General legal definitions

 

Claim Petition

The document used to begin a workers’ compensation claim where the employer has denied the injury.  Claim Petitions are often filed electronically with the department in Harrisburg.

 

 

Date of Injury

Normally, the day the employee noticed the injury.  Injuries can occur gradually (e.g. carpal tunnel) or can be when the doctor diagnosed the condition.

 

Injury Report

The employer is required to document all work injuries.  An injury report does not open a workers’ compensation claim.  See “Notice of Compensation Payable.

 

Medicals only Notice of Compensation Payable

This is acceptance of a clam only for the payment of medical bills.  No wage loss benefits will be paid.

 

Notice of Compensation Payable

This document must be issued by the employer to open a workers’ compensation case. It also describes the injury actually accepted. If you do not receive this document within 21-days of notice, the claim is denied.(See Form “1”)

 

Partial Disability

Partial disability benefits will paid for no more than 500 weeks.  Where an injured employee is not completely disabled from all work by a medical professional, the disability is said to be a partial disability.  An employee may work at a reduced rate of pay or at a light-duty job and receive partial disability benefits.

 

Posted or Listed Physicians

These are medical providers listed at the place of employment who must be used by the injured worker for the first 90 days

 

Scars

The Workers’ Compensation Act provides for the payment of scars which appear on an individual’s head, face and neck if caused by work.  The scars in question must be permanent and visible.  Scars, like specific loss injuries, are paid in a number of weeks of benefits normally several thousand dollars.

 

Statement of Wages

This document calculates the employee’s exact workers’ compensation rate.  Every injured employee should receive this document within 30 days

 

Suspension of Benefits

Under a suspension of benefits, wage loss benefits are stopped, but medical bills continue to be paid.

 

Supersedeas

A Supersedeas is a request made to the Court to suspend payments.  The Supersedeas is commonly requested in a Termination Petition.  The employer is asking for permission to stop paying on the claim during the litigation before the Workers’ Compensation Judge. If you receive a request for supersedeas contact a JH & Associates.

 

Supplemental Agreement

This is a document that sets forth any agreement between the injured employee and the employer.  For example:  an increase in the hours worked while on light-duty or a change in the amount paid per week.

 

Temporary Workers’ Compensation

While an employer has a period of 21 days to accept or deny a claim they may pay the claim on a temporary basis under what is called Temporary Worker’s Compensation.  In this circumstance, Temporary Workers compensation benefits are paid for a period not to exceed 90 days, however, at the conclusion of the 90 day period the employer may deny the claim. (See Form “2”)

 

Termination of Benefits

A termination completely closes a case.  No future wage loss or medical bills will be paid.

 

Total Disability

A complete restriction from work based on the opinion of a medical doctor.  Total disability benefits are paid at the injured worker’s full rate.  While total disability benefits can last for the worker’s entire lifetime if no recovery occurs, after a two (2) year period there is to be an evaluation to determine whether the injured employee is more than 50% disabled.  If the injured employee is not more than 50% disabled, the injury is redefined as partial disability.

 

Workers’ Compensation Benefits

1.  Wage Loss - Benefits are approximately 2/3rds of the employee’s average weekly wage paid for each week the employee is disabled.

2.  Medical Benefits – The insurance carrier is required to pay all medical expenses related to the work injury.  No co-payment by the injured employee is permitted.

 

Workers’ Compensation Judge (WCJ)

The Workers’ Compensation Judge (WCJ) is the individual who hears the Workers’ Compensation case and ultimately rules on the facts and law of the case.  Evidence and testimony are provided to the WCJ at hearings.