Pittsburgh Workers’ Compensation Law Firm

Injuries can happen to anyone at any time, no matter what type of job they are doing. From the construction worker who falls from scaffolding to the office employee who develops carpal tunnel syndrome, the risk of injury is a constant presence in the workplace. 

When you are injured on the job, the immediate concerns are profound and often overwhelming. You need help with your medical expenses, which can quickly become astronomical, and you need a way to replace your lost wages while you recover. The possibility of not being able to return to your previous job, or any job at all, can throw your future into a state of profound uncertainty.

Navigating the aftermath of a workplace injury can be a daunting and confusing process. Although you may not need an attorney to help collect your initial workers’ compensation benefits, the system is complex and riddled with potential pitfalls. Seeking the advice of a workers’ compensation attorney is a proactive step that can help you understand your rights and ensure you receive the full benefits you are entitled to. 

At Caroselli, Beachler & Coleman, L.L.C., in Pittsburgh, we understand the anxieties and frustrations that accompany a workplace injury. We will be happy to explain your rights under the Pennsylvania Workers’ Compensation Act and monitor the progress of your benefits at no charge. The insurance companies have legal teams on their side, and their primary goal is often to minimize payouts. Having a team of workers’ compensation lawyers working for you evens the playing field and ensures your best interests are protected.

Medical And Wage Loss Benefits In Pennsylvania: Establishing Your Eligibility

To be eligible for workers’ compensation benefits in Pennsylvania, you must be able to demonstrate a few key points. First and foremost, you must show that you were employed at the time of your injury. 

Your injury must have occurred while you were on the job, and it must be directly related to your employment. This can be as straightforward as a slip and fall in the warehouse or as complex as an illness developed over time due to exposure to hazardous materials. 

Over the last four decades, our lawyers at Caroselli, Beachler & Coleman, L.L.C., have built a strong reputation for helping clients suffering from a wide variety of injuries and illnesses. 

We have a proven track record of recovering millions of dollars on behalf of injured workers, developing effective strategies for holding insurers accountable and maximizing the benefits our clients receive. We have a deep understanding of the tactics insurance companies use to deny or reduce claims, and we are prepared to counter them with meticulous evidence and compelling legal arguments.

Our work extends to a vast range of injuries, from back and neck injuries to traumatic brain injuries and repetitive stress disorders. We also assist clients with claims related to occupational diseases, which can be even more challenging to prove. 

For example, a worker who develops lung disease after years of exposure to asbestos or silica may face a difficult fight against an insurance company that claims the condition is not work-related. Our firm has the resources to investigate these cases thoroughly, gathering medical evidence and expert testimony to build a strong claim.

The Interplay of Benefits: Navigating UC, SSD, SS, Retirement, Pension, and Medicare

If you are collecting workers’ compensation benefits, you may also be eligible for other types of benefits, such as Unemployment Compensation (UC), Social Security Disability (SSD), Social Security (SS), retirement, pension, and Medicare. However, navigating this landscape requires extreme caution. 

The receipt of certain benefits, such as Medicare or SSD, may reduce the amount of your workers’ compensation benefits. This is a critical point that many injured workers overlook, often to their detriment. 

Without proper legal guidance, you could inadvertently jeopardize your benefits or face financial penalties. 

Our attorneys can help you understand how these different benefit programs interact and advise you on the best course of action to maximize your overall financial recovery. We will work with you to ensure that any applications for other benefits are timed and structured in a way that does not negatively impact your workers’ compensation claim.

A Comprehensive Overview of Workers’ Compensation Benefits

The Pennsylvania Workers’ Compensation Act provides a range of benefits beyond just wage loss and medical coverage. It also includes partial disability benefits, which are for workers who can return to work in a reduced capacity or at a lower wage.

Specific loss/loss of use benefits are provided for the loss of a body part, such as a hand or foot, or the loss of its function. A disfigurement benefit may be available for serious and permanent scarring to the head, neck, or face. In the tragic event of a fatal workplace injury, death benefits are payable to a surviving spouse or dependent children.

The law also provides compensation for illnesses or occupational diseases suffered as a result of exposure to toxic or hazardous substances on the job, such as asbestos, silica, or lead poisoning. We also handle claims for illnesses that are from chronic overuse, such as tennis elbow or carpal tunnel syndrome, which can be just as debilitating as a sudden injury.

The Act also provides coverage for injuries arising out of workplace stress or overexertion, such as a heart attack or a mental breakdown. However, these types of claims are notoriously difficult to prove and require the hand of an attorney to gather the necessary medical evidence and expert opinions to support the claim.

It is crucial to understand the limitations of the workers’ compensation system. The wage loss benefits (also called disability benefits) and medical coverage provided by the workers’ compensation law are an exclusive benefit. This means that there are no other types of recoveries or damages that can be paid under the workers’ compensation law.

Consequently, an injured worker is not compensated for inconvenience, pain and suffering, or loss of services to the household. These types of damages are permissible only from the civil courts, and workers’ compensation is not a civil court remedy. It is a no-fault system, which means you do not have to prove your employer was negligent. In exchange, the law limits the types of damages you can recover to those outlined in the Workers’ Compensation Act.

The Calculation of Your Benefits: A Critical Component

The specific dollar amount of a particular worker’s benefit is based on a calculation of their “average weekly wage.” This is a critical concept, as it forms the foundation for all subsequent benefits. 

The average weekly wage is determined by averaging the total amount of wages earned in the year prior to the injury and should approximate what a worker would earn in a typical week of work. 

This calculation can be complex, especially for workers with fluctuating hours, seasonal work, or bonuses. Once the average weekly wage is determined, the benefit rate received by the worker for each week of wage loss is just about 67% of that figure. 

Obviously, this makes the accurate calculation of the average weekly wage a very important concept. Our attorneys will scrutinize the insurance company’s calculation to ensure it is fair and accurate, as even a small error can result in a significant loss of benefits over time.

There is another important detail to understand about the calculation of benefits. There is no cost of living adjustment or increase available under the workers’ compensation law. This means that a worker who is disabled by an injury in 1998 will continue to receive the same benefit rate, even if the injury causes them to miss time from work again in 2004 or 2008. The benefit rate is locked in at the time of the injury, regardless of inflation or rising living costs. This makes maximizing your initial benefit amount all the more important.

At Caroselli, Beachler & Coleman, L.L.C., we are dedicated to helping injured workers in the Pittsburgh area navigate this complex and often unforgiving system. 

We are committed to fighting for your rights, ensuring you receive the full range of benefits you are entitled to, and providing you with the peace of mind that comes with having a powerful advocate on your side. Contact us today for a free consultation to learn more about your rights and how we can help.

Common Reasons for Workers’ Compensation Denials

Here are some of the reasons employers frequently deny workers’ comp benefits:

1. The Injury was Not Work-Related

As we touched on earlier, in order to receive workers’ comp benefits, your illness or injury must result from performing occupational duties. If you were hurt outside of work, your claim could be legitimately denied. This type of case is not always clear-cut, however. For example, let’s say your supervisor asked you to go out and pick up lunch for you and the other workers and you were hurt in a slip and fall accident on your way back from the restaurant. Your employer might say that you were “off the clock”, but if you were carrying out the instructions of your supervisor, then you are still performing work-related duties.

2. You Did Not Notify your Employer within the Required Timeframe

In Pennsylvania, you have 120 days from the date of your injury (or the date that you become aware of your condition) to notify your employer. There are exceptions to this rule in cases of occupational diseases that result from chemical exposure, in which case you have three years from the date of the injury or disability to file a claim. But even if you notify your employer within the required timeframe, your employer might still deny you for other reasons; such as that you did not seek immediate medical attention, there are no witnesses that saw you get hurt, or a similar reason. It is always in your best interests to notify your employer as soon as possible after you become aware of a workplace injury or illness in order to help avoid issues like these.

3. Your Employer Disputes Your Version of Events

Your employer might try to say that the workplace accident did not happen the way you said it did, or that there are inconsistencies in your story. If you do not have any witnesses, it makes a situation like this even more difficult. If you are being unfairly accused of not telling the truth, it is best to speak with a workers’ comp attorney as soon as possible to discuss your case and what your next steps should be.

4. Your Illness or Injury is the Result of a Pre-Existing Condition

One common reason for a workers’ compensation denial is the claim that you have a pre-existing condition and therefore your injury or illness is not work-related. For example, maybe you had a prior back injury in which you had been seeing a chiropractor for regular adjustments. But after you tried to lift a 100-pound box, you suffered a herniated disc in a similar region of your lower back that left you laid up for several weeks. This, again, is one of those gray areas where you may appear to have a pre-existing condition, but in reality this is a completely different injury, or at the very least, a mild injury was severely exacerbated to the point where you were rendered unable to work.

5. The Employer Says Your Injuries Resulted from a Violation of Company Policy

Even though workers’ compensation is a no-fault system, there are some reasons an employer can legitimately deny your claim because of your own actions. This mainly has to do with violations of company policy, such as being under the influence of alcohol or drugs on the job or injuries that happen because of horseplay. Injuries that are self-inflicted would also fall under this category.

Some denials are legitimate, but there are many cases in which a workers’ compensation claim is wrongly rejected. There might also be a party other than your employer that could be responsible for your workplace injury. Before giving up, give our office a call to have your case assessed and to discuss your legal rights and options.

Death Benefits

Unfortunately, many people are killed at work, either due to accidents or to exposure to toxins or other chemicals. If you have lost a loved one due to a workplace accident or an illness contracted at work, you are entitled to benefits, particularly if the victim left behind children.

Specific Loss

Even if your work-related injury does not directly cause you to miss work or lose wages, you may still be entitled to certain benefits for other losses.

Under Pennsylvania’s workers’ compensation laws, an individual is entitled to receive workers’ compensation benefits for specific types of injuries, even if the injury does not cause an individual to lose wages. An individual may have suffered a specific injury to a particular body part that does not disable them, but they may be entitled to receive a set sum of benefits that has been predetermined by the workers’ compensation regulations.

These benefits are called specific loss benefits. They include what would be a specific loss of a finger, hand, arm, toe, foot, leg, etc. There are also benefits available to workers who have suffered permanent disfigurement or scarring to the face or head.

The Workers’ Compensation Act has established certain guidelines for those who can receive specific loss benefits. You must:

• Show that a particular body part has been amputated or that you have lost the functional use of that body part for all practical intents and purposes
• Show that the loss occurred in the course and scope of your employment
• Have reported the injury to your employer within 120 days of the injury
• Have filed a workers’ compensation claim within the three-year statute of limitations
• Have medical evidence to support this claim

When you have suffered an injury that you now believe is permanent, you are entitled to make a claim for a specific loss benefit if you can prove that you have lost the use of at least 50% of that body part.

What Is An Impairment Rating Evaluation?

After an injured worker has received 104 weeks of total disability benefits, an insurance carrier can request an injured worker to submit to an Impairment Rating Evaluation. An impairment rating is a percentage rating that is pursuant to guidelines established by the American Medical Association (AMA). If an injured worker’s impairment rating is less than 50%, the injured worker is presumed to be partially disabled. An insurance carrier can then unilaterally change the injured worker’s disability status from total disability to partial disability. The partial disability benefits are paid at the total disability rate for a period of not more than 500 weeks.

Duty to Notify Employer in Workers Compensation Claim

An injured worker’s first obligation to be entitled to workers’ compensation benefits is to provide his employer with notice that he or she has been injured on the job. Notice of the occurrence of the injury must be given to the employer within 120 days of the date of injury. If the employer is not notified within 120 days the claim for benefits will be barred.

Exceptions To The Rule

There are certain exceptions. For example, if a supervisor or managerial employee has actual notice of the injury (perhaps because they witnessed the injury occurring) the employer is deemed to have “actual knowledge” of the injury and, in that circumstance, the injured worker is not under an obligation to repeat what is obvious and known to the employer. The other exception relates to those cases where the injured person is not aware that an injury has yet occurred.

The Workers’ Compensation Act provides that for certain types of injuries the time for giving notice of injury does not begin until the employee knows, or should know of the injury, and its possible relationship to his or her employment. This is frequently referred to as the “Discovery Rule”.

Where a workplace injury is caused by continuing, multiple traumas, for instance, lateral epicondylitis (tennis elbow) caused from overwork of the elbow joint, or carpal tunnel syndrome, the injury is not deemed to occur until the last exposure or trauma occurs. Usually, this is the last day of work before a worker is disabled or unable to continue because of the injury. For these types of injuries the time to give notice does not begin to run until the last traumatic exertion contributing to the disabling condition.

For the loss of hearing as a result of the long-term exposure to hazardous noise in the work place, the 120 days in which to give notice does not begin until the claimant learns from a physician or health care provider that they have sustained permanent hearing impairment in excess of 10 percent, and that loss of hearing is related to work place noise exposure.

Because the various ways in which a work place injury or work place illness can arise are quite varied, an injured worker should immediately contact one of our workers’ compensation attorneys at Caroselli, Beachler & Coleman, L.L.C., as soon as possible, if they have any question as to their duty to provide notice.

Vocational Interviews for Workers Comp

After a work-related injury, your employer may assign you to light-duty work based on your physical ability and the recommendation of your doctor. However, if you are receiving workers’ compensation benefits and there is no light-duty work available with your employer, you may be subject to a vocational interview by the workers’ compensation insurance carrier. A vocational interview will be scheduled to determine whether or not you have the ability, both physically and vocationally, to return to the workforce in some capacity.

Before giving any statement to any representative of your employer or its insurer, speak to a lawyer about your rights. At Caroselli, Beachler & Coleman, L.L.C., we have more than a century of collective experience guiding injured workers through all stages of the workers’ compensation process, including vocational interviews.

Serving Workers In All Industries

Since 1972, we have represented various union members and their families. Our clients work in virtually all industries.

Marcellus Shale Fracking

The world needs natural gas products, and the technology developed to extract it is remarkable. But the processes used can be dangerous to workers, property owners and the environment surrounding the well site.

Access to the site requires the driller to build roads to the well pad and impoundments which create constant, large truck and heavy machinery traffic. All of these initial activities have the real potential to cause significant adverse impacts to the land owner who leased to the gas driller, and all land owners in the surrounding area and community. Also, fracking creates a risk of ground water well contamination and/or diminution to surrounding land owners.

Admiralty and Maritime Laws

A number of major rivers, such as the Ohio River, the Monongahela River, Allegheny and Delaware rivers, flow through Pennsylvania. These rivers are a major source of jobs and commerce, and people throughout Pennsylvania work on barges, ships and docks. This work can be dangerous, and people are regularly injured in these environments. People can suffer serious back, neck and spine injuries. In the worst accidents, death is the result. If you have been injured while doing this work, you may already know that there are specific federal laws that apply to your injuries.

For instance, the Jones Act and the Longshore and Harbor Workers’ Compensation Act dictate the types of compensation that injured maritime workers are entitled to receive. These laws allow for a greater recovery for injured workers than workers’ compensation alone. A lawyer can be of great assistance in helping an injured maritime worker recover appropriate damages under the law.

FELA Railroad Injury And Accident Lawyers

If you have been injured while working on the railroad, you may be entitled to certain benefits. Caroselli, Beachler & Coleman, L.L.C., represents injured railroaders in actions brought under the Federal Employers’ Liability Act (FELA), as well as the Federal Safety Appliance Act (FSAA) and the Locomotive Inspection Act (LIA).

Nursing Injury Attorney

Health care is one of the fastest growing fields in the United States today. Millions of individuals work in this field, and millions more are expected to as our population ages. As with any other area of employment, health care workers can suffer injuries on the job. In many cases, these injuries will prevent someone from working for a lengthy period of time. We have helped people throughout Pennsylvania and beyond obtain the benefits they are entitled to through the workers’ compensation process.

Unions and Labor Organizations

Since the establishment of the firm in 1972, our attorneys have represented injured individuals and their families throughout Pennsylvania. Because of the breadth of our experience, we have also developed a working relationship with organized labor throughout Western Pennsylvania.

Negotiating A Lump Sum Settlement

If you have been injured at work, receiving a lump sum workers’ compensation settlement may be an option for you. Lump sum settlements are often available as a compromise and release for all wage loss benefits and claims for future medical expenses related to your work injury.

When a Workers’ Compensation Lawyer May Not Be Necessary

There are definitely times when an injured worker should not have any trouble dealing directly with their employer’s insurer without the need for an attorney. This may include cases in which:

• Your injury is minor and does not require extensive medical treatment. For example, if you suffered a minor cut that required stitches and is expected to heal pretty quickly, then you will probably not need an attorney.
• Your employer acknowledges that the injury is work-related. Neither your employer nor their insurer disputes the fact that the injury happened on the job, and they are not alleging that it is related to a pre-existing condition.
• You will miss little or no work because of the injury. Your injury will only cause you to miss a little bit of work (if any), and it will not keep you out for any extended period of time.

Even when these circumstances are present, it still never hurts to at least speak with an experienced workers’ compensation lawyer to go over your case. Most lawyers provide free initial consultations, and it only costs you a little bit of your time to look over everything and make sure you didn’t miss any important details.

Don’t Miss Important Deadlines – Call For A Free Consultation

The workers’ compensation law includes a variety of different time limits, but the two most important relate to a worker’s duty to notify his or her employer that an injury occurred, and the statute of limitations within which a claim may be pursued.

We understand that an injury or loss of a loved one can take its toll on you and your family, making it difficult to get to an attorney’s office. For your convenience, we are available to come to your home, hospital, or union hall to talk with you and your family about your rights under federal and Pennsylvania laws.

If you have been injured on the job, you may have more options than you think. Contact the experienced Pennsylvania workers’ compensation attorneys at Caroselli, Beachler & Coleman, L.L.C., at 412-391-9860 or through our confidential website contact form. Initial consultations regarding work accidents are free and confidential.