Unmasking the Insurance Companies Traps

In workers’ compensation cases, the relationship between claimants and insurance companies often seems like a high-stakes game of chess. The problem is that you, as a claimant, must play the game, while the insurers play the rules.

While the system is designed to provide financial relief to those injured on the job, it’s no secret that insurance companies often employ a host of less-than-honest strategies to protect their bottom line.

Every workers’ compensation attorney in Allentown knows this and, as someone whose livelihood may depend on a successful claim, you need to be acutely aware of these strategies as well.

Today, we’ll be exploring several of these tactics, offering you an invaluable insight into how they work, in order to equip you with the knowledge essential to recognize and protect yourself in the face of the insurance industry’s schemes.

Notice of Temporary Compensation Payable: The 90-Day Trap

If the workers’ compensation insurance company is paying benefits to you pursuant to a Notice of Temporary Compensation Payable (TNCP or NTCP), you may be in for an unpleasant surprise. Benefits paid pursuant to such a document can be stopped by the insurance company at any time within 90 days of the date your disability began. By “coincidence”, the period of time during which you may be required to treat with a company doctor is 90 days.

Why does this make a difference? If the insurance company issues a Notice of Compensation Payable (NCP), or if they pay you benefits pursuant to a TNCP for more than 90 days, the company is legally responsible for your claim, which means that they have to keep paying you benefits until you agree to let them stop, you return to work at no loss of wage, or they obtain a court order, which is not easy. 

Pennsylvania Workers' Comp Offsets

Insurance companies are well aware of these deadlines and deal with them by entering into cozy relationships with company doctors. The doctor who is so nice to you for the first 60 days may suddenly turn on you just in time for the insurance company to issue a notice denying your workers’ compensation claim and stopping your benefits.

Insurance companies pressure these doctors to release work injury patients before 90 days have expired. This is ordinarily accomplished by having the doctor say that you have recovered or that your problems are related to some pre-existing condition.

Pennsylvania Supreme Court Subrogation Cases

The Pennsylvania Supreme Court has issued several cases that have a significant impact on an insurance company’s right to recover from the proceeds of personal injury cases against third parties arising out of cases in which the plaintiff has received benefits for a work-related injury.

Pennsylvania State Police v. Workers’ Compensation Appeal Board, 184 A.3d 958 (Pa. 2018)

Watch out if an insurance company tries to assert a right of subrogation in a case under the Motor Vehicle Financial Responsibility Law where the plaintiff is receiving Heart and Lung Act benefits. 

The Heart and Lung Act provides for payment of full salary and medical expense benefits to certain municipal employees including firefighters and police officers who are temporarily disabled because of work-related injuries.

An insurance company has no right of subrogation for either salary or medical expense benefits paid under this statute. Sometimes an insurance company will claim they are entitled to recover the amounts that were otherwise payable under the Pennsylvania Workers’ Compensation Act, or approximately two‑thirds of salary benefits and all medical expense payments.

They have no such right. If the third-party claim is covered by the Motor Vehicle Financial Responsibility Law and the benefits were paid pursuant to the Heart and Lung Act, the insurance company or the employer has no right of subrogation.

Whitmoyer v. Workers’ Compensation Appeal Board, 186 A.3d 647 (Pa. 2018)

Notice of Temporary Compensation Payable

Sometimes insurance companies try to slip language into third-party settlement agreements that give them the right to reduce payment of future medical expenses. For example, an insurance company may put language in a third-party settlement agreement in which they agree to pay 40 percent of future medical bills with the plaintiff/claimant to pay the remainder.

Under Pennsylvania law, following repayment of compensation paid to the date of the third-party settlement, the employer or the insurance company may not reduce payment of future medical expense benefits. They have the right to pay reduced wage loss benefits in the future if the third-party recovery exceeds the amount of the lien, but they do not have the right to reduce future medical expense payments.

Pennsylvania Workers’ Comp Offsets

It’s bad enough that your benefits are fixed on the date of injury and never go up. Insurance companies also have the right to cut your workers’ compensation benefits based on other benefits that you receive.

  • If you are receiving Social Security Retirement benefits, the insurance company is allowed to reduce your wage loss benefits by an amount equal to half of your monthly retirement benefits.  
  • If you’re receiving pension benefits from a plan that was funded by the employer for whom you were working at the time of injury, the insurance company can take a dollar-for-dollar credit for those benefits.
  • If you received a severance package that was funded by your time-of‑injury employer, the insurance company has a right to take credit for that.

Your benefits will also be reduced for each dollar you receive in unemployment compensation benefits during your period of work-related disability. The insurance company giveth and the insurance company taketh away. 

Where to find an experienced workers’ compensation attorney near me in Allentown?

If you need an adept legal team that factors in every detail to help you realize maximum benefits while avoiding common work comp pitfalls, you won’t find anyone better on either side of Little Lehigh Creek than Liberty Bell. 

For more than two decades, our ethical attorneys provided comprehensive guidance to injured workers throughout Allentown and the region, helping them realize maximum benefits and secure their future. Today, we’re here to do the same for you. Reach out to us for a 100% free, no-obligation consultation!