Navigating the aftermath of a workplace injury can be a highly difficult process. You may be able to recover payment for the lost income you incur during your recovery. However, Workers’ Comp only pays partial wage-loss benefits, so getting back to work is typically the only way to improve your finances.
Once your physician has determined that you have reached the stage of “Maximum Medical Improvement” (MMI), you may be cleared to return. However, you may still only be able to perform limited or light-duty work. Once cleared to return to work, you must return or else jeopardize your benefits.
Get support from our Certified Pennsylvania Workers’ Compensation Lawyers by calling Cardamone Law at (267) 651-7945.
Returning to Work After Filing a Workers’ Compensation Claim in Pennsylvania
Returning to work after an injury is typically something workers want to do, rather than be stuck on wage-loss benefits at 2/3 of the pre-injury wage for the rest of their life. Here’s how that return to work process works:
Doctor’s Orders
The decision to return to work after filing your Workers’ Compensation claim usually comes from your physician. They will carefully monitor your recovery progress to determine when you have reached maximum medical improvement (MMI). Then, they will issue a Notice of Ability to Return to Work.
What is MMI?
MMI refers to the stage at which you have reached a recovery plateau. In other words, this is the stage at which your condition will not improve any further.
Reaching MMI doesn’t mean that you are “all better” or that you have healed back to your pre-injury state, it just means that more healing time will not improve your condition any further. At this stage, it is time to start looking for work you can do, rather than staying on disability forever, if possible.
Healing Periods
The period of time in which you are unable to work is often referred to as your “healing period.” As outlined by § 306(c)(25) of the Pennsylvania Workers’ Compensation Act, the length of your healing period is sometimes defined by code rather than the specific circumstances of your case.
Notice of Ability to Return to Work
Your doctor will send you a Notice of Ability to Return to Work when they think you are able to return. This triggers requirements on your part to start looking for work, and to take any available work you can do.
You may have work restrictions – more on that below – but refusing work you can perform may mean losing your benefits.
Remaining Limitations
Once you have reached MMI, you may be cleared to return to work. However, it is important to remember that not all MMI designations are created equal. For example, a worker who suffers a sprained muscle may reach MMI and be fully recovered. Meanwhile, a worker who incurs a spinal cord injury may reach MMI but still have significant limitations that prevent them from performing their pre-injury job duties.
A Notice of Ability to Return to Work will usually include specific guidelines for your employer to assign you modified or light-duty tasks that suit your physical capabilities.
Returning to Work Before MMI
If you are able to do so, you might go back to work before getting back to maximum medical improvement. For example, if you broke your leg and will be in a cast for a few months, you may be able to do modified work in a “desk job.”
This is permitted, and often encouraged, in Workers’ Comp. Just keep in mind that your demonstrated ability to work might undercut your claim that you are disabled, and it will certainly change your benefits.
Can You Still Receive Lost Wage Benefits After Reaching MMI in Pennsylvania?
You may continue to receive lost wage benefits if you reach MMI but are still suffering from physical limitations caused by your on-the-job injury.
What Total vs. Partial Disability Means
If you are deemed to qualify for “total disability” benefits, then there is no limit to how long your benefits may continue to be paid out. However, if you only qualify for “partial disability” benefits, then your benefits must be halted after a maximum of 500 weeks, as outlined by § 306(a.2)(7) of the Workers’ Compensation Act.
Many workers with serious conditions will be on total disability, then get the final 500 weeks of partial disability at the end of their coverage.
Benefit Amount
The total vs. partial distinction only affects how long your benefits last; it does not affect your benefit rate. That is instead based on whether you are actually working or not.
If you are not working at all because of the disability, you can receive 2/3 of your pre-injury wages, subject to caps and floors. If you are working part-time, you receive 2/3 of the difference in pre- and post-injury wages.
Determining Total vs. Partial Disability
In order to determine whether you qualify for total or partial disability benefits, your employer’s insurance company may send you in for an Impairment Rating Evaluation (IRE). The physician performing the IRE may be selected by both you and the insurer, or one may be selected by the Bureau of Workers’ Compensation.
Timing
This evaluation can only be requested after you have reached MMI or received temporary total disability benefits for at least 104 weeks (2 years).
IRE Requirements and Guidelines
The guidelines for how to conduct an IRE and determine an appropriate impairment rating have been fiercely contested by various parties. However, in 2018, the Pennsylvania legislature enacted Act 111, which re-established the IRE process under § 306(a.3) of the Workers’ Compensation Act.
Under the new IRE guidelines, the examining physician must use the Sixth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment to determine your impairment rating. This method helps ensure objectivity in evaluating your condition. Previously, physicians were only instructed to use the “most recent” edition of the guide.
Threshold for Partial Disability
If the physician determines that your impairment rating is below 35% (previously the threshold was 50%), then the classification of your lost wage benefits may shift from “total disability” to “partial disability.”
This change limits the duration of time that those benefits can be received to 500 weeks. Fortunately, anything higher than 35% will constitute total disability and will qualify you for benefits that may be paid out for an indefinite length of time.
What if You Do Not Want to Return to Work After Filing a Workers’ Compensation Claim in Pennsylvania?
If conflicts emerge between you and your employer while you are receiving Workers’ Compensation benefits, or if you decide that returning to your previous role is not something you want or are capable of doing, you are not legally obligated to return. However, this usually ends your benefits.
Can You Retire While on Workers’ Comp?
Yes, you can – but it will typically stop your benefits. You can only get Workers’ Comp coverage if you want to work, but are unable to.
Can You Change Fields?
Often, injured workers have to change fields or careers to return to work after an injury. If your disability prevents it, you may not return to the same employer, let alone the same type of work you did when you became injured.
Often, vocational counseling and job retraining services are available through Workers’ Comp.
Can You Change Employers?
Many workers will change employers when returning to work. There is no requirement to go back to work with the same employer, whether that is your choice or the employer’s. Many settlement agreements also say you will not return to work with that employer.
That being said, you often must take available work under Workers’ Compensation rules, and saying no to your previous employer when other work has not become available could jeopardize your benefits.
Return to Work Forms in Pennsylvania Workers’ Compensation Claims
The requirement to provide a “return to work” form is set forth by § 306(b)(3) of the Workers’ Compensation Act.
Notice of Ability to Return to Work
Under this requirement, your employer’s insurer must promptly send you a written Notice of Ability to Return to Work if they receive medical evidence suggesting that you are capable of returning to work in any capacity.
Contents
This notice will inform you about the perceived change in your physical condition. It will also explain that you have an obligation to search for available employment. Further, if the insurer provides proof of available employment opportunities, then your right to continue receiving benefits may be jeopardized.
FAQs for Returning to Work After Pennsylvania Workers’ Compensation
Can You Keep Your Benefits If You Go Back to Work?
Medical care coverage should last as long as you still need treatment for a work-related injury, whether it affects your ability to work or not.
Wage-loss benefits, however, only last as long as you face a reduction in earning power. If you return to work and have no lost income, then your employer can file to stop wage-loss benefits immediately. If you return with a reduced wage, you can still get 2/3 of the reduction.
However, if you have undergone an IRE and it found you were under 35% impairment, your “partial disability” benefits only last for 500 more weeks as long as you are still making less than before the injury.
Does Your Employer Have to Keep Your Job Open?
No, but they may rehire you. If your employer cannot afford to leave the position open, they can hire a replacement and have no obligation to provide you with a job if they don’t have a position for you.
However, many employers are willing to take employees back. If not, Workers’ Comp can help you find another job you can do.
Can You Be Fired While You’re Out on Workers’ Comp?
Maybe. You cannot be filed in retaliation for filing a Workers’ Comp claim, but you can be fired for other legal causes, e.g.
- The fact that you caused the accident that injured you
- There is no open position for you
- Your disabilities prevent you from being able to work your old job, even with accommodations.
Most employees are “at will,” which means they can fire you for any reason – they just can’t fire you for an illegal reason like retaliation or disability discrimination.
Call Our Attorneys for Help with Your Workers’ Compensation Claim in Pennsylvania
Seek assistance from our Certified Philadelphia Workers’ Compensation Lawyers by calling Cardamone Law today at (267) 651-7945.
