, 24 hours a day.

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I was told about Attorney Calhoon by a few people. Believe me when I tell you, he is the best that I have ever contacted. He jumped right on the case and didn’t let up. At first I contacted [name omitted, one of those law firms that has to spend over 500k a year to get clients] , what a mistake that was. They sat on my case for 2 years and did nothing. When I contacted Mr. Calhoon, he immediately started working on it. Within a month or so, we had our first hearing with Workman’s Comp. He stuck right with the case and within a few short months, we went to settlement. Not what he or I wanted, but if … would not have just sat idle, we probably could have negotiated for a much bigger settlement. Due to the fact that I reached Medicare age, we had to take what we could get [he got my past bills finally paid and a lump sum that had to stay under a certain number due to Medicare issues]. Ron is a very intelligent lawyer and I would recommend him to anyone who is having a problem with Workers Compensation. As a matter of fact, I recommended my daughter call him because of her problem. I thank you and your staff, from the bottom of my heart for everything you did for me. -James P. Harrisburg, PA

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Injured worker, Sam, suffered a work injury to his left knee, an MCL tear. He was off all work for a year, and during that time, had left knee surgery, which did not fully heal his knee.

On October 21, 2014, he began funded employment with Vision Resource Center/Employment Alternatives as a sheltered workshop assistant. The job was created by the workers’ compensation insurance carrier, and was not meant to last forever. It is not a position available to the general public or performed by regular employees. The PA workers’ compensation carrier funds the employment (i.e., they pay the employer to employ the injured worker at no cost to the employer). The position was created solely for the injured worker as a way to reduce workers’ compensation benefits. In this position, Sam stands or sits with another individual and inspects candy that has been boxed by blind people. He is able to take breaks when needed and is allowed to produce less “work” than other workers.

Although injured worker Sam receives partial disability workers’ compensation benefits for this injury, we also applied for Social Security Disability benefits to increase his monthly income. The Social Security Administration determined that this “funded employment” is not substantial gainful activity, as it does not involve performing significant and productive physical or mental duties and is performed under special conditions. Social Security Disability benefits were awarded to the injured worker on top of his wages and workers’ compensation. Now, if we reach a settlement of his workers’ compensation, his SSD benefits should dramatically increase. In addition, he will have Medicare health insurance.

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Simetimes people need help just like in my case. Ron handled every little detail with his knowledge of law and kept me informed from day one and made sure things went well. I can honestly say I made the right choice on calling him to represent me. Never would of thought that getting hurt on the job would be a burden, but Ron took that burden away. Ron in person looks just like an average blue collar man, easy going and laid back look. After you talk several minutes you sense his knowledge, his determination, his presence. Ron is one of the best I’ve ever came across. Art C., a Truck Driver, who received a $191,500.00 workers’ comp settlement for an elbow injury not requiring surgery.

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“Warning: Fatal Error on the Motherboard!!!”

If you are like me, these words give you that sinking feeling in your stomach. There are fatal errors that can annihilate your workers’ compensation case before it even gets started. Once these errors are committed, even the best workers’ compensation attorney will be hard-pressed to reboot your claim. It is vital that you become aware of these mistakes, understand them, and avoid them at all costs. . .

Hiding past accidents. . .

If you were involved in a prior accident, the insurance company WILL know about it. They will then try to draw a correlation between that accident and your current injury. Assuming that there is no correlation, an experienced workers’ compensation attorney can help you prove the point, and maybe even help you identify unclaimed benefits resulting from the earlier accident.

However, if you try to conceal the prior accident from your employer, the insurance company, your attorney, and/or the Workers’ Compensation Board, you will most likely lose your case.

Hiding past injuries. . .

Same rationalization as above. When you file your claim, you will be asked if you have experienced any similar injury or illness in the past – be honest. The insurance company is hoping that you will lie. If you do, your case is closed.

Misrepresenting your earnings. . .

Your workers’ compensation benefit for loss of wages will be based, by definition, on your wage history. We have seen cases where the employee claims a wage history in excess of that paid by his employer. The reasoning goes like this: “Well, I earned $1,500.00 per week at the office, but I also earned $600.00 per week in my home business. Now that I am injured, I can’t do either job.” The problem is that the $600.00 income stream cannot be proven.
If you cannot support your income claim with tax returns, do not try to include it on your workers’ compensation claim. Remember, honesty is the best policy.

Misrepresenting your activity level. . .

It is your job to inform the insurance company, your attorney, and the Workers’ Compensation Board if you return to work in any way, shape, or form. This includes work in a different capacity, part-time work, and even volunteer efforts.

The insurance company hires investigators to monitor your activities. Misrepresentation is the kiss of death for your case. Additionally, claiming that you cannot stand, stoop, lift, etc., had better be the truth. If you are caught dancing or playing Frisbee on the beach, your case may be over and done with.

Failing to seek employment within your new capabilities. . .

The insurance companies have managed to convince the Workers’ Compensation Board that if you are only partially disabled and are not looking for a job that you can still do, then you are no longer in the workforce. Workers’ compensation cases have been denied on this basis alone. An experienced workers’ compensation attorney can help you navigate this one without rocking the boat.

Come in for a free consultation. We will listen to your case, advise you on its merit, and help you to keep the system working for you. The road to protecting your rights under the law starts with Calhoon & Associates, P.C.

Avoid Fatal Errors!

Call Us Today: 877-291-9675

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ABLE TO SPEED UP WORKERS’ COMP SETTLEMENT

Ron was very informative and was able to get me a fair settlement. He was straight forward and honest about my case and what I was able to ask for as far as compensation. He was also able to speed things up by filing a penalty petition when the insurance company failed to send payment on time. Would highly recommend. Thank you for a job well done. My family and I appreciate your help in getting this case resolved. Mark S., Jersey Shore/Williamsport, PA after a $212,500 settlement of workers’ compensation case settling future benefits.

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“Sure, I’d love to have an attorney handle this workers’ comp mess, but I can’t afford it!”

Sound familiar? Let’s examine the value proposition. . .

The initial consultation is FREE. . .

That’s right. Free. Zip, zilch, nada. You can make an appointment with an experienced workers’ compensation attorney, sip his coffee, and talk about yourself! We will listen.

Each case is different, and we have decades of experience with employees and insurance companies to bring to the table. We will answer your questions about the strength of your case and its distinctive attributes.

If you have a straightforward case, we will advise you not to hire an attorney. We will also advise you on what steps to take if you decide to “go it alone” without further legal counsel.

If it is a more complex case, we will explain how the system works and how we can help you going forward.

Conversation, coffee, and insight. For FREE. What are you waiting for?

Workers’ Comp attorney fees are set by a special workers’ compensation judge. . .

Workers’ compensation attorney’s fees are set by statute and are normally made up of a percentage of the total benefit, plus costs. The percentage is generally in the ten to twenty percent (10% to 20%) range. Fees are not paid unless and until after approved by a judge.

Workers’ Comp attorney fees are not charged until the case has been won and the benefit paid. . .

The fees are deducted from your reward when we win your case. No fees are charged if there is no benefit payment. Plus, costs are paid by the insurance company when we win or settle. If we do not obtain you an award or settlement, all of our guidance, legal counseling, expert attorney advice and help is for FREE. We only get paid on results.

We can make lemonade out of lemons. . .

No two workers’ compensation cases are alike. Employees, employers, co-workers, work duties, and environments all vary. But, in very general terms, workers’ compensation attorneys are very useful in these four categories of claims:

• The worker has been denied benefits to which he or she is entitled.
• The worker has been directed to return to work before medically able.
• The worker has been denied extended or permanent compensation despite significant disabling injury.
• Carefully coordinating various benefits to maximize all available benefits with a lump sum settlement of future workers’ compensation benefits.

In all of these types of cases, an experienced Pennsylvania (PA) workers’ compensation attorney can make an enormous difference in securing the benefits to which an employee is entitled.

Come in for a free consultation. You will probably decide that you can’t afford NOT to hire an attorney to protect your rights. The road to protecting your rights under the law starts with Calhoon & Associates, P.C.

The call is FREE.
Our conversation is strictly confidential.
And there is absolutely NO obligation.

What are you waiting for?

Call Us Today: 877-291-9675

Serving injured workers throughout Pennsylvania.

FREE CONSULTATION • FREE CASE MANAGEMENT • NO RECOVERY, NO FEE

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I can’t file a claim because I already tried and my case was denied. . .
Ideally, you consult an experienced PA workers’ compensation attorney as soon as the accident occurs or the work-related injury becomes apparent. However, if you filed the claim on your own, and it has been denied by the adjuster, it is not too late!
A qualified attorney can ensure that the facts in your case are presented in the proper manner so as to address the reason for denial. Claims can be denied for many reasons including:
• Lack of proper medical documentation
• Pre-existing conditions
• Failure to seek medical help
• An adjuster who does not know the law

You are already coping with injury, pain, loss of wages, and medical billing nightmares. Do you really need the extra stress of denied claims? Let a professional handle it for you.

I didn’t have an accident. How could I prove that my condition is work-related?

Workers’ Compensation Insurance protects employers from litigation resulting from work-related illness, medical condition, and chronic injury, as well as acute accident-related injury. Here are a few examples:

• Back Pain
• Repetitive Stress to joints
• Carpal Tunnel Syndrome
• Pain Management
• Psychiatric treatment for depression resulting from loss of work due to injury
• Cartilage damage
• Exposure to chemicals

All of these conditions can qualify for PA workers’ compensation insurance claims. An experienced workers’ compensation attorney can help you establish a legitimate link between your condition and your work.

I am not a US citizen. How could I be entitled to Workers’ Compensation benefits?

If your injury is work-related, and the employer was compensating you, you are covered by your
employer’s workers’ compensation insurance policy. This includes:

• Part-time employees
• Workers paid “under the table”
• Temps
• Workers paid in cash
• Seasonal employees

Do not talk yourself out of benefits to which you are entitled and for which your employer has paid. Call an experienced workers’ compensation attorney to learn about your rights.

My husband died from his work-related injury. I already collected life insurance. . .

Death benefits are provided to surviving spouses and dependent children of workers who are killed on the job. Your life insurance policies, whether employer-purchased or self-purchased, are entirely separate from the workers’ compensation benefits to survivors.

I didn’t think it was a big deal when it happened. I still have pain, but it’s been a year, so I think it’s too late to file. . .

You are required to notify your employer of a work-related injury within thirty (30) days. But you have three (3) years to file a workers’ compensation claim. We can also sometimes prove that an employer was notified, even though a form was not filed. Co-worker witnesses and reconstruction of discussions in the workplace can be used to establish notification.

It was my own dumb fault. I knew the drawer was broken, so I shouldn’t have tried to open it all the way. . .

Workers Compensation Insurance is founded on a no-fault guiding principle. It does not matter who was at fault: you, your boss, your co-worker, or no one. You are still covered.

I am in the country illegally. I can’t file for benefits. . .

If you are injured on the job, you are entitled to workers’ compensation protection, regardless of legal status. Of course, by filing a workers’ compensation claim, you will most likely be discovered, and your deportation may be the result. Depending on your injury, going home with a good workers’ compensation settlement may be the best course of action. Come see us for a free and discreet review of your options.

Come in for a free consultation. If you are not entitled to benefits, we will tell you. But chances are, you may be pleasantly surprised. . .

Don’t sell yourself short. Get the facts you need TODAY.

For a confidential conversation at no cost, Call Us at 877-291-9675

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THE ART OF WAR

The Art of War is one of the most successful books on military strategy in the world. It was written in China 2500 years ago by a man named Sun Tzu. It has influenced eastern military thinking, as well as the strategies of Napoleon, McArthur, and Operation Desert Storm.

A great deal of the book emphasizes outwitting your opponent so that physical combat is unnecessary. Consequently, it has become a teaching tool in the business world, as well.

What’s War Got To Do With It?

From the moment that your injury report is filed, you are doing battle with your employer’s insurance company. Your employer is not obligated, nor inclined, to be your advocate. In fact, your employer has insurance so that it can remain uninvolved when workplace injuries occur.

We have dealt with many insurance companies over the years, and it has become clear that just like Napoleon, General McArthur, and every Toyota Motor Corporation executive, they have read Sun Tzu’s book. Here are a few examples:

Tactics. . .

Sun Tzu taught that victory via full-on battle is undesirable because of lost soldiers and spoils of war that are spoiled by combat. Instead, win the day without shedding a drop of blood by moving quickly and by engaging an unprepared enemy.

Insurance companies do this by quickly sending an adjuster to talk to you. The adjuster will often tell you that you do not need a lawyer and that lawyers are an unnecessary expense. They offer to quickly start your weekly payments and to approve your medical bills. This early intervention is designed to prevent you from seeking legal advice.

The Sheathed Sword. . .

Victory comes from breaking the enemy’s resistance without fighting. The insurance company knows that they can wear you down by delaying weekly benefit payments, constantly requesting more medical information, questioning your doctor’s orders and denying bits of your medical bills, and making it difficult for you to reach them with questions.

If you give up on the claim, take what you have gotten, and return to work (albeit in a reduced capacity), they win. And you leave benefits that are rightfully yours “on the table.”

Laying Plans. . .

Sun Tzu held that all warfare is based on deception. Keep that in mind when the friendly insurance adjuster shows up to “help” you. The insurance company has contracted him or her, even if the business card says otherwise.

The adjuster’s job is to make you feel secure and comfortable, so that you will not ask too many questions about the rights and benefits to which you are entitled.

Espionage. . .

Sun Tzu warned that true victory comes only with foreknowledge. Without spies, generals will achieve victory accompanied by heavy losses of people and resources. The advent of YouTube, Facebook, MySpace, e-mail, text messaging, and cameras on every cell phone makes espionage a cinch.

Insurance companies gather information on your medical history, as well as your current activities, and present the information to their best advantage, not to yours.

If you or someone you love has been injured in the course of employment, you are engaged in a conflict. You can enter the battle on your own or with the advice of a team of seasoned professionals. We have read the book, too. We are here to help.

Don’t let the insurance company deceive you!
Call Now for a FREE Telephone Consultation:

(717) 695-4722 or (877) 291-WORK (9675)

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I could not have made a better choice.

I had the pleasure of being represented by Calhoon and Assoc., specifically Thomas Cook. A few years back I realized I would need an attorney to help me through the complicated Workers Comp. and disability system. Since I never had the need for an attorney, I was at a lose on how to go about hiring representation. I googled the best attorneys in Pennsylvania. From this list I read the reviews and pulled Calhoon and Assoc. out of the hat. I could not have made a better choice. Tom stood by me, always available to answer questions and offering advice that didn’t always make sense to me. I am so glad I followed his instructions. Tom’s experience was invaluable. I have finally settled my case with a much better outcome than I had hoped for. Joan R, Shamokin, PA

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No one wants to have to call a lawyer. It seems like opening a can of worms. But let’s examine some of your potential concerns. . .

I don’t want to lose my job. . .

It is not in the employer’s best interest to fire an injured worker simply because he or she sought legal guidance regarding a workers’ compensation claim. The whole idea of workers’ compensation insurance is to avoid costly lawsuits.

Firing an injured worker would encourage a lawsuit, and the employer knows it. In fact, the employer will be even more careful with an employee who is getting legal advice on his rights.

In addition to anti-discrimination and anti-retaliation laws, the employer knows that failing to provide work to an injured worker exposes them to payment of wage loss workers’ compensation benefits.

I just want my medical bills to be paid. . .

In the case of a civil lawsuit, you have to pay your medical bills and make do with lost wages until the settlement. Not so with workers’ compensation cases.

Workers’ Compensation Insurance should pay for your medical care as long as you need it, and send you a weekly wage payment while you are unable to work due to your work-related injury.

You are entitled to compensation for lost wages. These costs can continue after the medical bills stop. An experienced workers’ compensation attorney will make sure that you receive ALL of the benefits that you are entitled to.

I don’t want to sue my employer. . .

Good, because you can’t. Not unless your employer intentionally injured you.

An experienced workers’ compensation attorney will make sure that you are given all the benefits that you are entitled to under the law. If benefits are being denied or inappropriately delayed, the attorney will take that up with the insurance company, not with your employer. The employer will not be sued.

The adjuster seems nice enough. . .

That is his job. He gets paid by the insurance company to keep the payouts low. He does this by making you feel comfortable, so that you will not ask too many questions and will just “go with the flow.” It is not his job to advise you on additional benefits you may be entitled to.

I can’t afford a lawyer. . .

At Calhoon & Associates, P.C., your initial consultation is free. You may even discover that you do not need a lawyer.

If you do decide to continue with legal representation, the fees will be set by a workers’ compensation judge, and deducted from your benefits once we have won your case. There is NO FEE if we are unable to secure benefits for you. However, you may be responsible for expenses, which we strive to keep at a minimum, and often waive.

No one wants to have to call a lawyer. But the road to justice starts with finding out the facts. It starts with understanding your rights under the law.

The law firm of Calhoon & Associates, P.C., has been helping people in Pennsylvania, for over seventy (70) combined years. We are committed to protecting your rights and protecting you in your time of need.

There’s no cost to speak with us, and absolutely no obligation.
Call Us Today: 877-291-9675

Come in for a free consultation. It will be a whole lot less painful than you think. We may even swap a few jokes! The road to protecting your rights under the law starts right here.

Serving injured workers throughout Pennsylvania.

FREE CONSULTATION • FREE CASE MANAGEMENT • NO RECOVERY, NO FEE

1-877-291-WORK (9675)

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I had a difficult workmans comp case. We did not have concrete proof that my acquired illness was a direct cause from my work injury three months prior. The specialists who treated the illness would not back my case because they had not treated the initial injury. Mr Cook told me right from the start this would be difficult to win. Mr. Cook and Lindsay Hahn (Paralegal) were at all times professional, friendly, personable, and patient. They kept me informed of what was going on with the case. They explained and reexplained when I didn’t understand the legal terminology or things that were happening with the case. Lindsay was extremely thorough and if I emailed her 10 times in one day she would answer each email within a timely fashion. Mr. Cook ALWAYS left the decisions up to me without trying to sway my decision. I was able to make informed decisions because he explained the possible outcomes and the pros and cons of each decision. The rest of the staff at the office were always friendly And courteous when I had to call the office number.
So with much heartfelt gratitude…They WON my case!!! My $50,000 worth of medical bills will now be paid and I received a check for the time out of work. Mr. Cook did not gain financially on my case. Yet was sincerely happy for me and told me he felt happy and had the satisfaction of winning such a challenging case. So that shows me that Mr. Cook is genuine and decent person who loves his work. I most definitely recommend Mr. Cook and if you can hook Lindsay Hahn then you’ve got an excellent chance to win your case with these two on your side! Jackie, Chambersburg 2-18-15

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Dr LevinThe Professional of the Year honor is highly competitive and is granted based upon evaluation of individual credentials, innovation in one’s industry, outcome scores and in-house review and recommendation. Dr. Bruce Levin placed very highly among the over 1,400 qualifying physicians nominated. Furthermore, following a rigorous three-level screening process and a waiting period, PR Newswire felt it entirely appropriate to recognize his achievements on their Times Square Digital Billboard. Incidentally, Healthcare is by far the largest industry profiled in our Who’s Who and America’s Registry editions, and has been so for nearly 25 years. Hence, this naturally is among the most competitive. To attain the exclusive position of Doctor of the Year a physician must secure an unanimous vote from all seven board members. Calhoon & Associates congratulates Dr. Levin on his accomplishments and wish him ongoing success.

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They will find out.

If you have had prior accidents or injuries, the insurance company WILL know about them. Attempting to hide the information could, in all likelihood, shatter your case.

Prior to injury in the workplace, most workers think that Workers’ Compensation Insurance is a benefit provided by their employer to protect them. Once they are injured and “in the system,” they learn that battle lines have been drawn, and that the employer is not engaged in the combat. It is you versus the insurance company.

How does an insurance company make money?
1. Charge clients the highest premium possible (limited by competition and, in the case of workers’ compensation, by legislation)
2. Sell to new clients (i.e. employers)
3. LIMIT PAYOUTS
The insurance company has a huge staff of well-trained, expensive professionals hired solely to find ways to pay out the least amount possible on workers’ compensation claims. They begin their quest the minute your case hits their desks.

Don’t Make It Easy For Them. . .

We live in an information age. Your history will become available to the insurance company. You can take that to the bank. Prior accidents and/or injuries can complicate a claim if not properly presented to the Judge. Failing to disclose them will annihilate it.

An experienced workers’ compensation attorney will help you present your past experiences in the proper form, with the proper details, and at the proper time. We, at Calhoon & Associates, P.C., are committed to protecting your rights and to safeguarding our clients by guiding them through the jungle that the insurance companies have created.

The road to protecting your rights under the law starts with Calhoon & Associates, P.C.

A single mistake could COST you. Find out what you need to know.

The call is Free, so why wait? 877-291-9675

Very truly yours,

Ronald L. Calhoon
rcalhoon@pa-workers-comp-lawyers.com

Serving injured workers throughout Pennsylvania.

FREE CONSULTATION • FREE CASE MANAGEMENT • NO RECOVERY, NO FEE

1-877-291-WORK (9675)

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A Brief History of PA Workers’ Compensation Law

“I was injured at work. I have insurance through my employer – workers’ comp insurance that will cover me. Why would I need a Lawyer?”

I have heard this line of reasoning from my clients on a number of occasions. Sounds logical, and it may be true. However, it could also be a naïve and costly position to take.

I believe that a rudimentary understanding of the history and intent of Workers’ Compensation Insurance (known for years as Workman’s Compensation), its strengths, as well as its limitations, will help you make sound decisions regarding your workplace injury or accident.

Workers’ Compensation is a compromise between employees and employers. . .

• Employees receive compensation for medical bills, lost wages (indemnity), and disability caused by a work-related event or experience, regardless of fault.

• Employers receive protection from having to spend time and money defending lawsuits and from disproportionate awards.

Although there is evidence of some form of insurance protecting workers as well as employers as far back as 3000 B.C. (in ancient China, ship owners got together and agreed to split cargo and share losses as an early form of insurance), that insurance protected employers, not workers.

The U.S. Workers’ Compensation Insurance program is a product of the Industrial Revolution. Beginning in Germany in the early 19th century and then moving to other European countries, the program replaced a system that was heavily biased in favor of the employer.

Prior to Workers’ Compensation, an employee’s only recourse was to sue the employer, and an employer could avoid payment by demonstrating any of three defenses:

1. The employee knew of the inherent risk before he took the job;
2. The employee caused the accident himself;
3. Another employee, not the employer, was negligent.

Obviously, changes were needed. In 1914 Pennsylvania, the average work related death case settled for 9 months pay!!! The United States entered the workers’ compensation arena in 1911 in the State of Wisconsin. One hundred years ago, Pennsylvania followed suit in 1915. In 1934, FDR presided over sweeping social insurance programs at the federal level, including Social Security and Unemployment programs.

However, the Workers’ Compensation program was already entrenched at the state level, and it was not politically expedient to institute a federal program. So it remains a state run program.

Today, each state requires employers to provide Workers’ Compensation Insurance to their employees. Although details vary from state to state, employers must select to:

• Purchase insurance from an insurance company; or
• Set aside funds to self-insure; or
• Contribute to a state-run insurance fund in case of bankruptcy.

The vast majority of employers purchase insurance policies from private insurance companies. Additionally, each state has a Bureau of Workers’ Compensation that attempts to provide efficient resolution of disputes between employees and insurance companies (always represented by experienced lawyers). Even if a case is settled between the injured party and the insurance company, it must be presented to a Workers’ Compensation Judge for approval.

Insurance Companies Know the Rules of the Game. . .

So, the insurance companies have been at this for one hundred years. They are experts. They know how to save money by limiting benefits, curtailing treatment, avoiding long-term benefit programs, and questioning circumstances and health conditions. (To be fair, they also raise insurance rates or deny coverage if the employer does not adhere to the best of safety standards, so, in this way, we all enjoy safer work environments.)

Unfortunately, without representation, it is you against the insurance company. Specialized workers’ compensation attorneys are experts, also. We, too, understand the system, and we are here to protect your rights.

We at Calhoon & Associates, P.C. have been serving injured workers and their families for over seventy (70) combined years. We are recognized as being among the best. Call us to discuss your case, and we will give you the advice you need to determine whether you need legal representation.

How is the insurance company going to limit YOUR case? Find out now. . .

Call us for a FREE phone consultation and get the facts.
Call 877-291-9675

Information is always the first key to justice.

Ronald L. Calhoon
rcalhoon@pa-workers-comp-lawyers.com

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Local Doctor Accused of Rape

Dr. Jay Cho, a Pennsylvania pain management doctor with offices in Cumberland and Franklin County is facing charges including sexual assault and rape. His alleged victims are stating that Dr. Cho overprescribed prescription pain killers to his patients with the intent of getting them addicted. He would then use this addiction to make his patients perform sexual favors. Twelve patients are stating that they were afraid that if they did not perform these sexual advances, he would stop prescribing the pain medications. Dr. Cho is currently out on bail facing rape charges. Police believe their are more victims and are asking anyone with information to call 717-850-8273.

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Harold Binder of Millerstown injuries when he was electrocuted at work in June of 2013. The injury to his head had severe and pervasive lingering effects on his memory and concentration abilities. He was diagnosed with post-concussive syndrome and has not been ready to re-enter gainful employment due to his workers’ compensation injuries.

Four months after the work related accidental electrocution, the Employer initiated litigation by filing a Suspension/Termination Petition alleging that Mr. Binder had unreasonably refused to return to work in two positions offered within his medical restrictions. The restrictions were based upon a release of a nurse at Hershey Medical Center that was provided by the Employer when she examined him in September of 2013.

Mr. Binder testified his memory was poor, he suffers from headaches daily, is sensitive to noise, experiences ringing in his ears, has nightmares and only drives on a limited basis. The job offered by his employer would have required him to take inventory, and ride along with a team leader.

Dr. Stanton E. Sollenberger, a Board Certified neurologist, testified on Mr. Binder’s behalf. His diagnosis was that Mr. Binder suffered from traumatic brain injury with post-traumatic encephalopathy and post-traumatic headaches. Dr. Sollenberger definitively and unequivocally testified that Mr. Binder’s problems all started with the electrical jolt in June of 2013 and that he condition from the work injury would not permit him to perform the light duty job offered. The nurse at Hershey Medical Center and her supervising doctor testified he should be able to do the job assuming his condition improves.

The Judge found Mr. Binder’s testimony credible and found Dr. Sollenberger’s testimony to be more credible and persuasive the medical witnesses for the workers’ compensation carrier. He found that Mr. Binder was not able to return to the offered job and found that there was no evidence that his symptoms improved after September of 2013.

The Judge ordered the Employer to pay the injured worker attorney fees for unreasonably contesting Mr. Binder’s workers’ compensation benefits. The Employer’s Suspension and Modification Petitions were denied. Mr. Binder continued to receive his full total disability benefits as a result.

The law firm of Calhoon & Associates represents injured workers and those seeking Social Security Disability throughout Pennsylvania, including but not limited to, Altoona, Harrisburg, Pottsville, Allentown, Reading, Bloomsburg, Easton, Bethlehem, Norristown, Bristol, Williamsport, State College, Wilkes-Barre, Scranton, Lancaster, Waynesboro, York and all cities in Bucks County, Chester County, Columbia County, Dauphin County, Delaware County, Lackawanna County, Lancaster County, Lebanon County, Lehigh County, Luzerne County, Lycoming County, Montgomery County, Monroe County, Montour County, Northampton County, Northumberland County, Philadelphia County, Pike County, Schuylkill County, Wyoming County and York County, PA. Our offices are located at 2411 North Front Street, Harrisburg, PA and 14 North Main Street, Suite 300, Chambersburg, PA, and we can arrange for meeting locations at law offices throughout the State.
Calhoon & Associates
2411 North Front Street
Harrisburg, PA 17110
1-877-291-9675

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Samuel Newton (name changed for this summary) was injured in the course of his employment in Waynesboro, PA. Mr. Newton testified that he had been receiving both total temporary disability (TTD) benefits and total partial disability (TPD) benefits per the Pennslyvania Workers’ Compensation Act based upon a Supplemental Agreement dated November 5, 2013. On January 29, 2014, Neil P. O’Malley, M.D., placed Mr. Newton off from work. Mr. Newton testified that he contacted the insurance adjuster to receive his workers’ compensation check but did not receive it until the second week of March 2014. We filed a Penalty Petition against Underwriters Safety & Claims, the workers’ compensation insurance carrier for their violation of the Act in failing to pay workers’ compensation checks on a timely basis. The payment history revealed that Mr. Newton’s payment for TTD benefits for the time period January 29, 2014 through March 9, 2014 was issued on March 5, 2014 and that his payment for TPD benefits for the time period January 20, 2014 to January 28, 2014 was issued on March 7, 2014. The Penalty Petition was heard by a Workers’ Compensation Judge in State College, PA. Due to the insurance company’s untimely late payments of Mr. Newton’s TPD and TTD benefits, the Judge assessed penalties of 50% on the amount of compensation due to Mr. Newton that was over 30 days late and assessed penalties of 10% on the amount of compensation due to him which was less than 30 days late. The Judge also ordered that the Insurer pay Mr. Newton’s attorney’s fees for unreasonable contest because they did not have a reasonable basis to contest the Penalty Petition.

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Wage Loss Benefits and 50% Penalty Awarded to Laborer

Mr. Nonan suffered from a work injury on January 5, 2010 when he was throwing Christmas trees into a dump truck. At that time, he had shoulder and back pain. The Pennsylvania workers’ compensation insurance company only accepted medical liability for a left shoulder aggravation of tendinitis/bursitis. Mr. Biller continued to work on light duty restrictions; however, because he was on restrictions he did not work as many hours and was not offered overtime. Therefore, he was not making the same amount or more than he was at the time of injury. In 2014, the carrier filed a petition to review his chiropractic treatment as being not reasonable or necessary. That caused him to consult with Calhoon & Associates who filed a petition to retroactively recover Mr. Biller’s lost wages. We also filed a penalty petition for failure of the Pennsylvania workers’ compensation insurance company to pay reasonable and necessary medical bills related to Mr. Biller’s work injury and to add the back injury to the accepted claim. The Pennsylvania workers’ compensation insurance company filed a termination petition alleging that he was fully recovered from his work injury.

After over a year of litigation, in 2015, the Pennsylvania workers’ compensation judge found Mr. Biller to be credible and awarded him partial wage loss benefits. It was also found that he was not recovered from his work injury and the termination petition was denied. The Judge awarded a 50% (maximum amount) penalty for failure to pay both the wage loss benefits as well as the medical bills and added the back injury to the accepted claim for life time medical coverage.

The law firm of Calhoon & Associates represents injured workers and Social Security Disability applicants throughout Pennsylvania, including (but not limited to): Allentown, Altoona, Bellefonte, Bethlehem, Bloomsburg, Carlisle, Chambersburg, Easton, Enola, Fayetteville, Gettysburg, Harrisburg, Hazelton, Hollidaysburg, Huntingdon, Lancaster, Lebanon, Lewisburg, Lewistown, McConnellsburg, Mechanicsburg, Mifflintown, Millersburg, Milton, New Bloomfield, Newport, Philadelphia, Pittsburgh, Pottsville, Reading, Scranton, Shippensburg, State College, Sunbury, Uniontown, Washington, Wellsboro, Wilkes-Barre, Williamsport, York and all cities and towns in Adams County, Allegheny County, Berks County, Blair County, Bucks County, Centre County, Chester County, Clinton County, Columbia County, Cumberland County, Dauphin County, Fayette County, Franklin County, Fulton County, Huntingdon County, Juniata County, Lancaster County, Lebanon County, Lehigh County, Luzerne County, Lycoming County, Mifflin County, Montgomery County, Northumberland County, Perry County, Philadelphia County, Schuylkill County, Tioga County, Union County, Washington County and York County, Pennsylvania.

Calhoon & Associates
2411 North Front Street
Harrisburg, PA 17110
1-877-291-9675

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Jesus Arellano settled his Pennsylvania workers’ compensation case for a broken hip. That settlement included a Medicare Set Aside for his future medical treatment. A Medicare Set Aside, or MSA is money that is put in a separate interest bearing account to be used by the injured worker to pay for future medical costs, expenses, and bills related to the injury. The Centers for Medicare strongly recommend that the money is used for this purpose; however, Mr. Arellano decided to buy a truck and two properties with the money. (*If an MSA is not properly used, Medicare will deny payment of any medical expenses they feel are related to a work injury. We strongly suggest you contact an experienced Pennsylvania workers’ compensation attorney before you consider this option)

When Mr. Arellano filed for bankruptcy, he argued that the truck and properties should be exempted from the proceedings. The bankruptcy judge agreed and found that a MSA should not be included in bankruptcy proceedings because it was slated for medical expenses and not property of the bankruptcy estate.

If You Are Involved in a Work-Related Accident, Call Our Experienced Pennsylvania Worker’s Compensation Attorneys
If you would like to speak personally to us about your Pennsylvania or Harrisburg work-related accident, injury, or benefits, please fill out our confidential online contact form or call Calhoon & Associates toll-free at 1-877-291-WORK (or 9675). Whether you wish to begin the claims process, or are encountering problems and concerns while on workers’ compensation, Calhoon & Associates will fight to obtain the benefits you are entitled to receive, guide you in the right direction, and obtain a fair settlement if that is in your best interest. There is no fee for us answering your questions or advising you of your rights so you head in the right direction.

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In April 2008, a Pennsylvania state store manager, Gregory Kochnowicz was robbed by a masked man who put a gun to Gregory’s head and then duck tapped him to the chair. Kochnowicz was diagnosed with post traumatic stress disorder and was unable to work since that robbery. He filed for Pennsylvania workers’ compensation benefits. In Pennsyvlania, in order to be awarded workers’ compensation benefits for a mental disability, the claimant must prove that an abnormal work condition caused the psychological injury. In this case, the Defendant argued that this was a normal work condition for a state store employee. They stated that there were 99 robberies in the Philadelphia area in state stores from 2002-2008 and that state store employees are trained on how to respond to robberies. After several years of litigation and appeals, the Pennsylvania Supreme Court recently decided that Mr. Kochnowicz was entitled to Pennsylvania workers’ compensation benefits due to an abnormal work condition.

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If you’re looking for an attorney who is knowledgable, honest, and not afraid to push for what is right for you, call Ron. Any issue that I faced, he knew exactly what to do to quickly resolve it so that my well being was never compromised. Being on Worker’s Comp is very stressful, I couldn’t have handled it without a great attorney who has a great staff behind him! Trena 1-4-2015

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The Kids’ Chance of PA scholarship application is now available for 2015-2016!

The mission of Kids’ Chance of Pennsylvania, Inc. (Kids’ Chance of PA) is to provide scholarship grants for college and vocational education to children of Pennsylvania workers who have been killed or seriously injured in a work-related accident resulting in financial need.

The scholarship application is available online through the Kids’ Chance website. Please follow this link to complete an application.

Contact them at 610-970-9143 or by email info@kidschanceofpa.org if you have any questions.

The application deadline is April 15, 2015. Please share this information so eligible students do not miss out on this opportunity.

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In Pennsylvania, if you are receiving workers’ compensation benefits for 104 weeks, the Pennsylvania workers’ compensation insurance company is entitled to have you submit to an IRE (Independent Ratings Evaluation). An IRE is a series of tests you are asked to perform by a doctor qualified by the Bureau of Workers’ Compensation and selected by the Bureau. At the end of the evaluation, the doctor calculates a score or percentage of how disabled you are felt to be under the Pennsylvania workers’ compensation system. If that score is greater than 50%, then you can continue receiving your full (TOTAL) Pennsylvania workers’ compensation wage loss benefits. If it is 50% or less, then your benefits are reduced to a partial but your weekly rate is not impacted. If the score comes back at over 50%, the Pennsylvania workers’ compensation insurance company is allowed to send you to another IRE within a 12 month period from the last evaluation. They are only allowed to request two IRE’s within a 12 month period. If you have bee scheduled for an IRE, you need to contact a Pennsylvania workers’ compensation attorney right away. We will not charge you for phone calls, advice or a review of your case. We can be reached at 1-877-291-9675.

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INTRODUCTION TO The Almost Hassle-Free Way to Collect PA Workers’ Compensation Medical Bills authored by Calhoon & Associates, P.C.
What follows is a guide on the basics of obtaining payment for medical bills in Pennsylvania workers’ compensation matters. Medical billing in workers’ compensation matters can be an unfamiliar and uncertain task. What is the process? What forms are to be used? What happens if payment is not timely or is denied? What are the time limits? Some common complaints are: workers’ compensation never pays on time, denies submissions, fails to pre-approve treatment, or just ignores the bill. Sometimes, it just seems easier to avoid dealing with workers’ compensation. However, this book is here to help you. Knowledge makes all the difference.

STEP 1:
PROPERLY SUBMIT THE BILLS

When a patient first presents to you stating they suffered a work injury, you must get some crucial information from them. Ask them for their employer’s name, address, and phone number. Next, ask for the workers’ compensation carrier’s name, address, and phone number. You will also need the claim number and the date of injury.

The patient should be asked to provide their Notice of Compensation Payable, Notice of Temporary Compensation Payable or a Workers’ Compensation Judge’s award recognizing the work injury. These documents will provide all of the above crucial information and, more importantly, confirm that the patient has an accepted workers’ compensation injury.

If the injury has been accepted, workers’ compensation pays for all reasonable, necessary and work-related medical treatment by “practitioners of the healing arts”. The Notice of Compensation Payable issued by the workers’ compensation insurance carrier describes the injury under the heading “Description of Injury” and “Body Parts” on the top left side of the form. Please keep in mind that workers’ compensation is only required to pay for treatment which falls within the “Description of Injury” and “Body Parts”. For example, if the injury is described as a cervical strain, workers’ compensation must pay for treatment to the neck. However, if the treatment being billed to workers’ compensation is to the right shoulder, workers’ compensation is not automatically responsible for payment. Some exceptions exist, such as when a test is performed to another body part to rule out causes for the work injury or pre-surgical testing. Knowledgeable counsel can help when such questions arise. Further, if the patient’s doctor feels that a condition not described on the Notice of Compensation Payable is work related, there are legal methods available to have the treatment paid for by workers’ compensation.

If the treatment or injury is denied as not work related, you may bill the patient’s private health insurance, Medicare or other government-sponsored health insurance. This is prudent for many reasons; most importantly, it protects the patient’s health and workers’ compensation claim by allowing them to continue treatment during denial by workers’ compensation. Besides lower reimbursement rates, drawbacks to billing sources other than workers’ compensation include:

• Unnecessary and costly co-pays to patient;

• Unnecessary and costly deductibles to patient; and

• Maximum private health insurance benefits attained prematurely, precluding further treatment for any condition over the patient’s lifetime.

If a medical bill is denied by workers’ compensation as not work related, a provider can then bill other insurance. The Commonwealth of Pennsylvania issued two (2) memorandums regarding the Insurance Department’s regulations governing the use of exclusions for workers’ compensation insurance in accident and health insurance (attached). These regulations require health insurance companies to pay claims if the workers’ compensation insurance company refuses coverage. If the health insurance company refuses to pay “because the treatment is work-related,” a letter enclosing these two (2) memos almost always causes quick payment. If private health insurance and/or government-sponsored insurance is billed during the course of litigation, in the event of a favorable Decision, workers’ compensation will be required to repay the private health insurance. Sometimes this is done by the workers’ compensation insurance carrier issuing a check directly to the private health insurance. The workers’ compensation insurance carrier can also make payments directly to the medical provider, who, in turn, will need to reimburse the patient’s private health insurance accordingly.

A sample letter to the health insurance provider and the two memorandums addressing the use of exclusions for workers’ compensation and a sample of a Notice of Compensation Payable and a Temporary Notice of Compensation Payable can be seen in the PDF or hard copy of our free book at www.pa-workers-comp-lawyers.com/doctors

After the patient has been seen by the physician and a HCFA 1500 or UB has been created, you need to fill out an LIBC-9. Remember, this is a two-sided form even though you are only filling in one side. You should then mail the bill, LIBC-9, itemized bill, and medical records to the workers’ compensation carrier. An itemized statement or standard billing summary means nothing to the workers’ compensation insurance carrier! The itemized statement or billing summary are not sufficient requests for payment, and can legally be ignored. Compliance with the requirement that a completed LIBC-9 be sent with the bills is a almost always a prerequisite to the carriers’ obligation to process and pay the medical bill!

STEP 2: TAKE ACTION

In Pennsylvania, workers’ compensation carriers have thirty
(30) days (plus 6 days for mailing) to respond to a billing. If the response is late, compensation carriers have to pay 10% per annum interest. They can respond in the following manners:
1. Payment;

2. Denial (If denied as not work related, contact attorney);

3. Filing a utilization review request; or

4. Silence.

FEE REVIEW(Amount of Payment)

If the carrier does not respond in the allotted amount of time or a payment amount is incorrect, the medical provider can then file a fee review. The Fee Schedule is on the Bureau of Workers’ Compensation Website at www.dli.state.pa.us. Fee Review is the procedure to review the amount of the payment. This can be due to improper downcoding. If the carrier does not strictly comply with the downcoding procedures mandated by Section 127.207 of the regulations, the provider is entitled to reimbursement for the actual charges. A Fee Review can also be used to challenge the timeliness of payment as can a penalty petition.

Fee reviews must be filed within ninety (90) days of the original bill date OR within thirty (30) days after a denial or disputed payment is received, whichever occurs later. These time limits are strictly enforced and any fee review filed late will be dismissed.

The Department of Labor and Industry, Healthcare Services Review Section governs these reviews. Only a medical provider can file a Fee Review. A tutorial is available at the Bureau of Workers’ Compensation website at www.dli.state.pa.us, Workers’ Compensation Medical Treatment Information, Healthcare Services Form Tutorials. FAQS are also available at www.dli.state.pa.us, Workers’ Compensation, FAQS, Healthcare Services Review FAQS. You may call the PA Workers’ Compensation Hotline at (717) 772-4447 to obtain a Fee Review form for filing.

It is important to remember that to file a fee review you must fill out a LIBC-507 (see above sample form) and send it with a copy of the original bill, itemized bill, LIBC-9 (with original bill date) and medical records. Include a summary of why you are filing the review. Send a copy of the packet to the compensation carrier and keep a copy for your records. The original gets mailed to the Bureau of Workers Compensation. They will notify you of a decision within thirty (30) days of receipt of all necessary documents. The party unsatisfied with the fee review determination may file an appeal by filing a Request For Hearing To Contest Fee Review Determination (see Form on next page). The appeal must be filed within thirty (30) days of the administrative determination and will be assigned to a hearing officer who will issue a decision within ninety (90) days of the close of the evidentiary record. Further appeal will now be assigned to a workers’ compensation judge.

UTILIZATION REVIEW
(Reasonableness & Necessity)

If the workers’ compensation carrier has filed a Utilization Review (UR), you should check to be certain that the UR was filed within thirty (30) days of the workers’ compensation insurance carrier’s receipt of the medical bill(s) being re- quested for review. It can be argued that the failure of the carrier to timely challenge a bill waives their right to challenge the reasonableness and necessity of the treatment.

When requested by the assigned utilization review organization (URO), you should do the following:

1. Timely provide your records to the URO!;

2. Insist on a telephone conference with the UR’er;

3. Encourage the patient to continue reasonable treatment;
and

4. Encourage the patient to provide a written statement to the UR’er when requested.

When the medical provider is requested to provide medical records to the URO, the URO shall provide reimbursement to the medical provider for copying costs at the rate specified by Medicare, along with payment for actual postage costs. Also, reproduction of radiographic films (x-rays, MRI’s, CT Scans, etc.) shall be reimbursed at the usual and customary charge. (See Section 127.463(a) and (b) of the Rules and Regulations governing actions under the Pennsylvania Workers’ Compensation Act).

If the UR determines that the treatment was unreasonable and/or unnecessary, contact the Attorney to file an appeal of the UR determination.

The appeal will be a brand “new” review of the treatment by a Workers’ Compensation Judge. Also, most importantly, the workers’ compensation insurance carrier will now have the BURDEN to prove that the treatment was unreasonable and unnecessary. The petition to review the UR determination will be assigned to a workers’ compensation judge and will not be binding on the judge.

How long does the UR process take? When a UR request if filed, it takes about five (5) days for the Bureau to assign the petition to a URO. The URO will then collect the medical records and is prohibited from giving opinions on causation. A request for UR shall be deemed compete upon receipt of the medical records from the provider, or thirty (35) days after the notice of assignment of the review to a URO, whichever comes first. The provider will be given thirty (30) days to provide the records. Failure of the medical provider to timely provide records will cause the treatment to be denied as not reasonable and necessary! Filing an appeal will not help. Once deemed completed, the URO has thirty (30) days to render their decision.

If a provider, an employee or an employer disagrees with the UR determination, they can file a request for review of the UR determination. The medical provider is not dependent on the injured worker filing an appeal. The medical provider has standing to file the appeal. We represent many treating doctors who hire us directly to file the appeal and to get their bills paid after a negative UR determination is issued.

STEP 3 SILENCE

In the event that you receive NO RESPONSE to your original submission of your bill(s) to the workers’ compensation insurance carrier or receive some excuse like “the check is in the mail,” then you should immediately contact the Attorney, who will review the matter to determine which of the following petitions should be filed:

1. FILE PROSPECTIVE UR: a quick and effective method of obtaining pre approval to guarantee payment of medical bills before the treatment is even rendered (don’t believe the myth that there is no such thing as pre-approval in PA workers’ comp);

2. FILE REVIEW PETITION for the payment of medical bills and an additional 10% interest on the unpaid bills;

3. FILE PENALTY PETITION requesting the additional payment of up to 50% penalties for the carrier’s violation of the PA Workers’ Compensation Act by delaying payment of medical bills.

A review petition is needed when the treatment is for a condition not clearly related to the injury accepted in the Notice of Compensation Payable. A Penalty Petition can be filed when payment is not made within thirty (30) days, or if payment is received well past the 30-day time frame. A Penalty Petition is most often used when workers’ compensation ignores medical bills which are properly submitted and clearly related to the work injury. When filing a Penalty Petition, the medical bill must be clearly work-related, i.e., the medical documentation that was submitted with the

bill clearly identifies treatment to the injury/body part described on the Notice of Compensation Payable or Judge’s Award.

Often times the mere filing of the Penalty Petition will be enough to effectuate payment from the workers’ compensation insurance carrier. If not, a Judge will issue a Decision as to whether the workers’ compensation insurance carrier failed to make timely payment and, if so, order payment to be made. The Judge can also order penalties to be paid by the workers’ compensation insurance carrier, up to 50% of the outstanding medical bills plus 10% interest.

Lastly, if a bill is denied because it was within the first ninety (90) days of treatment and the doctor is not on the company posted list, call us to see if any of the many exceptions apply. Usually, one does and the compensation carrier must pay the bill. It is a myth that injured workers cannot treat with a doctor of their own choice during the first ninety days.

CONCLUSION

Payment of medical bills under the Pennsylvania Workers’ Compensation system can be confusing and complicated. It is the desire of the attorneys at Calhoon & Associates that this guide book, the flow chart and the sample forms contained herein will assist you in an organized and simplified fashion to collect your medical bills in an almost hassle free fashion. However, hassles are bound to occur. When they do, feel free to contact the attorneys at Calhoon & Associates to assist you with this process and achieve the ultimate goal of providing medical care to your patients and getting your BILLSPAID. If you have any questions regarding workers’ compensation feel free to call or to email Ron Calhoon at rcalhoon@pa-workers-comp-lawyers.com.
A copy of all the forms and petitions referred to herein can be seen in the PDF or hard copy of our free book at www.pa-workers-comp-lawyers.com/doctors

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What Should I Do If Injured at Work?

First, read your copy of Seven Deadly Sins That Can Destroy Your Pennsylvania Workers’ Compensation Case. . .

. . . And NOW you know that the insurance company is going to want the flow of information to be a one-way street. They are under no pressure whatsoever to resolve your case and, in fact, they are making an enormous profit while YOU wait.

The insurance adjuster’s job and duty is to seek out and find as many defenses and arguments as possible against your case. This all starts when the adjuster pretends to be your friend and wants to “take a statement” or have you “sign a few forms.”

There are four things you should be doing right now. . .

These four steps are the most important things that you can be doing right now, and surprisingly, many people miss at least one step.

1) Seek Medical Care

It’s always important to seek medical care. A lot of people will injure themselves and think, “Oh, it’s not too big.” Then they take some Tylenol and worry about it later. That could be okay for some things, but what happens if that particular injury or condition gets worse down the road, and you have never seen a doctor?

I always encourage people by what I call my “Treat and Forget Rule.” See a doctor, get some treatment, and if you do not think it is anything worse, then you can forget about it. We then know that you have had some type of medical situation, so that if something happens down the road, there is a paper trail (proof) for all your injuries – not just for the one that currently hurts the most.

2) Notify Your Employer

You should always notify your employer if you have been hurt at work. Do not make the assumption that because you were injured while you were working, a supervisor or an employer would know about it automatically. Unless you inform your employer about the injury being work-related, they most likely will not know.

3) File Your Claim

After getting medical care, and after telling your boss about your accident, you have to file a Claim Petition if no Notice of Compensation Payable has been issued or if you have not received wage loss benefits under the Workers’ Compensation Act.

Even though you have told your employer, even though your employer’s insurance company contacts you, and even though they may have paid for some medical treatment, that is not enough. that does NOT legally accept the injury as work related and provides absolutely no protection against future earning loss or future medical expenses.

If you do not file your case within a certain period of time (generally three years in Pennsylvania), you could permanently lose significant benefits.

4) Review Accepted Injury and Compensation Rate

Once the insurance carrier has issued a Notice of Compensation Payable, make sure the accepted injury is correct (i.e. a herniated disc is not a strain) and make sure the Statement of Wages used to calculate your compensation rate used ALL of your gross wages and earnings.

You Do Not Have to Do This Alone. . .

It is essential that you know your rights, and it is important to have all of the information you need to be able to effectively deal with the insurance company and protect your rights under the law.

With over seventy (70) years of continued workers’ compensation experience, we are ready to help. We will discuss your case with you and decide together if Calhoon & Associates, P.C., is the right firm to represent you.

We are not a fit for everyone, but we do pride ourselves on helping our clients make the right choice. If we are not a good fit, we will be quite happy to refer you to other lawyers who will be a good fit.

Avoid potentially disastrous mistakes. Get experienced advice NOW at no cost.
Call Us at 877-291-9675

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Date Of Injury for Workmans Compensation Purposes

Occupational diseases and occupational hearing loss are complicated areas of workers’ compensation law. The fact that these injuries do not seem to have an easily ascertainable starting date may seem like a problem for an Employee but the law is generous in these situations. The Date of Injury is determined to be the date on which the Employee was last exposed to that hazard which caused the injury. When dealing with work-related hearing loss, a workers’ compensation court will look for four things: whether the claim was timely filed, whether the hearing loss is permanent, whether there is a binaural hearing loss of at least 10%, and whether the hearing loss was caused by the hazardous occupational noise. In a situation where an Employee does suffer a permanent, binaural hearing loss of at least 10%, the Employee will be entitled to an award of at least 26 weeks of the Employee’s compensation rate, not to exceed 260 weeks (or 5 years) of the Employee’s compensation rate.
In some situations the time limit for filing can be extended to start tolling when an employee knew (usually when a doctor tells you) or should have known the condition was related to working. In some cases, the injured employee is better off with an older date of injury for compensation rate purposes. You have 120 days to provide notice to your employer that you suffered a work injury and three (3) years to file a claim petition. Statute of limitations can be real tricky and there are many exceptions. If you have any questions, feel free to call us at 1-877-291-9675 at no cost.

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The Pennsylvania Workers Compensation Act specifically addresses disfigurements of the head, face or neck. Some injured workers find themselves with permanent scarring or disfigurement after a work related injury and they don’t realize that they could be entitled to workers’ compensation benefits as a result in addition to the wage loss benefits. Benefits for a scar or disfigurement are called specific loss benefits. They include scars caused by surgery.
In order for a disfigurement to qualify for PA Workers’ Compensation Benefits, it needs to be serious, permanent, unsightly and caused by something “not usually incident to the employment.” In addition, it must be above the clavicle area of the lower neck, so if the disfigurement or scar below the neck line it doesn’t qualify for benefits under the Pennsylvania Workers’ Compensation Act. If the disfigurement or scar is still present after 6 months, it would be reasonable to expect that it is going to be permanent. The unsightliness of a disfigurement is at the sole discretion of a Workers Compensation Judge to make that determine at a hearing. For an example of a case we handled in which the Judge awarded the maximum amount of workers’ compensation specific loss benefits allowed click here.
The period of the time that an injured worker will be compensated for the disfigurement is either by the Workers’ Compensation Judge after a hearing or by a settlement agreement of the parties. Determination of the proper amount of weeks for the disfigurement requires experience as there are no established guidelines. Trying to negotiate with the Workers’ Compensation Insurance Companies on your own is not recommended as the interplay between wage loss and specific loss benefits even confuses most experienced attorneys.
If you have suffered a scar or have been disfigured as a result of a work injury, call the Calhoon and Associates at 1-877-291-9675. Our experienced workers’ compensation attorneys will guide you and explain your rights at no cost.

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You need to carefully read and get legal advice on the “fine print” of the Long Term Disability (LTD) policy and you need to find out whether you paid the premium, the employer paid the premium or both paid. The WC insurance company is entitled to take a credit (deduction) for the part of the LTD they paid for. The fine print of the LTD policy may have language about additional credits or deductions. You have to be very careful to research these issues before you accept LTD in addition to workers’ compensation as it can actually cost you money (i.e., be a net loss) to collect both. There are also tax implications and destruction to your leverage for a lump sum settlement of the workers’ compensation benefits.
You also have to be careful not to retire from the time-of-injury employer since the WC insurance company can claim that you have taken yourself out of the workforce and are not entitled to WC. Sometmes an employer will want you to take LTD in conjunction with a separation from employment. Also, you should understand that the employer may be entitled to further credits from retirement or severance payments.
Generally, LTD carrriers want you to apply for SSD because their policy will say that they are entitled to pay you less LTD if you are receiving SSD.
It may be a good idea for you to receive SSD in addition to WC. WC does not have a credit for SSD; thus, you can receive full WC and partial SSD. This topic is covered in much more detail in other articles on this site. You need to be careful; however, if you are close to retirement age. At that point your SSD will turn into Social Security Retirement SSR). At that point, the credit situation reverses and WC can deduct the amount of your SSR from the WC.
Thus, while it is possible to receive WC, LTD and SSD; there may be credits or deductions which could lessen the amount of your WC check. The WC insurance carrier and the LTD carrier will not explain this to you . It is a good idea to get expert legal advice before proceeding. Call us at no cost for advice at 1-887-291-9675.

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Kyle Kenny was employed as a maintenance supervisor in Harrisburg, Pennsylvania (PA). He suffered a work injury to his back when he was moving 4 big and bulky mats that weighed over 100lbs. When he lifted the 4th mat, it jerked him badly. He sat down to take a break and started to feel a little back pain. Shortly after sitting down, his legs began to badly tingle and he was soon unable to move them. His co-workers called an ambulance for him and he was taken to the hospital. Kyle is currently paralyzed from the waist down. His work injury was accepted by Notice of Compensation Payable and his injury was described as “Lumbar Strain”. Often Workers’ Compensation Insurance carriers list a legally accepted injury simply as a “strain”. This is a tactic to minimize what disability and what medical expenses the workers’ comp carrier has to automatically pay.
15 months later, the workers’ compensation insurance company filed a Petition to Review Compensation Benefits claiming that the Paralysis was not the result of a Work Related Injury. Their claim was based on an Independent Medical Examination (IME) by Dr. Katz. This Petition sought to stop all benefits alleging he had recovered from the “strain.” Since he was no longer suffering from a strain, then compensation should be stopped unless he could prove from his motorized wheelchair that the paralysis was due to the injury. Ron Calhoon filed an Answer and the case was assigned to a workers’ compensation judge in Harrisburg, PA.
In support of their Petition, Defendant’s Insurance Carrier presented the testimony by Dr. Katz that injured worker’s Paralysis was not caused by the back injury suffered at work but rather was due to a viral condition that the paralysis would of happened at the very time no matter we he was at. Dr. Katz’s testimony was not found to be credible, competent or persuasive as the treating physicians’ testimony.
In defense of Petition to Review Compensation Benefits, the injured worker and his treating physicians, Drs. Edwards and Dr. Albert Skocik, testified and the Judge found their testimony credible. Dr. Edwards competently and persuasively testified that the small disc herniations shown on MRI were sustained during the work injury, which caused either a vascular tear resulting in hemorrhage or bleeding in the spinal cord with ischemia and a subsequent destruction of the cord; or a release of abnormal molecules from the disc, which triggered an autoimmune response and inflammatory system attack on the spinal cord. Dr. Skocik competently and persuasively testified that Claimant’s herniations noted on MRI were work-related and the cause of Claimant’s paralysis.
The Judge denied Defendant’s Petition to Review Compensation Benefits, finding that Kyle’s Paralysis was from his work injury. The Judge amended the description of injury to include Paralysis, and ordered Defendant to pay workers’ compensation medical benefits relating to Kyle’s Paralysis, the injured worker’s costs of litigation for defending the Petition to Review Compensation Benefits, and the attorney’s fees for unreasonable contest.

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INJURED WORKER WINS PRE APPROVAL FOR NURSING HOME CARE

On August 8, 2008, Fred Howe (name changed for this blog) suffered a work injury to the left ankle while loading a lawn mower onto a trailer. He was employed by Strange & Associates. The workers’ compensation carrier, Selective Insurance Company, accepted liability for the work injury by issuing a Notice of Compensation Payable.

Due to the work injury, the injured worker developed symptoms and pain in his left ankle and leg, radiating up the leg. He also developed numbness and swelling, jerking in his sleep, headaches, and muscle spasms. Over time, these symptoms began spreading to the right side. Medical treatment included pain medications, a brace/splint, and spinal cord stimulator. These symptoms were aggravated by activity, rest, or inactivity. The injured worker required frequent hospitalizations due to these symptoms. He also received medical treatment from his family doctor, Dr. Charles Lowe. Dr. Lowe felt FH suffered from reflex sympathy disorder (RSD) and/or complex regional pain syndrome. In early 2013, different living arrangements were being pursued to help with self-care and to avoid hospitalizations. He had also developed a sore on the back of his left thigh, which would not heal and required home health assistance.

In January, 2013 we filed a prospective Utilization Review Request, asking that an independent doctor decide whether nursing home care would be appropriate treatment for his work injury. Dr. Paul Doghramji of Margroff Review Services, stated that patients with RSD are known to become highly dependent on others for their activities of daily living, and need an assisted living environment. Dr. Doghramji felt that placement in a nursing home was reasonable and necessary due to Dr. Lowe’s documentation of great difficulty in performing activities of daily living. Winning the prospective utilization review grants him legal pre approval of the treatment and the treatment must immediately be paid for by the workers’ compensation carrier when the treatment commences. Even if the carrier appeals the unitization review determination, they must pay for the treatment while the case is on appeal.

If you would like to speak personally to us about your Pennsylvania or Harrisburg work related accident or injury, or benefits, please fill out our confidential online contact form or call Calhoon & Associates toll-free at 1-877-291-WORK (or 9675). Whether you wish to begin the claims process, or are encountering problems and concerns while on workers’ compensation, Calhoon & Associates will fight to obtain the benefits you are entitled to receive, guide you in the right direction, and obtain a fair settlement if that is in your best interest. There is no fee for us answering your questions or advising you of your rights so you head in the right direction.

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Did you know that the Washington State Department of Labor and Industry recently did a study on the link between certain careers, an employee’s obesity and potential to be a smoker? Truckers, movers, firefighters and policemen and women are the most likely to be obese. Doctors, teachers and scientists are the healthiest. The purpose of this study was to identify a need of workplace obesity prevention programs. The hope is that once these target professions are identified, this information can be used for prevention purposes. Interestingly enough, truckers were also amongst the highest percentage of employees that smoked. It is felt that truckers are influenced by the availability and convenience of food choices that they have available to them while working.

The full study can be found here: http://www.cdc.gov/pcd/issues/2014/13_0219.htm

Obesity and smoking can also be factors in your ability to fully recover from a work injury. If you were injured at work and still have not recovered from that injury, contact an experienced Pennsylvania Workers’ Compensation attorney right away. Defense attorney and IME doctors have recently been trying to blame ongoing disability on these factors in efforts to terminate benefits. Steps can be taken to help avoid these tactics before they happen.

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As workers’ compensation attorneys who only represents injured workers, we have had numerous clients call in a panic because brick and mortar pharmacies would not fill their prescription due to the fact that the insurance adjuster was not available to approve it or the adjuster denied pre approval for whatever whimsical dishonest reason they happen to come up with that day. Even adjuster’s admit the prescription cards issued by the workers’ compensation carriers are not worth the paper or plastic they are printed on. For those that do not use Injured Workers’ Pharmacy, www.iwpharmacy.com, this leads to unnecessary stress, denied treatment or high out of pocket expenses.
Some treating doctors have taken this issue into their own hands by issuing the necessary medications themselves right out of their own office. The carriers resent this practice as they have no ability to block treatment and argue that because the prices of these prescriptions are not regulated, physicians are taking advantage and charging more than a prescription dispensed by a pharmacy. State Rep. Marguerite Quinn introduced a bill to limit physician dispensing last year. This legislation passed in the House and was amended by a Senate committee. This amended legislation was recently voted on and passed in both the House and Senate on October 22, 2014 and is now on its way to Governor Corbett for his signature.
HB 1846 will effectively stop physician dispensing of all prescriptions to their workers’ compensation patients. Ultimately, it requires physicians to dispense only a limited day supply (depending on what type of drugs are being dispensed) of medications and must provide the original NDC code of the manufacturer drug so that the cost may not exceed 110% average wholesale price of the original drug. The dispensing of the medications by physicians is limited to a one-time supply and is limited to the first health care provider. No additional health care providers can seek reimbursement for drugs dispensed under the same workers’ compensation claim. Over the years, the legislature has expanded the “treat only with company doctor requirement” from a few days to 90 days. Now, they want to decide where an injured worker can obtain medications for the life of their injury.
The passage of this bill is troubling because not only was it quickly passed, but it is government interference with an injured workers’ right to obtain needed medical treatment.

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Injured worker Betty Thompson was employed by the Commonwealth of Pennsylvania, Department of Public Welfare, Selinsgrove Center, as a licensed practical nurse for seven (7) years. On September 30, 2012, she suffered a work injury to the right hip and low back when she slipped and fell on a wet floor at work. This work injury was accepted by Notice of Compensation Payable described as “right hip and low back strain”. The workers’ compensation insurance carrier is Inservco. Listing the legally accepted injury as merely a strain is an often used (almost universally used) tactic to minimize what disability and what medical expenses the workers’ comp carrier has to automatically pay. It can take well over a year for a judge to make a workers’ compensation carrier responsible for medical treatment not clearly related to the accepted “strain” injury (i.e., surgery, injections, etc.)

On June 25, 2013, Defendant Inservco filed a Termination Petition to stop workers’ compensation benefits as of April 12, 2013 based on an Independent Medical Examination (IME) by Dr. Richard G. Schmidt. This Petition was assigned to the a workers’ compensation judge sitting in Williamsport, PA.

In support of their Petition, Defendant Inservco presented the testimony of Dr. Richard G. Schmidt, and the Judge found his testimony not credible that injured worker was fully recovered from the work injury.

In defense of the Termination Petition, the injured worker and her treating physician, Dr. Matthew Eager, testified and the Judge found their testimony credible. Dr. Eager testified that injured worker has had continuous complaints of right sacroiliac joint, posterior hip and right leg pain and right leg numbness, that he imposed sedentary restrictions of no lifting over 10 lbs., that Betty was not fully recovered from the work injury, and that the description of injury should include right sacroiliitis, right trochanteric bursitis and lumbar spondylosis with right lower extremity radicular irritation. Betty testified that, since the work injury, she has experienced right leg and right buttock area pain aggravated by walking or sitting, and that she cannot perform her LPN duties as pushing a cart, bending and walking could aggravate her symptoms. Dr. Schmidt’s testimony was not found to be credible, competent or persuasive as the treating physician’s testimony.

The Judge denied and dismissed Defendant Inservco’s Termination Petition, finding that Betty was not fully recovered from her work injury. The Judge amended the description of injury to include right hip bursitis and sacroiliitis, and ordered Defendant to continue paying workers’ compensation wage loss benefits, medical benefits, and ongoing attorney fees; along with the injured worker costs of litigation for defending the Termination Petition.

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What follows is a guide on the basics of obtaining payment for medical bills in Pennsylvania workers’ compensation matters. Medical billing in workers’ compensation matters can be an unfamiliar and uncertain task. What is the process? What forms are to be used? What happens if payment is not timely or is denied? What are the time limits? Some common complaints are: workers’ compensation never pays on time, denies submissions, fails to pre-approve treatment, or just ignores the bill. Sometimes, it just seems easier to avoid dealing with workers’ compensation. However, this book is here to help you. Knowledge makes all the difference.

STEP 1
When a patient first presents to you stating they suffered a work injury, you must get some crucial information from them. Ask them for their employer’s name, address, and phone number. Next, ask for the workers’ compensation carrier’s name, address, and phone number. You will also need the claim number and the date of injury.

The patient should be asked to provide their Notice of Compensation Payable, Notice of Temporary Compensation Payable or a Workers’ Compensation Judge’s award recognizing the work injury. These documents will provide all of the above crucial information and, more importantly, confirm that the patient has an accepted workers’ compensation injury.

If the injury has been accepted, workers’ compensation pays for all reasonable, necessary and work-related medical treatment by “practitioners of the healing arts”. The Notice of Compensation Payable issued by the workers’ compensation insurance carrier describes the injury under the heading “Description of Injury” and “Body Parts” on the top left side of the form. Please keep in mind that workers’ compensation is only required to pay for treatment which falls within the “Description of Injury” and “Body Parts”. For example, if the injury is described as a cervical strain, workers’ compensation must pay for treatment to the neck. However, if the treatment being billed to workers’ compensation is to the right shoulder, workers’ compensation is not automatically responsible for payment. Some exceptions exist, such as when a test is performed to another body part to rule out causes for the work injury or pre-surgical testing. Knowledgeable counsel can help when such questions arise. Further, if the patient’s doctor feels that a condition not described on the Notice of Compensation Payable is work related, there are legal methods available to have the treatment paid for by workers’ compensation.

If the treatment or injury is denied as not work related, you may bill the patient’s private health insurance, Medicare or other government-sponsored health insurance. This is prudent for many reasons; most importantly, it protects the patient’s health and workers’ compensation claim by allowing them to continue treatment during denial by workers’ compensation. Besides lower reimbursement rates, drawbacks to billing sources other than workers’ compensation include:

• Unnecessary and costly co-pays to patient;
• Unnecessary and costly deductibles to patient; and
• Maximum private health insurance benefits attained prematurely, precluding further treatment for any condition over the patient’s lifetime.

If a medical bill is denied by workers’ compensation as not work related, a provider can then bill other insurance. The Commonwealth of Pennsylvania issued two (2) memorandums regarding the Insurance Department’s regulations governing the use of exclusions for workers’ compensation insurance in accident and health insurance (attached). These regulations require health insurance companies to pay claims if the workers’ compensation insurance company refuses coverage. If the health insurance company refuses to pay “because the treatment is work-related,” a letter enclosing these two (2) memos almost always causes quick payment. If private health insurance and/or government-sponsored insurance is billed during the course of litigation, in the event of a favorable Decision, workers’ compensation will be required to repay the private health insurance. Sometimes this is done by the workers’ compensation insurance carrier issuing a check directly to the private health insurance. The workers’ compensation insurance carrier can also make payments directly to the medical provider, who, in turn, will need to reimburse the patient’s private health insurance accordingly.

After the patient has been seen by the physician and a HCFA 1500 or UB has been created, you need to fill out an LIBC-9. Remember, this is a two-sided form even though you are only filling in one side. You must then mail the bill, LIBC-9, itemized bill, and medical records to the workers’ compensation carrier. There are no exceptions to this rule. An itemized statement or standard billing summary means nothing to the workers’ compensation insurance carrier! The itemized statement or billing summary are not sufficient requests for payment, and can legally be ignored. Compliance with the requirement that a completed LIBC-9 be sent with the bills is a prerequisite to the carriers’ obligation to process and pay the medical bill!

STEP 2

In Pennsylvania, workers’ compensation carriers have thirty (30) days (plus 6 days for mailing) to respond to a billing. If the response is late, compensation carriers have to pay 10% per annum interest. They can respond in the following manners:

1.Payment;
2.Denial (If denied as not work related, contact attorney);
3.Filing a utilization review request; or
4.Silence.

FEE REVIEW (Amount of Payment)

If the carrier does not respond in the allotted amount of time or a payment amount is incorrect, you can then file a fee review. The Fee Schedule is on the Bureau of Workers’ Compensation Website at http://www.dli.state.pa.us. Fee Review is the procedure to review the amount of the payment. This can be due to improper downcoding. If the carrier does not strictly comply with the downcoding procedures mandated by Section 127.207 of the regulations, the provider is entitled to reimbursement for the actual charges. A Fee Review can also be used to challenge the timeliness of payment as can a penalty petition.

Fee reviews must be filed within ninety (90) days of the original bill date OR within thirty (30) days after a denial or disputed payment is received, whichever occurs later. These time limits are strictly enforced and any fee review filed late will be dismissed.

The Department of Labor and Industry, Healthcare Services Review Section governs these reviews. Only a medical provider can file a Fee Review. A tutorial is available at the Bureau of Workers’ Compensation website at www.dli.state.pa.us, Workers’ Compensation Medical Treatment Information, Healthcare Services Form Tutorials. FAQS are also available at www.dli.state.pa.us, Workers’ Compensation, FAQS, Healthcare Services Review FAQS. You may call the PA Workers’ Compensation Hotline at (717) 772-4447 to obtain a Fee Review form for filing.

It is important to remember that to file a fee review you must fill out a LIBC-507 (see above sample form) and send it with a copy of the original bill, itemized bill, LIBC-9 (with original bill date) and medical records. Include a summary of why you are filing the review. Send a copy of the packet to the compensation carrier and keep a copy for your records. The original gets mailed to the Bureau of Workers Compensation. They will notify you of a decision within thirty (30) days of receipt of all necessary documents. The party unsatisfied with the fee review determination may file an appeal by filing a Request For Hearing To Contest Fee Review Determination (see Form on next page). The appeal must be filed within thirty (30) days of the administrative determination and will be assigned to a hearing officer who will issue a decision within ninety (90) days of the close of the evidentiary record. Further appeal will now be assigned to a workers’ compensation judge.

UTILIZATION REVIEW (Reasonableness & Necessity)

If the workers’ compensation carrier has filed a Utilization Review (UR), you should check to be certain that the UR was filed within thirty (30) days of the workers’ compensation insurance carrier’s receipt of the medical bill(s) being requested for review. It can be argued that the failure of the carrier to timely challenge a bill waives their right to challenge the reasonableness and necessity of the treatment.

When requested by the assigned utilization review organization (URO), you must do the following:

1. Timely provide your records to the URO!;
2. Insist on a telephone conference with the UR’er;
3.Encourage the patient to continue reasonable treatment; and
4.Encourage the patient to provide a written statement to the UR’er when requested.

When the medical provider is requested to provide medical records to the URO, the URO shall provide reimbursement to the medical provider for copying costs at the rate specified by Medicare, along with payment for actual postage costs. Also, reproduction of radiographic films (x-rays, MRI’s, CT Scans, etc.) shall be reimbursed at the usual and customary charge. (See Section 127.463(a) and (b) of the Rules and Regulations governing actions under the Pennsylvania Workers’ Compensation Act)

If the UR determines that the treatment was unreasonable and/or unnecessary, contact the Attorney to file an appeal of the UR determination.

The appeal will be a brand “new” review of the treatment by a Workers’ Compensation Judge. Also, most importantly, the workers’ compensation insurance carrier will now have the BURDEN to prove that the treatment was unreasonable and unnecessary. The petition to review the UR determination will be assigned to a workers’ compensation judge and will not be binding on the judge.

How long does the UR process take? When a UR request if filed, it takes about five (5) days for the Bureau to assign the petition to a URO. The URO will then collect the medical records and is prohibited from giving opinions on causation. A request for UR shall be deemed compete upon receipt of the medical records from the provider, or thirty (35) days after the notice of assignment of the review to a URO, whichever comes first. The provider will be given thirty (30) days to provide the records. Failure of the medical provider to timely provide records will cause the treatment to be denied as not reasonable and necessary! Filing an appeal will not help. Once deemed completed, the URO has thirty (30) days to render their decision.

If a provider, an employee or an employer disagrees with the UR determination, they can file a request for review of the UR determination. The medical provider is not dependant on the injured worker filing an appeal.
The medical provider has standing to file the appeal.

We represent many treating doctors who hire us directly to file the appeal and to get their bills paid after a negative UR determination is issued.

STEP 3 SILENCE

In the event that you receive NO RESPONSE to your original submission of your bill(s) to the workers’ compensation insurance carrier or receive some excuse like “the check is in the mail,” then you should immediately contact the Attorney, who will review the matter to determine which of the following petitions should be filed:

1. FILE PROSPECTIVE UR: a quick and effective method of obtaining pre approval to guarantee payment of medical bills before the treatment is even rendered (don’t believe the myth that there is no such thing as pre-approval in PA workers’ comp);
2. FILE REVIEW PETITION for the payment of medical bills and an additional 10% interest on the unpaid bills;
3. FILE PENALTY PETITION requesting the additional payment of up to 50% penalties for the carrier’s violation of the PA Workers’ Compensation Act by delaying payment of medical bills.

A review petition is needed when the treatment is for a condition not clearly related to the injury accepted in the Notice of Compensation Payable. A Penalty Petition can be filed when payment is not made within thirty (30) days, or if payment is received well past the 30-day time frame. A Penalty Petition is most often used when workers’ compensation ignores medical bills which are properly submitted and clearly related to the work injury. When filing a Penalty Petition, the medical bill must be clearly work-related, i.e., the medical documentation that was submitted with the bill clearly identifies treatment to the injury/body part described on the Notice of Compensation Payable or Judge’s Award.

Often times the mere filing of the Penalty Petition will be enough to effectuate payment from the workers’ compensation insurance carrier. If not, a Judge will issue a Decision as to whether the workers’ compensation insurance carrier failed to make timely payment and, if so, order payment to be made. The Judge can also order penalties to be paid by the workers’ compensation insurance carrier, up to 50% of the outstanding medical bills plus 10% interest.

Lastly, if a bill is denied because it was within the first ninety (90) days of treatment and the doctor is not on the company posted list, call us to see if any of the many exceptions apply. Usually, one does and the compensation carrier must pay the bill. It is a myth that injured workers cannot treat with a doctor of their own choice during the first ninety days.

CONCLUSION

Payment of medical bills under the Pennsylvania Workers’ Compensation system can be confusing and complicated. It is the desire of the attorneys at Calhoon & Associates that this guide book, the flow chart and the sample forms contained herein will assist you in an organized and simplified fashion to collect your medical bills in an almost hassle free fashion. However, hassles are bound to occur. When they do, feel free to contact the attorneys at Calhoon & Associates to assist you with this process and achieve the ultimate goal of providing medical care to your patients and getting your BILLS PAID.
No part of this blog may be copied or reproduced in any manner whatsoever without the express written consent of Calhoon & Associates, P.C. Comments in this blog are not intended to provide legal advice. This is a guide. For specific legal advice on your case, you should call a reputable and Board Certified workers’ compensation lawyer. It should never cost you any money to consult with such a lawyer. We can be reached 24 hours a day at 1-877-291-9675 or by emailing rcalhoon@pa-workers-comp-lawyers.com

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Ron was my workers comp lawyer for over a year. 5times my check was delayed on 3 of those occasions ron had gotten my claims person to overnite me a check. other 2 had it in mail in 2 days. every question or concern I had, it was either answered or addressed within 24 hours. In the end, Ron got me more than my wife & myself were willing to settle for. THANK YOU RON ! Henry 10-9-14

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We Couldn’t have…

Tom Cook was very professional and responded quickly to our questions. Helped navigate us through the legal process which we couldn’t have done on our own. Easy to work with and contact with questions. Robert- Harrrisburg

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The injured worker KG was employed by JDB Construction as a trade carpenter, working construction framing houses. On December 6, 2006 he slipped and fell into a ditch and herniated two (2) discs. The workers’ compensation insurance carrier is State Workers’ Insurance Fund (SWIF), who accepted liability for this work injury. The injured worker KG underwent back surgery in 2007, along with back and hip injections. His treating physicians are Dr. Robert Boyer, a chiropractor in Chambersburg, PA, and Dr. Curtis Goltz, an orthopedic surgeon in Harrisburg, PA The injured worker KG has been treating with Dr. Boyer for many years.
On November 17, 2011 The injured worker KG settled his wage loss benefits for a fair and reasonable lump sum wherein Defendant SWIF remained responsible for payment of ongoing, work-related medical treatment for the rest of KG’s life. On September 11, 2012, a Utilization Review Determination found Dr. Boyer’s chiropractic treatment to be reasonable and necessary. It was not appealed. Workers’ comp still refused to pay the medical bills.
We filed a Penalty Petition for Defendant SWIF’s failure to pay Dr. Boyer’s medical bills since March 2013. The injured worker KG and Dr. Boyer testified, and the Judge found their testimony credible. The injured worker KG testified that Dr. Boyer has been providing chiropractic treatment for several years and that the treatment helps with stiffness and enables him to do things. Dr. Boyer testified that he has been providing chiropractic treatment for several years to maintain back function, and that Defendant SWIF had been paying the medical bills.
The judge granted The injured worker’s KG”s Penalty Petition. The Judge found that Defendant SWIF unilaterally stopped paying the injured worker’s medical bills. The Judge ordered Defendant SWIF to pay all of the medical bills plus fifty (50%) percent penalties to the injured worker KG totaling $1,729.00, unreasonable contest attorney fees of $2,801.25, and costs of litigation of $850.10.

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In August 2014, a Miami trial court judge ruled that the exclusive remedy provision of Florida’s Workers’ Compensation Act unconstitutional as a matter of law. The exclusive remedy provision prevents an injured worker from
suing for a work injury and limits recovery to workers’ compensation. Workers’ compensation caps damages and does not allow any recovery for pain and suffering or lost health and pension benefits.
Circuit Judge Cueto found that the Act was “no longer an adequate exclusive replacement remedy in place of common-law tort, as required by the 14th Amendment to the U.S. Constitution or by the Florida Constitution.”

He observed that the act “became unconstitutional as an exclusive remedy in stages,” as legislative amendments “decimated” the benefits provided through the years.
During this process, Cueto said, “fundamental rights guaranteed by the Constitution were eviscerated by merely enacting a statute and relying upon the police power of the state for validity.”
As it stands now, he opined, the act “fails miserably” in promoting the public morals, health, safety and welfare of the citizenry of Florida, and plainly does not pass constitutional muster.
Cueto said, the “benefits provided by the act should have increased substantially to account for the change in the value of the trade; i.e., allegedly fast, sure and adequate payments in exchange for the tort remedy that was
cumbersome, slow, costly and under which it had been legally difficult for injured workers to prevail.”
Lawmakers again tinkered with the act in 2003, to eliminate the payment of any compensation for a permanent loss of wage-earning capacity that is not total in character, Cueto noted. And even if the loss is total, then the act, as amended, cuts off benefits once the worker hits 75 or after receiving benefits for five years.
The amended version of the act also apportioned medical care expenses for workers between an employer and the worker, and if the worker can’t afford his share of the cost, then the worker can’t get treated, Cueto said. Unlike many states, claimants in Florida must make co-pays when receiving medical treatment for their workplace injuries.
Cueto reasoned that if the Act would “provide full medical care and some compensation for total or partial disability, it remains constitutional.” But as it now stands, Cueto said, “it is inadequate as an exclusive replacement remedy for all injured workers.”

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If you’ve received a form in the mail titled “Employee’s Report of Benefits” (LIBC-756), “Employee’s Report of Wages” (LIBC-750), or “Employee’s Verification of Employment, Self-Employment or Change in Physical Condition” (LIBC-760) you might be confused and suspicious.
The first thing you should know is that these are standard forms. Your employer or their Pennsylvania (PA) Workers’ Compensation Insurance company can send you these forms every six months. These forms are rather straight-forward and ask you to report any wages you’ve earned while collecting or seeking workers’ comp, ask if you have been employed or self-employed at any point while collecting or seeking compensation benefits, and ask if you’ve received any Social Security, pension, severance, or unemployment benefits during the period you have been collecting or seeking Pennsylvania WC benefits. If you are receiving Social Security Disability benefits do not report them as Social Security Old Age benefits as this will cause the carrier to take an imporper credit against your weekly compensation. These forms may also require the employee to report any change in physical condition that could affect his or her entitlement to TTD benefits. This is an easy way for the Insurance company to gather information about your case.
These forms require that you complete them and return them to your insurance company within thirty (30) days. Failure to complete these forms and return them within these 30 days allows the insurance company to file a Petition to Suspend your workman’s compensation wage loss benefits. The insurer can suspend your benefits until the proper forms are completed and submitted. Additionally, if an employee’s benefits are suspended due to a failure to timely return these forms and the employee later fills out and returns the forms, the employee’s benefits will start back up, but the employee will be unable to get retroactive benefits the portion of time that coincides with the suspension. This is another reason why it is very important to complete, sign, and send the forms back within the 30 day time period.
An injured worker must take care to ensure that the information being provided on these forms is complete and accurate. If a worker dealing with a work-related injury knowingly, with intent to defraud, fails to make the required reports or gives false or misleading information, he may be liable under the fraud provisions of the Workers’ Compensation Act.
It is very important that these forms are filled out on time and filled out accurately. For this reason, it is a good idea to consult with an experienced workers’ compensation attorney before trying to fill out a form that you might not understand. If you have any questions, we can answer them for free.

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My opponent didn’t stand a chance against him.

I chose to hire Ron Calhoon on the recommendations of a doctor. I am so glad I did. From the first time we talked till the day we got news we won the case he fought for me. Between e-mails, phone calls and letters I was always in the know of what was happening. All my questions were answered in a timely manner.Ron is very knowledgeable about Workman’s compensation issues. My opponent didn’t stand a chance against him. Sonya B. Bloomsburg, PA

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Mr. Calhoon was contacted about a settlement that Worker’s Compensation was offering. I knew nothing about his firm except what was on his web site. Mr. Calhoon was courteous and respectful from the first contact. Mr. Calhoon explained my options thoroughly and answered any questions I had. After taking my case, Mr. Calhoon processed the settlement paperwork quickly and efficiently. I received a check in the amount agreed to and there were no problems with the paperwork, the courts or the compensation lawyers. The most surprising detail is that I am in Texas and Mr. Calhoon is in Pennsylvania and I felt as comfortable as if we were in the same state. I would not hesitate to recommend Mr. Calhoon’s firm for worker’s compensation cases.

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Under the Pennsylvania Workers’ Compensation Act and applicable case law, a non-U.S. citizen who is not eligible to lawfully work in the United States (undocumented worker) is permitted to receive workers’ compensation benefits if they are injured at work. However, in order to continue to be entitled to wage loss benefits, the work injury must totally disable the employee from working. Once an undocumented worker is medically released to return to some type of work, wage loss benefits can be stopped without an Employer showing job availability.

The Pennsylvania Supreme Court recently ruled that when an injured worker invokes his Fifth Amendment right against self-incrimination when being questioned at a hearing regarding his citizenship status, the court cannot assume that the injured worker is not permitted to be employed in the United States. The courts have consistently held that a party cannot meet its burden of proof in a civil proceeding merely by relying on a party’s failure to testify. Such an “adverse inference” is not evidence. Without independent evidence (proof of citizenship or residence status or I-9) supporting that a claimant is an undocumented worker, an Employer is not relieved of its burden to show earning power or job availability to suspend worker’s compensation wage loss benefits.

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Melissa was very helpful

Melissa was very helpful and informative through out my whole case. Listens to what you have to say and gives you options and informs you of things you may have never thought about. Notified me anytime an offer changed. She knows her stuff. I would recommend her to anyone with a workers comp case. – Craig

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Calhoon & Associates
2411 North Front Street
Harrisburg, PA 17110
Phone: 717-695-4722
Toll Free: 877-291-WORK (9675)
Fax: 717-695-4988
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14 North Main Street
Chambersburg, PA 17201
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Office

Calhoon & Associates

2411 North Front Street
Harrisburg, PA 17110
Phone: 717-695-4722
Fax: 717-695-4988

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