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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. 

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)

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!

Considering how life-altering workplace injuries can be, both physically and financially, securing fair compensation through a workers’ compensation claim can be a critical step toward financial stability.

However, while settling a work comp claim can provide you with the support you need to recover and move forward with your life, this process is not without its hidden dangers that, more often than not, go unmentioned.

Fortunately, it is possible to avoid these common pitfalls, especially if you have a good Allentown workers’ compensation attorney, who will expand on the information we provided here, thereby giving you all the tools necessary to successfully realize your claim.

Understand the Compromise and Release Agreement

In Pennsylvania, workers’ compensation cases are settled by entering into a compromise and release agreement. The parties then must go to a hearing in which the workers’ compensation judge determines whether the injured worker understands the significance of the agreement.

In Hong v. WCAB, 51 A.3d 905 (Pa. Cmwlth. 2012), the injured worker entered into a lump sum settlement. The agreement did not say whether unpaid medical bills would be paid in addition to the lump sum. After the settlement, the injured worker learned that one physician had an outstanding bill in excess of $37,000.00 which the employer refused to pay.

The Commonwealth Court stated that to set aside a compromise and release agreement, the party trying to set it aside must show fraud, deception, duress, or mutual mistake. The court found that none of these factors was present. 

The court found that had the claimant wanted to ensure payment of past medical bills in addition to the lump sum, his counsel could have included appropriate language in the agreement. That the claimant had counsel was an important factor for the court.

Bottom line: Make sure you understand the Compromise and Release Agreement, including any provisions concerning the payment of medical expenses.

Protecting your right to medical coverage

If you are keeping the medical expenses open when you settle your case, look closely at the language. Sometimes injured workers will settle a workers’ compensation case while keeping the insurance companies’ responsibility to medical bills open.

In DePue v. WCAB, 61 A.3d 1062 (Pa. Cmwlth. 2012), the injured worker entered into a compromise and release agreement which described the injury as “closed head injury with seizure disorder and short-term memory loss.”

After the compromise and release agreement was approved, the injured worker filed a penalty petition alleging that the employer failed to pay for medical bills for a shoulder injury and then filed a review petition to add a left shoulder injury to the description of injury.

The Commonwealth Court ruled that the injured worker cannot do so. In connection with the resolution of the case, the injured worker is bound by the description of injury contained in the compromise and release agreement. 

The parties can, by agreement, say that the agreement is without prejudice to the right of the claimant to add additional injuries at some future point. Absent that language, the injured worker is going to be bound by the description of injury contained in the compromise and release agreement.

Bottom line: If you are keeping medical expenses open in the settlement of your workers’ compensation case, pay careful attention to the description of the injury contained in the agreement, to avoid falling into this common insurance company’s trap.

What was the biggest workers’ comp settlement in Pennsylvania?

This is one of the most common questions work comp lawyers hear anywhere from Lehigh Valley to Pitsburg, expecting to hear about astronomical sums. The truth, however, is – it doesn’t really matter.

There are limits on the benefits an injured person may receive under the Pennsylvania Workers’ Compensation Act.  For the profoundly injured or disabled worker who may need expensive medical care, it may make no sense to settle a workers’ compensation case.  Merely because an attorney settled a workers’ compensation case for a large sum of money may mean nothing if the client gives up medical coverage.  If the settlement is used to pay for medical treatment and the money runs out, the client may have nothing but Medicare to pay for additional medical treatment, and Medicare has very significant coverage limitations.

Workers’ compensation is not like a personal injury law, in which an individual can recover for loss of future earning power, pain and suffering, and economic damages.  Most workers’ compensation recoveries in Pennsylvania are limited primarily to medical expense coverage. When the parties settle a workers’ compensation case, it is a true settlement in which all parties agree to the settlement amount. In a personal injury case, an attorney can always let a jury decide the value of the case. That cannot be done in workers’ compensation court.

If a firm brags about a multi-million-dollar workers’ compensation settlement, they represented somebody who suffered a catastrophic injury and settled the case for a lump sum the insurance company was willing to pay because it thought it would be cheaper than paying for future medical expenses. 

If the insurance company thinks it is cheaper to pay millions in a lump-sum settlement of medical expenses, do you think the worker may have been better off with open life-long medical coverage? Don’t be fooled by people bragging about settling such cases.  We routinely reject requests to settle their claims for medical benefits because it sometimes is not in the interests of the profoundly sick or injured to give up medical coverage.

Where in Allentown can I find a dedicated workers’ compensation attorney?

At Liberty Bell, we have extensive experience helping individuals navigate the convoluted alleyways of Pennsylvania’s work comp system. Our team of highly knowledgeable lawyers from Allentown knows the ins and outs of the process and can help you avoid common dangers and pitfalls with the utmost confidence. Reach out to us today for a free consultation and ensure you have a team who will fervently advocate for your rights!

It is a well-known fact that workers’ compensation cases can become extremely complex, either from the very beginning or at some point during the process, primarily because of a massive number of factors that must be taken into consideration.

While having complete medical documentation and adept legal guidance from a reputable work injury attorney in Allentown are key, there are two lesser-known factors that can impact the favorable resolution of your claim: the witness’s memory and the judge’s mindset.

How can the witness’s memory impact the claim resolution?

While we generally think our memories are excellent, we tend to reconstruct the past in a way that is consistent with our interests and emotional needs. However, this also makes our minds easily tricked into remembering things that did not occur.

Attorneys throughout Lehigh County often deal with witnesses who are far too confident in their recollections. Some people simply cannot be convinced that their memories may be wrong no matter how strong the evidence.

A real-life example

Years ago, a young associate I supervised was concerned that a particular witness in a workers’ compensation case did not wish to acknowledge that her memory of the events that led to her injury was incorrect. The theory in the case was simple.

She was a woman in her 50s who, for many years, hoisted reams and boxes of paper onto her right shoulder to carry them from one location in the store to the other. Over the course of time, her right rotator cuff deteriorated and finally tore. 

Because virtually all the burden of doing this was on her right shoulder and arm, her left rotator cuff was fine. The woman, however, was convinced she suffered a specific incident in which she hurt her shoulder. 

While it is probable that, at some point, she started feeling some pain in her shoulder when she lifted boxes, the problem was that she wrote two separate statements about how she injured her shoulder and made no mention of any specific incident.

In both statements, she said that she developed the symptoms over time. This was a perfectly reasonable explanation for her condition which, if accepted by the judge, would have resulted in a determination in her favor.

To make matters worse, the medical records of five separate medical providers, including a physical therapist, made no mention of a specific incident resulting in an injury. She insisted, however, that she told “all of them” about the time she lifted a box of paper on her shoulder and hurt herself. 

I explained to my associate that she needed to discuss with the woman the problems associated with contradicting her own medical records and statements and talk to her about the fallibility of memory and the tendency for people to remember things that occurred in the past in a way that is consistent with their emotional makeup, needs, and interests. 

I joined the associate in a conference room while she spoke with the claimant. She began by discussing the issue of memory, and the client acknowledged that she understood that memory is fallible. She discussed the problems associated with contradicting your own statements when testifying before a judge.

She explained the problem of trying to say that six separate medical providers had somehow recorded her history incorrectly. In the end, the woman agreed her memory of the incident was wrong, and that there could not have been a specific injury that resulted in her rotator cuff tear.

The U-turn

When she appeared before a judge, she testified consistently with her statements and the history that she provided to her medical providers, stating that the symptoms had occurred over the course of time and seemed to worsen during work hours. Her testimony was perfectly fine.

However, on cross-examination, the attorney asked the claimant if there was a specific incident that resulted in her injury. So strong was her memory of a specific incident, that she fell into the trap.

She claimed there was a specific incident, and then was subjected to 25 minutes of cross-examination during which she was confronted with both of her witness statements and the medical records from six different medical providers in which no history of a specific incident was recorded.

The Outcome

I genuinely believe this woman was testifying truthfully, in the sense that she honestly believed that her shoulder injury had resulted from a single incident in which she had lifted a box of paper onto her shoulders. I also believe, however, that this memory was completely false and that her shoulder problem resulted from repetitively lifting such boxes onto her shoulder over the course of time.

When the pressure was on, however, she could not resist insisting on the accuracy of her memory, which had predictable consequences: While my associate was able to get the case settled, the value of the settlement had gone down considerably. 

The Takeaway

When a witness testifies to a story that is contradicted by multiple documents containing descriptions of statements made by the witness, it is nearly impossible to convince a finder of fact that the witness is testifying truthfully. 

Therefore, if you’re due to testify in a workers’ compensation case, it is highly advisable to acknowledge the fact that your recollection of past events may not be perfect and to rely on the guidance of your legal counsel instead.

Will the mindset of the judge affect the outcome of my case?

Does the mindset of the judge have an impact on the likelihood that you will win or lose your workers’ compensation case? This is one of the most common questions we hear in our law firm and the answer is, unsurprisingly, “yes”. Like everyone, workers’ compensation judges in Pennsylvania have their own viewpoints, biases, and life experiences. 

Some are highly skeptical about certain medical providers. Others are skeptical about particular attorneys or law firms. Some judges are pro-employer, others pro-claimant. As such, it is only natural to conclude that the mindset of the judge can have a serious impact on whether you win or lose your workers’ compensation case.

Who’s the preferred work injury attorney near me in Allentown?

Whether you wish to discuss your options regarding long-term disability benefits or need a reliable team to help you avoid insurance companies’ traps after filing a claim, Liberty Bell should be your first choice. With a proven, 20-year-long track record of success, our dedicated team from Allentown has extensive experience of the region’s legal landscape and can help you navigate every facet of Pennsylvania Workers’ Compensation law with utmost confidence. Reach out today!

Many working Americans have long-term disability coverage through their employers. What they don’t realize is how the deck is stacked against purchasers of employer-supplied disability insurance.

Imagine you were injured in an automobile accident and filed suit against the man who drove his car into the back of yours because he was busy texting his bookie. You showed up in court and amazingly enough, the judge is the person who smashed into the back of your car! 

Over in the jury box are his wife and family. The defense attorney is his brother. You, of course, are all alone, because you didn’t know that you needed a work injury lawyer in Allentown. What do you think the outcome will be?

License To Steal: How Long-Term Disability Insurance Companies Cheat You Blind

The above hypothetical scenario, disconcerting as it may be, paints an almost perfect picture of how long-term disability claims are handled. Though the law that governs these types of policies says that the insurance companies are supposed to administer these claims in a fair and impartial manner, most of the insurers pay lip service to this requirement.

The insurance company has an array of professional claims people who gather your medical records, and have them reviewed by physicians who make their money certifying that you’re not disabled. Claims personnel make intrusive phone calls to your doctors and then place misleading descriptions of the conversations in the claim record.

To top it all off, you probably won’t know that you’re entitled to take a look at all the records that the insurance company is using to determine whether you’re entitled to benefits. If the record in the case is closed by the insurance company, you won’t have the right to submit more evidence into the record if you’re required to take an appeal of the decision to a federal judge.

Considering all the complexities of the process already imposed by the system, as well as the immense potential for further complications, it’s safe to say that trying to pursue a long-term disability claim on your own would be a grave mistake. Instead, hire an experienced lawyer at the earliest possible moment and let their expertise guide you toward financial security.

Supplementing Your Lost Income: How Your Long-Term Disability Insurance Should Bridge The Gap

After a life-changing injury or medical condition leaves you disabled, it can be difficult to know what your future has in store for you. Other than your own recovery, one of your first priorities is to secure your finances.

Facing what could amount to years without an income is certainly frightening, but fortunately, long-term disability insurance may be able to help you stay afloat during your absence from the workplace.

However, while long-term disability insurance can be a wonderful asset, it can also be very tricky for some individuals to obtain. With complicated application and appeal procedures, many people have a challenging time collecting the benefits that they have paid for much of their tenure with a particular employer.

When these individuals do finally succeed in obtaining long-term disability benefits, many are surprised to learn that it is not an immediate and complete income replacement: it acts primarily as a supplement and is not available immediately. Here are some important things to know about your long-term disability policy benefits:

• You will not receive your long-term disability benefits immediately after you apply. There is a window in which you will not receive long-term disability benefits. This is known as the elimination period and typically lasts three to six months. During this time, your short-term disability will still be paying out, so you will still have some supplemental income.
• You may have to apply for Social Security Disability Insurance, as well. Insurance companies are concerned with their bottom line, and if there is another way for you to collect money, they will insist that you do so. If your Social Security Disability Insurance application is successful, the amount you receive monthly will be taken out of your long-term disability benefits, and you will receive the excess.
• Long-term disability benefits are not meant to replace your income, they are meant to supplement it. This means that you will be receiving a percentage of your income, which will be outlined in your long-term disability insurance policy. Typically, those on long-term disability receive about 60% of their former income.
• Employer-sponsored plans are covered by the Employee Retirement Income Security Act (ERISA), a law drafted to benefit employers, not employees. If your claim is denied, you may have to pursue internal appeal rights. If you do not have an attorney assisting you in your internal appeal, the decision may be nearly impossible to get reversed.

Now That Taxes On The Wealthy Have Been Cut, It’s Time To Cut Benefits For The Disabled

One of the saddest myths perpetuated by the right is that most people collecting Social Security disability benefits are lazy, as Senator Rand Paul once implied. “Who doesn’t get up a little anxious for work every day and their back hurts?” – Senator Paul asked, demonstrating that he has no idea what the program is about.

President Trump’s 2018 budget called for $72.5 billion in cuts in SSDI and supplemental security income (SSI), another program for disabled people, over 10 years. His position on this is ironic, given that nine out of the ten counties with the highest share of working-age adults collecting SSDI benefits voted for him. 

Social Security Disability Insurance (SSDI) is not a welfare program

We pay into the program to insure against the risk that someday our bodies may give out on us and we will be unable to work. The benefits paid are meager and difficult to get. Sixty percent of the claims are turned down anyhow and, if you appeal a denial, it can take as long as 2 years to get a hearing before a Social Security judge. 

SSDI is a program for people who are desperately ill and suffering from cancer, severe heart disease, uncontrollable diabetes, or other terrible ailments. Beneficiaries of SSDI benefits have a mortality rate that is three times that of people their age. About one-fifth of men and one-sixth of women in the program die within 5 years of getting their first Social Security disability check. 

Do You Qualify For Social Security Disability Insurance Benefits?

The process for applying for Social Security Disability Insurance (SSDI) benefits can be daunting. Many people are unsure of where to start and are intimidated by the large number of applicants who are denied benefits each year.

One of the first questions we are often asked as Social Security disability attorneys is if the individual even qualifies for SSDI benefits. While it can be challenging to determine each individual’s eligibility, especially since many people suffer from several ailments simultaneously, we have included some of the basic requirements for disability benefits below.

Are You Eligible to Receive Social Security Disability Benefits?

SSDI benefits are benefits that you work hard to earn, and have paid for over your working life through FICA taxes. Depending on the length and recency of your work history (it varies based on your age), you may have already met the work requirements to be eligible for SSDI, so let’s look at some of the other qualifiers:

• You are unable to work because of a disability;
• You have medical records that support your disability;
• You have been, or are expected to be, disabled and unable to work for at least 12 months;
• You are under the age of 65.

The Social Security Administration provides a comprehensive list of qualifying disabilities, and here is an example of just a few:

• Blindness;
• Amputation;
• Cancer;
• Traumatic brain injury;
• Spine injuries;
• Multiple sclerosis;
• High blood pressure or cholesterol;
• Heart conditions;
• Diabetes;
• HIV-positive diagnosis;
• Mental impairments such as depression, bipolar disorder, schizophrenia, or PTSD.

Each condition has its own set of guidelines and standards for being considered a disability, and solid medical evidence of your conditions and treatments provided by your physician can greatly help your case. Remember, be sure to list all of your conditions when applying for SSDI and not just the ones you consider disabling, as their effects will be considered as a combined whole.

Star Trek, Social Security Disability, and the Nature of Human Rationality – Thinking Like Mr. Spock Is Not Logical

In Antonio Damasio’s book, Descartes’ Error, he relates the story of a patient he calls Elliot, who appeared to be “intelligent, skilled and able-bodied,” but who nonetheless was incapable of working and whose application for disability benefits had been denied.

When Dr. Damasio met Elliot, he was coherent and capable of talking about all that was occurring in the world, including political affairs, history, and business. His memory of his life story was flawless.

Elliot had an excellent job and was rising up the ladder in a good firm. Eventually, however, he began to develop headaches that interfered with his ability to concentrate. His condition worsened, and his work had to be completed or corrected by others. His family physician suspected a brain tumor, which turned out to be correct. 

Just above his naval cavities, he had a tumor about the size of an orange that compressed both frontal lobes. Though benign, the tumor was growing rapidly and he had to undergo surgery if he were to survive.  His medical team successfully removed the tumor. Unfortunately, however, he was left with a radical change in personality.

Though he continued to be intelligent, he could not get up for work without prompting. He proved to be unable to manage time and devoted inordinate effort to activities that were only loosely related to his main tasks or were relatively trivial compared to other pressing matters.  

He read and understood the materials provided to him, but he would devote his time to activities he found most interesting rather than those that were most important. For example, he occasionally began sorting client documents, which he ordinarily did well. Suddenly fascinated by a particular document, he would waste an entire day reading and analyzing it, ignoring more important tasks.

Soon he lost his job, fell prey to con artists, and lost all his money and his family. Elliott suffered no anxiety from his poor decisions. He accepted catastrophic reversals with complete aplomb, never losing any sleep. He could have starved to death, calmly accepting his terrible fate.

Star Trek fans think of emotions as interfering with, rather than supporting rationality. When the Enterprise faced annihilation at the hands of the evil Klingons, Captain Kirk nearly always turned to Mr. Spock, whose emotionless logical advice often saved the day. Had Elliott been advising Captain Kirk, he might have been too busy making a paper clip chain to consider how to maneuver the ship away from the Klingon death rays.

Decision-making can be rational only if we suffer the emotional consequences of error. Though anxiety can be disabling if it is excessive, it is an adaptation crucial for survival. If he were not a fictional character, it is likely that Mr. Spock would need Dr. Damasio to testify in his social security disability hearing.

Who’s the leading work injury lawyer near me in Allentown?

While long-term disability benefits do have certain limitations, they are an important financial lifeline for many individuals and families throughout the United States. If you have been injured and are applying for long-term disability benefits, or have already been denied, reach out to Liberty Bell Workers’ Compensation today, located near Allentown Public Library.

With decades of experience in the field and thousands of successful cases behind us, we’re the premier team to guide you through the complexities of Pennsylvania’s legal system. Don’t wait to realize your rights – call our office or begin a live chat now to schedule a free consultation with our firm!