Pennsylvania Workers Compensation Act: Ways an Insurance Company can reduce or stop your wage loss benefits

If you have sustained a Pennsylvania work-related injury and are receiving wage loss benefits, there are some pitfalls to consider when you are offered work by your employer or accept alternate work with another employer. First, the day you return back to work at equal or more than your pre-injury wage, the insurance carrier will file a Notification of Suspension, LIBC 751. This is authorized by the Workers’ Compensation Act Section 413(c). If this Notification is not challenged within 20 days of your receipt of the document, this becomes the controlling Bureau document. That means, the status of your wage loss claim is in suspension (non- payment) since you are earning actual wages equal to your pre-injury wages. It is important to note that the running of the 20 days is from your receipt of the Notice, not the date of the Notice. Plus, if the information in the Notice is faulty or incorrect, a Judge can set it aside after the 20 days has run.

This Notification must be mailed to you within 7 days of the date the insurance company intends to suspend your wage loss benefit. This may be appropriate if your Pennsylvania Work Injury never causes you to miss time from work or you never lose any partial wages compared to your wages pre-injury. Medical benefits are not affected at all by either a Notification of Suspension or a Notification of Modification (which will be discussed below).

However, if you are losing some wages upon return to work or have to stop working completely due to your work injury, then a Reinstatement Petition must be filed and litigated. It can take some time to litigate such a petition to get you back into payment status. In the meantime, the insurance company will not be paying you any wage loss benefit. Consequently, you will have no money coming in which obviously can be a severe financial hardship. Therefore, before returning to work you must be confident that you are medically ready to return and sure that the work injury will not cause you to stop working and incur a wage loss after 20 days (the challenge period). This is certainly something to discuss with a workers’ compensation attorney before returning to any position.

There are also concerns when you return to work part-time or at wages less than your pre-injury wages. Your Employer might seek to have you gradually return to the workforce by having you work half days or simply not allow you to work the overtime you worked before the work injury. Typically, an employer will offer you a modified position which is less strenuous then your pre-injury position which pays less than pre-injury wages. In such a case, the insurance company should have filed a Notification of Modification, LIBC 751, upon your return to part-time wages. Such is authorized by Section 413(d) of the Workers’ Compensation Act. This is designed to reduce your workers’ compensation wage loss benefit, as you are receiving partial wages from your job. In this scenario, you would only be entitled to two thirds of the difference between your pre-injury average weekly wage and your current wages. Again, this must be challenged within 20 days or you are then locked into this partial wage loss benefit. Consequently, if you have to stop working due to the work injury and have not challenged this petition, the insurance company is only obligated to continue to pay this partial wage loss payment, even though you are losing full wages. As with the Notification of Suspension, a Reinstatement Petition must be filed, litigated to completion and a Judge rule in your favor before the insurance company will be required to resume payment of total disability wage loss benefits, or the full amount you were collecting before you returned to work.  This is why it is extremely important to have an experienced workers compensation attorney to review the paperwork that an insurance carrier sends you.

Another pitfall with any return to work while still suffering the effects of a work injury is if your employment is terminated by your employer for what the Employer deems “cause”. A termination for cause means that your conduct or performance was unacceptable and the employer had a valid reason for terminating your employment irrespective of the work injury. It will argue that your termination had nothing to do with your work injury, even though you may suspect that it was because you suffered a work-related injury and your employer simply does not want an “injured” employee anymore. Here, if a Notification of Suspension or a Notification of Modification is in place, and was not challenged within 20 days, then as stated above a Reinstatement Petition must be litigated and the added issue of whether your employer truly did have cause for the termination will have to be decided by the workers’ compensation judge. Again, during this entire litigation period—you are receiving no wage loss benefits or partial wage loss benefits depending on which Notice was issued. Therefore, it is crucial that you seek experienced Pennsylvania Workers Compensation Attorney versed in such issues whenever you decide to return to work or are offered work by your employer following a work related injury.  Call our office for a free consultation at 717-238-1657