Regardless of your date of injury, reasonable and necessary medical expenses related to the work-injury are the responsibility of the worker’s compensation carrier for life. If your injury occurred on or before June 23, 1996, there is no artificial time limit to how long your total disability wage loss benefits can last. The passage of a certain period of time or the obtainment of a certain age does not cause total disability to cease. However, the amount of benefits can be reduced and the duration of benefits can be shortened or stopped. Below is the description of how benefits can be modified or stopped for injuries occurring on or after June 24, 1996, when the most recent changes to the Pennsylvania Workers’ Compensation Act went into effect. All of the below discussions apply to injuries occurring on or before June 23, 1996, except with regard to the use of Impairment Rating Evaluations and Labor Market Surveys to shorten and reduce benefits. Those can only be used for injuries occurring on or after June 24, 1996, and cannot be used with regard to earlier injuries.
If a lump sum settlement is negotiated and approved by a workers’ compensation judge, the settlement can provide for single lump sum final payment or for periodic guaranteed payments in an annuity like structure. If you settle your case by receiving a lump sum payment, your weekly or bi-weekly wage loss benefits will stop. Death also ceases wage loss benefits.
Your wage loss benefits may be terminated if the carrier obtains a medical opinion of full recovery from any physician and a workers’ compensation judge believes that physician over any other physicians.
If you return to work anywhere earning the same as your average weekly wage at the time of injury, your benefits would be suspended. If your earning loss reoccurs, you may have the right to have those benefits reinstated. The burdens of proof for reinstating benefits is depends on the specific situation.
If you return to work anywhere at wages less than your time of injury average weekly wage, your benefits would be reduced to partial disability benefits, and you are limited to five hundred (500) weeks of partial disability benefits.
The carrier can also attempt to modify benefits based upon referring open or available jobs to you. If you fail to follow through in good faith on referrals, the carrier can petition to have your benefits reduced for bad faith and can request the judge modify your benefits to partial as if you had obtained the job they referred.
For most wage loss injuries suffered on of after June 24, 1996, your wage loss benefits are limited to 11.6 years. After two years of receiving total disability benefits, the employer, can request you undergo an impairment rating evaluation. If this evaluation results in an impairment rating on the American Medical Association’s Guidelines of less than fifty percent (50%), you will automatically be placed in partial disability status. Although your compensation rate remains the same, the five hundred (500) weeks of partial disability entitlement begins. Five hundred weeks plus two years of total equals 11.6 years of compensation.
The employer can also seek to have your benefits reduced based upon an allegation that you have an earning capacity as set forth in a Labor Market Survey prepared by a vocational “expert” hired by the carrier. This does not involve referring you to any positions. It is commonplace to find out about the jobs in the Labor Market Survey at the first hearing on the carrier’s petition to reduce your benefits to two thirds (2/3) the difference between your time of injury average weekly wage and the alleged earning capacity. There is no allegation that you failed to follow through in good faith. There is merely an allegation that you, based upon your age, education, and residual productive skills have the capacity to earn an amount of money as concluded by the carrier’s vocational “expert.” When a carrier hires a vocational consultant to interview you, that interview should take place at your attorney’s office.
Prior to filing a Petition to Modify based upon a Labor Market Survey, the carrier must issue a document called a Notice of Ability to Return to Work which states who the medical professional was that released you for work and the extent of the release, i.e., what work restrictions you have. When received, you consult an attorney. Once the Notice of Ability to Return to Work has been issued, your time injury employer must offer any jobs it has available they are seeking to fill that are within your work restrictions and vocational abilities. They are not required to create a job. If your employer intends to modify or suspend your compensation benefits based upon a Labor Market Survey, it must show that, between the date that the Notice of Ability to Return to Work was issued and the date they filed the Petition to Modify, it had no job openings you could have performed with the time injury employer. If your employer had appropriate job openings during that time frame which it did not offer to you, the Petition to Modify should be dismissed. There are many ways an experienced workers’ compensation attorney can defeat a Modification Petition.