If you have been receiving a weekly check for Pennsylvania workers’ compensation benefits, and a Judge issues a decision stopping your benefits, are you able to take any action which would allow you to receive a weekly check again? It depends on the type of decision that the Judge made in your case. We will go through the various scenarios in which your benefits are stopped and explain to you if your benefits are definitely done for good, or if you have a chance of getting your benefits reinstated.
Settlement – If you reach a settlement of your workers’ comp. case, you will enter into what’s called a Compromise and Release Agreement which will describe the terms of your settlement — in other words, the amount of money you will receive (usually in a lump sum) from your employer’s insurance company, and what medical bills they will pay. Usually, the insurance company will pay your medical bills for treatment you underwent up until the date the Judge holds a hearing to determine if your settlement is approved; only in rare cases will an insurance company agree to pay medical bills for treatment into the future.
At your settlement hearing, you will testify before the Judge and will be asked questions by your lawyer, the insurance company’s lawyer, and the Judge to make sure that you understand what you’re getting in the settlement and what you’re giving up. To approve the settlement, the Judge will need to conclude that you are entering into the settlement voluntarily and are aware that it is a full and final settlement (assuming that after the payment of the lump sum and past medical bills, you will receive nothing more), thus preventing you from re-opening your case in the future. Unless you show any serious hesitation about entering into the settlement, the Judge will approve it.
Suppose, though, that after your settlement is approved, your injury gets worse, and a month, six months, or a year later, your doctor tells you that you need surgery and you will never be able to do your job again. Under these circumstances, if you realize that you made a big mistake by settling and want to re-open your case so you can collect a weekly check again, we are sorry to say that you are out of luck. Once you enter into a full settlement of your worriers’ comp. claim, regardless of whether your condition worsens, you are barred from re-opening it.
Judge Terminates or Suspends your Benefits – After you start to receive weekly workers’ comp. benefits, the insurance company may file a petition to terminate your benefits on the basis that you fully recovered from your work injury and/or a petition to suspend your benefits on the basis that you recovered from your injury to the extent that you can return to work earning as much money as you were at the time of your injury. If the Judge terminates your benefits, you will no longer receive a weekly check or payment of your medical bills; if the Judge suspends your benefits, your checks will stop but the insurance company will remain responsible to pay your medical bills. Either way, you will no longer have any money coming in.
If you receive a bad decision like this from the Judge, your chances of getting a weekly check again are better than if you had settled your case, but we have to caution you — it’s still a steep hill to climb. You can appeal the Judge’s decision to the Workers’ Compensation Appeal Board, but they do not reverse Judges’ decisions often. The reason for this is because the Judge has the discretion to decide which witnesses to believe and which not to believe. So if the Judge accepts the opinion of the insurance company doctor that you fully recovered from your work injury and/or can go back to your regular job, the Appeal Board will likely affirm — or agree with — the decision of the Judge. Your lawyer will have to convince the Appeal Board that the Judge made a key legal error, warranting the reversal of the Judge’s decision. An unsuccessful appeal to the Appeal Board will leave you with the option of appealing to the Commonwealth Court of Pennsylvania, and if that fails, to the Supreme Court of Pennsylvania.
Another avenue to seek reinstatement of your benefits is by filing a new petition to be decided by a Judge — a petition to reinstate. If your benefits have been terminated, it’s going to be very hard to convince a Judge that you fully recovered from your work injury but once again are disabled and unable to work due to your work injury. You have a better shot if your benefits have been suspended because in that the case, the Judge who suspended your benefits acknowledged that you have not completely recovered from your injury and therefore are still suffering the effects from that injury. If you can prove that your condition has worsened since the suspension of your benefits — a new MRI which shows your injury has progressed is one way — you may be able to convince the Judge that you are entitled to a reinstatement of your benefits.
All of these scenarios — settling your case, appealing an unfavorable decision, and petitioning for reinstatement of your benefits — are difficult to navigate without an experienced and knowledgeable workers’ comp. lawyer fighting for you every step of the way. At Pearson Koutcher Law, workers’ comp. is all we do —we have represented thousands of clients in their workers’ comp. cases over the years and hope you will be our next client. So if you have injured yourself at work, please call us right away for a free, prompt consultation.