The Supreme Court is considering whether an insurance company has the right to "step into the shoes" of an injured party and sue a third party in negligence.
Frequently work injuries are the results of the negligence of a third party. The injured worker has the right to sue the third party, and the workers' compensation insurance carrier has a right to collect against the third party.
The issue faced by the Supreme Court is whether the workers' compensation insurance company can sue a responsible third party where the injured employee has not done so.
The Superior Court ruled that any action against a third-party tortfeasor must be brought by the injured employee.
Fenner & Boles LLC
Monday, October 20, 2014
Friday, October 10, 2014
It's been quite a while since I wrote my last blog entry and
I'm going to try to be more conscientious.
The Pennsylvania Supreme Court recently had an interesting
holding involving an injured worker who was allegedly an undocumented
alien. The employer's attorney asked him
during cross-examination if he possessed a green card. In response to this question, the claimant
invoked his Fifth Amendment right against self-incrimination. The judge in the case below ruled that the
worker was injured on the job, but denied him any wage replacement benefits,
finding that he was an undocumented alien and therefore not entitled to work in
the United States.
On appeal, the employer argued that it was the workers'
burden to demonstrate that he was eligible for employment under federal
employment law. The Supreme Court
rejected this argument and reversed the judge below. The court ruled that it was the defendant's
burden to demonstrate that it was entitled to suspend payment of wage
replacement benefits to the claimant, and it could not do so absent proof that
the claimant was an undocumented alien.
The court also ruled that taking the Fifth Amendment does not constitute
substantial evidence of the employee's undocumented status. The court found that the failure of an
employee to testify on this issue alone was not enough, and that the employer
had the burden of presenting probative evidence regarding the worker's citizen
status.
Friday, August 1, 2014
HOW DO LAWYERS ANALYZE THE VALUE OF CASES?
Cases are resolved by analyzing the
injured workers' future earning capacity and comparing it to the wages he or
she was earning at the time of the injury.
Attorneys also analyze the strengths and weaknesses of a particular case
in determining whether a case should settle.
The best way to explain the present value concept is to consider what happens when an individual wins a million dollar lottery. If you won a million dollars in the lottery, you would not receive a check for a million dollars, even if you paid no taxes. Leaving aside the issue of taxes, you would really receive $50,000.00 per year for 20 years. Obviously, this is not the same as receiving a million dollars up front. If you were to receive a million dollars up front rather than spread over 20 years, you could invest the money and live off the proceeds of the investment. If you received a 4% return on your million dollar investment, you would receive $40,000.00 per year in income alone for the rest of your life, and still have one million dollars left over. If you received a million dollars over 20 years ($50,000 per year), and spent $50,000.00 each year, at the end of 20 years, you would have no money left.
Under Pennsylvania law, if an
individual with residual disability in connection with a work injury returns to
employment at wages which are less than the employee's pre-injury wages, the
employer or insurance company is obligated to pay tax-free wage loss benefits
to the employee at a rate equal to two-thirds (2/3) of the difference between
the employee's return to work wage and his or her pre-injury average weekly
wage. Once an employee returns to work
at duties that are restricted due to the effects of a work injury, the law
considers the worker “partially disabled.” An individual may receive partial
disability benefits up to a maximum of five hundred (500) weeks for a work
injury.
Where an individual has undergone an
impairment rating evaluation and is found to be less than 50% disabled under
AMA guidelines, the employee may recover no more than 500 additional weeks of
benefits, even if he is totally disabled from all work.
In settling the case, the attorney
attempts to estimate the earning capacity of the employee in the future. Using this estimate, the attorney determines
what compensation would be payable to the employee if he or she returns to work
at wages less than the employee's pre-injury wage. Finally, the attorney reduces the future
payments to present dollars in order to determine the "value" of a
particular claim.
For example, if your average weekly
wage at the time of injury was $550.00, and you returned to work at a wage of $250.00 per
week, the insurance company would be obligated to pay a "make up"
check of $200.00 per week you. ($550.00
average week wage - $250.00 return-to-work wage = $300.00 x 2/3 = $200.00)
As long as you continued to receive
wages of $250.00 per week, the insurance company would be obligated to pay a
makeup check of $200.00 per week. If you
work continuously for 500 weeks straight, and earn $250.00 per week for each of
those 500 weeks, the insurance company would have to send you $200.00 per week
until the 500 week period ended.
What is the "present
value" of the insurance company's obligation to pay you $200.00 per week
for 500 weeks straight? At first glance,
it would seem to be $100,000.00. (500
weeks x $200.00/week = $100,000.00).
Insurance companies do not analyze the value of cases in this manner,
however, due to the effect of interest rates and investment income on their
obligation to pay benefits to you on a week-by-week basis.
The best way to explain the present value concept is to consider what happens when an individual wins a million dollar lottery. If you won a million dollars in the lottery, you would not receive a check for a million dollars, even if you paid no taxes. Leaving aside the issue of taxes, you would really receive $50,000.00 per year for 20 years. Obviously, this is not the same as receiving a million dollars up front. If you were to receive a million dollars up front rather than spread over 20 years, you could invest the money and live off the proceeds of the investment. If you received a 4% return on your million dollar investment, you would receive $40,000.00 per year in income alone for the rest of your life, and still have one million dollars left over. If you received a million dollars over 20 years ($50,000 per year), and spent $50,000.00 each year, at the end of 20 years, you would have no money left.
Under
Pennsylvania law, an employer and its workers’ compensation insurance company
has 21 days from the date disability begins for them to make a decision
about whether or not to pay your claim.
Where the injuries are obvious and self-limited, the insurance company
will probably pay the claim without a hitch.
For example, if you break your leg on the job, and must miss time from
work in connection with that injury, the insurance company will probably pay
the claim. From their perspective, the
injury is obvious and you will eventually recover in full.
For
more severe injuries, they probably will look more closely, even if the injury
is obvious. This may mean that there
will be some delays before they accept legal responsibility for your claim.
Even
if you are going to a doctor to whom you were referred by your employer, there
are things that you can do to make the insurance company’s process of looking
at your claim go more quickly. In most
cases, doctors that are designated by the employer send medical reports
directly to the insurance company. You
should not, however, assume that this is the case. Ask the doctor for a copy of the report, and
send it to the insurance company yourself.
You should find out who the insurance company is by asking your employer. The insurance company will assign a claims
adjuster to handle the file. A claim
number will also be assigned to the case.
And any letter you sent to the insurance company or any phone
conversation you have with the claims adjuster, you want to reference the claim
number.
Sometimes
the insurance company will refuse to pay a claim because the doctor does not
clearly state in a report whether the condition is work-related. Again, ask for a copy of the report. If the doctor does not state in the report
that the condition is work-related, ask him why he has not explicitly stated
that, noting to him that it may result in a delay in the processing of the
claim. If the doctor refuses to
acknowledge that your condition is work-related, you probably need to speak
with a lawyer.
If
the insurance company requests you give an oral statement, you need to be very
careful. Except in relatively minor
injuries, you probably want to seek the assistance of an attorney. While many attorneys will charge a fee for this
service, our office does not.
In
giving a statement to a claims representative, you need to assume that they
have information that you do not have.
Insurance companies have access to a central information source that
gives them all of the claims that you have ever made, whether the claims
resulted in a lawsuit or not. It is not
uncommon for claimants to make the mistake of informing an insurance company
that they had no prior injuries, that is false.
If
you are asked to give a statement, the statement, on the record, should be
preceded by the following comments: I am
giving this information to the best of my knowledge and belief. I do not have access to my medical records at
this time, and cannot recall specifically all that may be contained in those
medical records. If there is any
information that the insurance company has concerning me that I do not have, I
would like that information in advance.”
Except
in obvious injury cases, it is best to have a good knowledge of your prior
medical history.
Tuesday, July 15, 2014
MOST CONSTRUCTION WORKERS WHO SUFFER FATAL WORKPLACE INJURIES ARE LATINO
Fox News reports that New York City Latino construction
workers disproportionately die on the job.
According to Fox, "From 2003 to 2011, three-fourths of construction
workers who die were either U.S.-born Latinos or immigrants, according to a
review of all of the fatal falls on the job investigated by the Occupational
Safety and Health Administration."
Consumer safety advocates in a study by the New York State Trial Lawyers
Association cited safety violations on the job sites run by smaller, non‑union
contractors and an unwillingness by some undocumented workers to report
violations as the main reason for the high number of deaths among Latino
workers.
It is not clear if Latino construction workers
disproportionately die in construction accidents in Philadelphia, but there is
no reason to think that the same results would apply from an analysis of
Philadelphia construction worker injuries.
Tuesday, July 8, 2014
The Phony Light or Sedentary Job
Some employees make the mistake of failing to follow through in an offer of light or sedentary employment from their employer. If they fail to show up and find out what the job is all about, they will have no way to prove that the job was inconsistent with their medical restrictions or otherwise is in violation of the law. Invariably in those cases an employer witness will testify to a Workers' Compensation Judge that they would have accommodated whatever restrictions the employee had. Accordingly, except under the rarest of circumstances, an employee should make a good-faith attempt to follow through on any offers of employment.
Wednesday, June 18, 2014
TAKING MONEY FROM YOUR POCKET
Under Pennsylvania Law, an
employer is entitled to a credit equal to 50% of any old age benefits against
workers’ compensation benefits the employee receives. If the employee was collecting old age benefits
before the work injury occurred, the employer is not entitled to a credit. This credit does not apply to social security
disability benefits.
For example, if an employee receives
$2,200.00 per month in workers’ compensation benefits and $1,100.00 per month
in social security retirement benefits (old age benefits), the insurance
company would be obligated to pay only $1,650.00 monthly.
($2,200-$1,100/2=$1,650.00)
In Caputo v. WCAB, an
injured worker challenged this position, arguing that it was a violation of the
Pennsylvania Constitution. The Court rejected the employee’s challenge.
Bottom line: Employers are entitled to reduce payments of
workers’ compensation benefits by 50% of social security retirement benefits
the injured worker receives.
Tuesday, June 17, 2014
KIDS WILL HAVE TO WATCH WHAT THEY SAY ON SCHOOL BUSES
Governor Tom
Corbett recently signed legislation allowing audio recording devices to be used
on school buses, and many districts are currently using these devices for
disciplinary and security purposes.
School
officials explain that with the cramming of students in the small spaces of a
bus, it is difficult if not impossible to investigate incidents, some of which
are violent.
The issue
first arose in 2006 after state police discovered audio recording equipment on
the school bus while they were investigating a complaint of overcrowding. Eight years later, a law that exempts school
buses from the state wiretapping laws. Though some have expressed concerns
about privacy, the use of these devices has wide support.
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