Theoretically, the wage loss and medical benefits can last a lifetime. However, this is exceedingly rare. Why is it rare? There are many reasons. First, some people will recover from their injuries. Also, many injured workers will settle their case for a lump sum rather than taking a risk in court in terms of having their benefits reduced or terminated. But the biggest reason is a concept called Partial Disability. Once an injured worker in Pennsylvania is converted to a Partial Disability status, the wage loss is capped at 500 weeks which is approximately 9.5 years.
Temporary Total Disability vs. Partial Disability
Let’s review the two types of situations with respect to wage loss benefits. One is called TTD- Temporary Total Disability. This is when you are out of work, receiving a full work comp check due to no earnings as a result of the work injury. This can last a lifetime, but again, that’s a rare situation. The other scenario is is Partial Disability- which has a limit of 500 weeks under the Pennsylvania Workers’ Compensation Act. An injured worker is on Partial Disability if they are earning money post injury, or if the Judge finds an earning power, or if the injured worker has reached maximum medical improvement (MMI) and undergone an IRE- Impairment Rating Evaluation which resulted in a whole body impairment of under 35%.
How to Get Partial Disability Benefits in Pennsylvania
There are two main ways to be converted to Partial Disability in Pennsylvania Workers’ Compensation cases. First, if the injured worker has an earning power, whether by actually working after the injury, or as a result of an Impairment Rating Evaluation, then the 500 weeks starts to run. With respect to earning power, if an injured worker is working after the work-related injury, but earning less than the pre-injury average weekly wage, then they get Partial Disability- 2/3 of the difference between the pre-injury average weekly wage, and the actual earnings post injury. However, even if the injured worker isn’t actually working, they can be converted to a Partial Disability status. How so? By way of a Labor Market Survey/Earning Power Assessment where the insurer hires a vocational expert to establish an earning power. If if the jobs don’t result in a job offer, the Work Comp Judge can find that the injured worker can handle the jobs from a vocational ability and physical capacity standpoint. Similarly, if the pre-injury Employer offers a job and the assigned Work Comp Judge believes the worker can handle it, even if they aren’t actually working, the conversion can take place and wage loss benefits can be reduced accordingly.
Why is it Rare for an Injured Worker to Stay on TTD for a Long Time?
One word- Independent Medical Exams! (well, three words, but one term) These are biased exams, that can happen every six months or so, whereby the insurance company hand selects a doctor to examine you, to review records, and to write a report with his/her opinions. They usually favor the insurer in some way, if not completely. So the insurance companies gain leverage this way and many cases settle as a result of the threat that a Judge could side with their doctor over your own treating physician. Also, some people have minor injuries and recover and go back to work- either with the time of injury employer, or another employer. Moreover, its’ extremely difficult to meet the 35% IRE threshold, so once an injured worker is on TTD for 2 years, (104 weeks), the insurer will request the IRE- and probably 95-99% of exams will fall under the 35% threshold, which means the worker gets put on partial disability status- and therefore, the 500 weeks begins to run. In other cases, the matter settles fully for a Compromise & Release, and sometimes a case goes to a Decision from a Workers’ Compensation Judge and the Judge finds an earning power or a full recovery. So when you put all these scenarios together, you don’t find many situations where an injured workers is on TTD for more than 3 to 5 years. It happens, but it’s not real frequent.
As for medical benefits, these tend to last longer. Why? There are fewer mechanisms to end those benefits. They end with a full Compromise & Release of the claim, or if a Judge finds a full recovery after a Petition to Terminate is filed/litigated. (or if it’s stipulated to). Of course, when you have open medical benefits, they are subject to challenge by way of Utilization Review- which is a challenge as to whether certain treatment is reasonable and necessary. We’ll discuss that in another blog post.
Our Workers’ Comp Attorneys Can Help
For more information, always free free to contact a Pennsylvania Workers’ Comp Lawyer at (215) 206-9068.