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Can Workers’ Comp. Benefits Last Forever?

  • Dave Brown, Esquire
  • 11/09/2020

Love sometimes lasts forever, but can your workers’ comp. benefits? The answer, theoretically, is yes, but it happens very rarely. Most workers’ comp. claims are fairly short-lived. We’re here to tell you how long you can expect your workers’ comp. benefits to last — and the ways in which they can stop.

Let’s say you injure yourself at work and are unable to work. You start to receive Pennsylvania workers’ comp. benefits called “total disability benefits” because you are considered totally disabled. Under the law, you could collect these benefits for the rest of your life. So if you get injured when you are 35, you could receive benefits until your death when you’re 80. It’s just extremely unlikely. And as we will explain, you wouldn’t want to do that anyway. Here are the ways your benefits can stop.

— YOU RETURN TO WORK – if you go back to work, either for the employer you were working for at the time of your injury, or another employer, you will no longer be entitled to total disability benefits. If you return to your regular job, earning as much money as you were before you were injured, your workers’ comp. benefits would be suspended. If you return to work, whether it’s your time-of-injury employer or a different employer, and are making less than what you were earning, your workers’ comp. benefits will change from total disability to partial disability. Example: You were earning $900 per week at your job, and after your injury, you go back at reduced hours, earning $600 per week. Because you have a $300 weekly wage loss, you would be entitled to 2/3 of that amount to make up the difference — $200. These are called partial disability benefits, which you are allowed to receive for a maximum of 500 weeks. So if your circumstances don’t change, you would receive the partial disability benefits for 500 weeks, which is about 9.6 years, and then they would stop.

— YOU UNDERGO AN IMPAIRMENT RATING EVALUATION – The workers’ comp. insurance company for your employer is permitted to have you submit to an Impairment Rating Evaluation, or IRE, after you have been collecting total disability benefits for 104 weeks (two years). If the physician determines that your degree of total body impairment (this is based on a complicated formula), falls below a certain threshold, the insurance company can convert your benefits to partial disability even though you have not returned to work. If this happens in your case, you will only be able to receive benefits for an additional 500 weeks.

— SETTLEMENT – Many workers’ comp. cases end because a settlement is reached between the injured worker and the insurance company. If you settle your case, you will most likely receive one lump sum of money from the insurance company, but you will not be entitled to any money in the future, even if your condition worsens. You will have to sign a settlement agreement, called a Compromise and Release Agreement, which specifies how much money you will receive, and that you will be giving up your right to future workers’ comp. benefits. You will be required to go before a Workers’ Compensation Judge for a hearing (in person before and after the pandemic; by phone during the pandemic), testifying that you understand the terms of your settlement. You may be asked the question, “Do you understand that by entering into this settlement, you will no longer be entitled to receive total disability benefits or partial disability benefits in the future?” You will have to say yes if you want the Judge to approve your settlement.

— THE JUDGE STOPS YOUR TOTAL DISABILITY BENEFITS – At some point in your case, the insurance company may file a petition to terminate, suspend, or modify your benefits. A Workers’ Compensation Judge will decide the petition after hearings are held and depositions are taken. You will need a lawyer to defend against the petition. If the judge terminates, suspends, or modifies your benefits, you will no longer receive total disability benefits. In fact, if the Judge terminates your benefits, not only will your weekly checks stop, you will no longer be entitled to medical treatment.

At the beginning, we told you that while it’s possible you could receive workers’ comp. benefits for the rest of your life, that is probably not in your best interest. Here’s why. Once your weekly workers’ comp. rate is established when you injure yourself, that rate is locked in for the duration of your claim. So if you were making $900 per week, your total disability rate would be $600. You would still receive $600 per week in 2021, 2025, 2030 — even 2050. It may seem unfair that there’s no cost-of-living increase but that’s the law in Pennsylvania. It also may seem unfair that you would have received raises if you continued doing your job, but you do not receive a “raise” in your workers’ comp. benefits — the amount stays the same. As opposed to receiving the same amount week after week, year after year, you’re much better off trying to settle your case for the largest lump sum possible.

It’s not easy navigating the workers’ comp. system, and you need a top-notch lawyer on your side. At Pearson Koutcher Law, workers’ comp. is all we do. Each of our lawyers has more than 20 years of experience handling workers’ comp. cases and is very knowledgeable about the law. Please call us for a free consultation and let us fight the insurance company for you.