Name: Cardamone Law
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When you face an injury at work and spend a few days in the hospital, it can upend your life for the next month or so, but you may be able to make a full recovery. When serious work injuries cause catastrophic injuries like paralysis, amputation, and traumatic brain injuries, your life may never be the same.

Workers’ Compensation should be available to cover injuries, no matter how serious, as long as they were work-related. However, employers often do not want to pay for the expense of catastrophic injuries, and you may be mired in legal issues for some time. Our attorneys can help make that process as smooth as we can and fight for your right to benefits every step of the way.

Call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945 for a free review of your injury case.

What Constitutes a “Catastrophic Injury”?

In Pennsylvania Workers’ Compensation cases, any work-related injury should be covered. However, not every work-related injury is equal. Those injuries that cause substantial medical care costs, sustained disabilities, and ongoing life changes are often considered “catastrophic.”

There is no special distinction or category for these injuries within the Workers’ Compensation Act, but courts, insurance carriers, and lawyers often treat these cases very differently. Common catastrophic work injuries include the following:

Amputation and lost function
Significant burns
Spinal cord injuries and paralysis
Traumatic brain injuries
Cancer, asbestosis, silicosis, and other ongoing illnesses.

Requirements for Workers’ Comp Coverage for Catastrophic Injuries

To get Workers’ Compensation benefits for your injury, your Philadelphia Workers’ Comp lawyers must show your case meets the following requirements:

Worker Was an Employee

Today, many workers are hired as “independent contractors,” especially when it comes to “gig workers.” If you were not an “employee,” you may be ineligible for Workers’ Comp.

However, your status is dictated by the facts of your employment and day-to-day work, not the name your employer insists on using for you.

Injury was Work-Related

The injury must have occurred in the course of your work or because of working conditions to qualify. This requirement rules out coverage for injuries and accidents outside of work.

In most cases, catastrophic injuries occur in catastrophic accidents like falls from heights, explosions, fires, and chemical spills, making it quite obvious they were work-related. However, injuries do not have to occur at your usual work site, so things like work-related auto accidents should still be covered.

Injury Was Disabling

Most injuries are put into the “catastrophic” category because they cause long-term or lifelong disabilities. Things like paralysis, amputation, and more might keep you from working for a long time or potentially stop you from ever working again.

Injuries must be disabling for at least 7 days for wage-loss benefits. However, most catastrophic injury cases see workers needing wage-loss benefits for the rest of their lives. Even after reaching maximum medical improvement (MMI) and healing as much as possible, most catastrophic injuries still leave workers unable to work after reaching MMI.

Filing Your Workers’ Compensation Claim for a Catastrophic Injury in Pennsylvania

You should always work with a lawyer when filing your claim. However, this information is here to help you understand the process:

Initial Injury Report

You might think that your employer already knows about such a serious accident, but you are still required to report the injury. This typically must be done within 21 days, but you have up to 120 days to file and still make your claim.

Insurance Carrier and Employer Decide

From there, the employer and their insurance carrier decide whether to grant benefits or not. They may grant partial benefits (e.g., medical care) but dispute the rest (e.g., wage-loss benefits), or they may grant temporary benefits for 90 days while they continue the investigation.

In any case, if the claim is denied in part or in whole, you can move on to a formal claim.

Claim Petition

Within 3 years of the injury, you can file a formal Claim Petition with the state. This gets the case assigned to a Workers’ Comp Judge (WCJ) who decides the case.

In many catastrophic injury cases, employers will be unwilling to settle the case, and it may need to go through every stage of the hearing process discussed below.

Medical Evidence

You will continue to receive medical care to heal up, but you will also need evaluations from doctors to prove what your condition is, how disabling it is, and that it was work-related.

The employer will also demand an IME – independent medical exam – with a doctor they choose. This will provide them with evidence to counter your evidence, but it might not convince the judge to ignore your doctors’ reports.

Depositions

Both sides will conduct depositions to gather evidence from witnesses and you. These are usually taken in office instead of being the kind of testimony that goes on in open court.

Hearings

All of the evidence collection typically comes in stages, with a period of time set aside for each side to collect evidence. From there, the WCJ will schedule a formal hearing.

This may take one day or multiple, depending on how much evidence there is to present and whether the WCJ wants to question you or others in the hearing. Then, the WCJ makes their determination.

Possible Appeals

If they decide against you, we can appeal to the Workers’ Comp Appeal Board and take further appeals to the Commonwealth Court and potentially the Pennsylvania Supreme Court.

Settlements

At any time, we can settle the case if the employer is willing. This usually means having your attorney explain the settlement terms to you and going before a judge. The judge will question you to ensure you understand the terms and reviewed them with a lawyer before signing off on anything.

Settlements can be “global” in that they settle all compensation, or they can be “wage-loss only” or “all but medical” in that they allow ongoing medical care to be billed to the Workers’ Comp insurance as it comes up. They can also be structured however you agree, e.g., as a lump sum or structured settlement.

Additional Challenges You Face with Catastrophic Injury Claims

Catastrophic injury cases often come across the biggest challenges that you might face in any work injury case, all rolled together in one claim. These specific legal issues are quite common:

Employer Challenges Disability

If your injury keeps you from returning to work for years – or potentially keeps you from ever working again – your employer may be on the hook for ongoing lost wages. This is something they will often fight hard to avoid.

They may use doctors who will counter your doctors’ reports and say your injury isn’t as bad as you say it is. They may even try to say you are exaggerating your condition, or that you can perform other work. We will often have to provide strong medical evidence and arguments to back up your claim of ongoing total disability.

Ongoing Medical Exams

Once you are on Workers’ Compensation for 104 weeks, your employer can have you attend medical exams every 6 months. This can be a big hassle. If, at any stage, the doctor says you are under 35% whole-body impairment, they can cut your benefits off after 500 more weeks.

If we can settle your claim, it might be possible to avoid these ongoing exams. Then, you can peacefully collect your damages as a lump sum or annuity and avoid having to worry about your employer looking over your shoulder every 6 months.

Return to Partial Work

If you remain on wage-loss benefits for the rest of your life, the pay rate will never increase. This means it is often in your best interests to get back to any work you can perform in your situation.

If you do become well enough to return to modified work or a new career, you may need significant accommodations. Finding work that you are qualified for with your disability – and making sure that you continue receiving the benefits you need while working – often takes oversight from a Pennsylvania Workers’ Comp lawyer throughout the process.

Damages for Amputation, Lost Function, Etc.

Workers’ Compensation has a special area of benefits called “specific loss” benefits that it pays for traumatic injuries.

Covered Injuries

There are specific listings in the Workers’ Comp Act, but they all involve at least one of these issues:

Serious facial scarring or disfigurement (e.g., scars of burns)
Amputation
Total lost function
Vision loss
Hearing loss.

Pay Rate

Specific loss benefits are paid at a rate of 2/3 of your pre-injury average weekly wage. They are also capped at the statewide average and cannot go lower than half that amount.

Duration

There is a list in the Workers’ Comp Act that says how many weeks the benefits last for for each listed injury. Consult these rules with a lawyer, especially if you faced multiple permanent injuries.

How Do Lifelong Wage-Loss Claims Work?

If you are going to be on wage-loss benefits for the rest of your life, it is important to know how they are calculated, how long they can last, and what issues you might face.

Rate

Wage-loss benefits are paid at a rate of 2/3 of your pre-injury wage. This is usually calculated as the average weekly wage (AWW), but hourly or salary work can be converted into your AWW.

If you do not work at all, your rate is 2/3 of your AWW; if you work partially while on benefits, your rate is 2/3 of the difference in pre-injury and post-injury AWWs.

Caps

You cannot get more than the statewide AWW or less than the lower of these two values:

1/2 the statewide AWW
90% of your pre-injury AWW.

Rate Doesn’t Change

Your rate will not be changed for inflation or other reasons. This means that if you are going to be on benefits for the rest of your life, your weekly check will be the same this year as it will be in 10 years or 20 years.

Settlement

If you are at MMI and your condition will not improve, then it is simple enough to project your wage-loss benefits for the rest of your life. This makes settlement simpler.

We can potentially get your case settled so you get all of the wage-loss benefits now in a lump sum or over time in a structured settlement. We can also potentially settle just the wage-loss portion of the case so that ongoing medical care needs can be paid for as they arise, instead of locking you into a set settlement amount to cover medical care costs, too.

Duration

Benefits can last for the rest of your working lifetime, but not if your condition improves or changes too much. If you undergo an impairment rating evaluation (IRE) after 104 weeks on benefits, the doctor might say you are under 35% whole body impairment.

If this happens, you are switched from “total disability” to “partial disability” and can only receive 500 more weeks of benefits.

Filing a Lawsuit for Catastrophic Work Injury Accidents

Many serious injuries happen in the course of everyday work, and you might have no grounds to file a lawsuit against the at-fault party. This is because you cannot sue your employer or yourself for an accident.

However, if the accident was caused by an outside third party, you may be able to sue them.

Examples of Third Parties

Many third-party lawsuits are filed against

Drivers
Other contractors
Outside equipment operators
Suppliers and vendors
Delivery drivers
Customers
Clients
Equipment manufacturer
Safety gear manufacturers.

FAQs for Catastrophic Work Injuries in Pennsylvania

Is There a Special Classification for “Catastrophic” Work Injuries?

Workers’ Compensation does not have a special distinction for “catastrophic injuries” or “serious injuries” like some insurance systems do. However, most injuries we would consider “catastrophic” require special care in filing and making sure your damages are covered in full.

Can You Get Pain and Suffering for a Catastrophic Injury Through Workers’ Comp?

Workers’ Compensation does not pay for pain and suffering or other non-economic damages, no matter how serious your injury is. The benefits paid for specific loss are similar, but they are not full pain and suffering damages.

The only way to get pain and suffering damages is to file a lawsuit and prove the defendant was liable.

How Do You Cover Ongoing Medical Needs?

If your catastrophic injury will require ongoing medical care for the foreseeable future, we generally have two options available to us:

Projecting the value of ongoing care and settling the case. Then, you can manage these expenses on your own out of a lump sum or structured settlement.
Settling only the wage-loss portion for the case so you can continue to bill ongoing care needs through Workers’ Comp.

Which option is best for your case depends heavily on how predictable and regular your care needs are, how clear it is to prove these values, and whether the insurance company is willing to continue to administer the case.