The Philadelphia Phillies kick off their 2022 baseball season this Friday at Citizen Bank Park in South Philly. Our Phillies will be striving to recapture their glory from the Jimmy Rollins/Chase Utley/Ryan Howard era and make the postseason for the first time since 2011.
Whether you’re a baseball fan or not, we’re here to tell you that if you injure yourself at work and cannot do your job, and the insurance company for your employer denies you benefits, you will need to hire a lawyer, and your case, in a sense, will be like a baseball game. You will be the “batter,” your worker’s compensation lawyer – and we hope you will hire Pearson Koutcher Law– will be your “manager,” and the insurance company and its lawyer will be the opposing team. Using the analogy of a baseball game, we will provide you with the basic information about the process of how a workers’ compensation case in Pennsylvania works.
Let’s start with a hypothetical: you injure your back while picking up a box off the floor at the warehouse where you work. You immediately notify your supervisor, who provides you with a list of medical providers to treat with for a work injury. The following day, you see an occupational medicine doctor at one of the facilities on the list, who diagnoses you with a back sprain, prescribes medication, and refers you for physical therapy and an MRI. Your claim is initially accepted, and you start to receive checks for Pennsylvania workers’ compensation benefits.
A month later, however, the same occupational medicine doctor whom you thought had your best interests at heart sends you back to your heavy-duty job at the warehouse. Because you know you are not ready to go back to your job because of your high pain level and difficulty walking, bending, and lifting even light items, you do not return to work. The insurance company turns around and stops your PA workers’ comp benefits on the basis that you refused to accept work which the occupational medicine doctor released you to perform.
It is at this point when you need a good workers’ comp. lawyer to “go to bat” for you and file a petition on your behalf, requesting workers’ comp. benefits for your lost time at work, past and future, as well as payment of your medical bills. Your petition will be assigned to a workers’ compensation judge, who will act as “umpire” and preside over you case.
The insurance company will hire a lawyer to fight your petition and try to “strike you out.” And don’t expect the worker’s compensation lawyer and the insurance company just to throw you easy-to-hit “fastballs” – they are likely to throw you “curveballs” to trick you up. For example, they may send out private investigators to your home to conduct surveillance on you for several days. If they video tape you participating in one minor activity – pulling your trash cans to the curb or making a grocery store trip to pick up a few items – they will try to use that against you and argue to the workers’ compensation judge that you are not as injured as you claim.
Yes, the insurance company will have you evaluated by another doctor, who may be as unscrupulous as the doctor who sent you back to full-duty work. This doctor may conclude that not only can you return to your job, you fully recovered from your back injury and do not require any additional medical treatment.
Unfortunately, the process before the judge can take up to a year because there will be hearings, depositions, and your lawyer and the insurance company lawyer will each submit a legal brief. If your case is complicated, though, your “game” could go into “extra innings” and take a year and a half. What are potential complicating factors? Suppose when you hurt your back lifting the box, you fell backwards and struck your head on the concrete floor, which caused you a concussion – headaches, dizziness, and memory loss. Your lawyer will have to present the deposition testimony of two doctors on your “team” – an orthopedic surgeon or pain management physician to describe your back injury, and a neurologist to testify about your concussion. As a result, the insurance company would subject you to two examinations and its lawyer will probably take the depositions of both doctors. All of this would prolong the process.
The insurance company’s lawyer may also counter your PA workers’ comp claim by presenting testimony from one or more of your co-workers who could state, for example, that they were there when you injured yourself and the box you were lifting was light; and you did not hit your head on the floor.
At the end of the case, the judge will evaluate all the evidence and make a decision on whether you win or lose – whether you are “safe” or “out.” The PA workers’ comp judge could call you out by finding that you did not injure yourself and award you no money. Or the judge could find that you injured yourself but by the time you were evaluated by the insurance company’s doctor a few months later, you had recovered, in which case you would be awarded some money but not much. That would be like hitting a “single.” In the best-case scenario, the judge would grant your claim, reject the opinion of the insurance company’s doctor that you fully recovered, and award you ongoing PA workers’ comp. benefits. Let’s call that a “double” or “triple” if that happens.
So how do you hit a “home run” in your Pennsylvania workers’ comp. case? At some point during the process – it could happen before the judge decides your case or later down the road – you may participate in a settlement conference, known as a mediation, with your lawyer, the insurance company’s lawyer, and a judge. That judge will work with both sides in an effort to facilitate a settlement, in which you receive a lump sum settlement. If that amount is high enough, my friend, you will have hit a home run.
The bottom line is that if you injure yourself at work, we strongly encourage you to hire the law firm of Pearson Koutcher to represent you in your claim. Our Pennsylvania workers’ compensation lawyers are experienced, hard-working, and compassionate. We won’t strike out, we won’t commit errors, and we might just help you hit a home run. If you are looking for a workers’ compensation attorney near me, contact Pearson Koutcher Law today.