Pennsylvania Supreme Court strikes down IRE provisions in Workers Compensation Act

Attorneys across the Commonwealth of Pennsylvania have been waiting for the Pennsylvania Supreme Court to clarify the status of the Impairment Rating Evaluation section of the Act, since the Commonwealth Court struck down provisions and remanded the case back to a Workers Compensation Judge.   The PA Supreme Court issued it’s decision as I sat in a workers compensation hearing around 11:30 AM this morning.   In Protz v. WCAB (Derry Area School District), No. 6 WAP 2016, the Court struck down the IRE provisions of the Act as unconstitutional in it’s entirety.

To help you understand, let me first explain the IRE process.  First, and foremost, it is a process used to limit injured worker wage loss benefits.  The injured worker is examined by a doctor chosen by the Commonwealth for what is called an impairment rating evaluation.  The IRE exam is solely used to establish a whole body impairment.  If the IRE examination finds an injured worker to have 50% or less whole body impairment from the work-related diagnoses, then wage loss benefits are capped to 500 weeks (about 9 1/2 years).   A request for an IRE examination by the insurance carrier cannot occur until an injured worker has received at least 104 weeks (2 years) of total disability compensation. Don’t confuse this examination with an IME  (defense) examination.  They are entirely different.  IRE examinations are nothing more than a tool for an insurance carrier to limit wage loss benefits of the injured worker.  Additionally, the provision is also unfair because it is nearly impossible to get a 50% or more whole impairment rating evaluation, outside completely catastrophic injuries. Continue reading

In Pennsylvania, what happens to Medicare Set Aside Funds

You may have heard about Medicare Set Aside agreements when it comes to Workers Compensation lump sum settlements.  They are complex and confusing too many.  Let me try and help explain a little about this complex area of law.

First, when is a Medicare Set Aside agreement required as part of a structured workers compensation settlement?  Generally, with a worker’s compensation settlement, federal law prohibits Medicare from paying for injury-related medical expenses or medications that an employer is responsible to pay.  In essence, other insurance coverage exists for those medical expenses.  To achieve that purpose, Federal government regulations require that a portion of settlement funds be “set-aside” in an account to pay for future medical expenses related to the work injury. So what specifically triggers this process?  Here are the general criteria when a settlement should be submitted for CMS review.

CMS will only review new WCMSA proposals that meet the following criteria:

  • The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or

  • The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00

So, what is the important words in here — “is” and reasonable Continue reading

New Opioid policy for Injured Federal Employees

The US Department of Labor’s Division of Federal Employee Compensation has issued new guidelines for the use of opioids to treat injured federal employees.  There has been significant nationwide concern over the growing opioid addiction epidemic across America and we should expect more changes to come, at the state levels as well.

Here is the gist of the new opioid guidelines.

  • Implementation is set for August 2017
  • Opioids can be prescribed for an initial 60 days.  However, the prescription must be broken down to  two 30 prescriptions each.
  • After the initial 60 day prescription, then to extend opioids, the treating physician must complete a Letter of Medical Neccessity (LMN). A LMN must be completed for any subsequent prescriptions.
  • Compound medications containing opioids must alway be prescribed with a LMN.  This guidelines goes into effect as of June 26, 2017.

The use of narcotic painkillers has been steadily increasing, and with that rise in use has come addiction, abuse and resulting deaths.  Many estimates put opioid use three times  higher this decade than previous decades.  Unfortunately, patients with long-term injuries are readily prescribed narcotic pain medications and that use has created significant dependency issues for many users, especially those suffering from arthritis and back injury. In many instances, insurance companies simply find it much cheaper to pay for opioid prescriptions than other treatments, including surgical procedures, that could provide much more effective long-term relief.

I suspect we will start to see similar measures rolled out in state Workers’ Compensation programs.

If you are an injured Federal Government employee, or you have suffered any work injury in the private sector and live in Pennsylvania or Maryland, contact Mooney & Associates today for a FREE consultation.  Don’t risk it going alone.  You have too much to lose.  You can call us at 717-200-HURT.

 

 

Understaffing at Pennsylvania Nursing Homes cause work injuries

back-work-injuryWe have seen the various reports from time to time on the overall impact of understaffing at Pennsylvania Nursing Homes.  In this report of 18 of Pennsylvania’s most understaffed nursing care facilities, ten of the eighteen are owned and operated by Manor Care, and three of the 18 are right here in the mid-state, in Chambersburg, Carlisle, and New Bloomfield in Perry County.  These reports generally focus around the sub-standard care is causes to the patients who reside or are being cared for in the facilities.  Rightfully so.

The untold stories of understaffing in these care facilities is the risk it puts on nursing home employees.  I get my fair share of injured nursing home employees.  Many times, understaffing is the culprit of these injuries.  Most common are lifting injuries.  These injuries usually occur when lifting patients.  They can occur due to lack of lifting equipment and understaffing.  Frequently we see back, neck, and shoulder injuries when it comes to lifting residents.   These injuries also occur due to lack of or sped up training due to understaffing.  It isn’t just sped up training though, many time it can be faulted to poor training programs.

We also see CNAs and LPNs injured by violent acts of residents.  Again, many times it is due to understaffing for patients with medical conditions that cause either violent tendencies or inability to understand or control reaction.  Fortunately, health care employees are speaking up regarding violence in health care facilities and demanding protections.  OSHA is considering new workplace violence standards.

We also see injuries occur due to lack of staffing because of employee fatigue.  Patient care is not easy.  It can be quite taxing.

Health care can be a quite rewarding career field.  Unfortunately, it is also a dangerous field, as health related work injuries now rank as high as construction work injuries.   The focus of understaffing at nursing homes should turn to patient care and employee safety.   For more information on workers safety in nursing homes, visit the OSHA website here.

Meanwhile, if you work in a nursing home in Pennsylvania and you have been hurt at work, protect your rights and potential entitlement to benefits.  Too many injured CNAs stay silent out of fear of their employer.  You don’t need to do that. Contact Mooney & Associates today for a FREE CONSULTATION.  Let us help protect you!  Call today at 717-200-HURT.

 

Seven Things to do in a Pennsylvania Slip and Fall accident

Thousands of people get hurt in slip and falls every year.  Often times these occur in places of business, such as grocery stores, retails stores, health care facilities and more.  The aftermath of these type of non-work related accidents can be overwhelming, worrisome, and costly.  Here, we provide you seven steps to take if you are a victim in a slip and fall accident.

  1. Get pictures.  I know, the last thing any person is concerned about when injured is taking pictures at the scene of the injury.   However, photos can be an important piece of evidence, as well as, an important tool for your attorney in evaluating the viability of your case.  If your slip and fall was the result of a defect, and you did not get pictures that day, return to the property and take pictures.
  2. Report the injury.  Many times, when a person slips and falls in a store, they are embarrassed.  They just get up, in pain, and go there way to try and get out of the store quickly.  Don’t do that.  Report the injury to the manager or property owner.  Property owners or managers must be made aware of the injury.  Report it.  Ask for an incident report after you report the injury.  Get the name of the manager or employee you spoke with to report the injury.  Get the name of any witnesses.
  3. Call Mooney & Associates.  Call us right away.  Call us at 717-200-HURT.  It is important that you contact us right away so we can guide you through the process and advise on what documents and forms to sign, and what not to.  Personal injury consultations with Mooney & Associates are FREE.  We will look at the circumstances and evaluate your case to determine if you have a viable case.  If so, you will be given a contingency fee agreement, which means, we do not get paid unless you get paid!
  4. Do not talk to Insurance Company.  Tall to Mooney & Associates first.  We can provide advice and guidance.  Recorded statements are meant to restrict and box you in.  Talk to us first.  Protect yourself.
  5. Treat.  Seems simple.  It is important when you are hurt in a slip and fall to seek medical treatment.  Follow your doctors treatment protocol.  Proper diagnosis is critical to getting your feeling better and recovered.  Keep notes and track your pain and treatment, it is critical for settlement evaluation.   Keep treatment information, like medical records, bills, insurance explanation of benefits forms, receipts, and more.
  6. Account for losses.  Keep an accounting of losses you incurred, such as deductibles paid, medical bills paid, prescriptions paid, and any other expenses you had to incur because of your accident.  Provide them to your attorney.
  7. Document changes.  Document changes you had to undergo, such as, things you have been restricted form doing, like hobbies, due to the injuries you suffered.  Document any wage loss you may have incurred due to the injuries.  Write it down, whatever you feel.  Keep a good injury and recovery journal.

Slip and falls are unfortunately too common.  Make your life and your case easier.  Follow these seven steps and protect yourself.

Mooney & Associates had 14 offices through South Central Pennsylvania.  That is for your convenience.  We bring our law firm close to you.  Simply call us at 717-200-HURT to schedule a FREE CONSULTATION.

Pennsylvania workers compensation time limitation for a claim

I am frequently asked questions on how long an injured worker in Pennsylvania has to file a claim and how long does an injured worker have to tell the employer about the injury.  They are extremely important questions and can have substantial impact on your work injury claim.

Statute of Limitation in Pennsylvania Workers Compensation

If you are injured at work, there are time limitations, called Statute of Limitations.  These time limitations are prescribed by law within the Pennsylvania Workers Compensation Act.  Generally, an injured workers has three years from the date you were injured to file a claim for workers compensation benefits.  Whether a Denial or a Notice of Compensation Payable is issued,  an injured worker has three years to bring a claim.  It is a bit different for repetitive type trauma.  These time limitations can run from the last day you worked due to the repetitive trauma.  Having the right medical evidence is crucial.  If you are beyond the statutory time frames, then your claim may be barred.

When the work injury results in death of the injured worker, a death claim must be filed within three years from the date of injury. In addition, the death of an injured worker must be causally linked to the work injury and occur within 300 weeks from the date of the work injury.

There are other complex nuances to timely filed work injuries.

Work Injury Notice Requirements

Statute of Limitations to file a claim is different than notice requirements.  The Pennsylvania Workers Compensation Act also provides time limitations providing notice to your employer that you sustained a work-related injury.

Many employees are told by employers that their claim is denied and they have no right to workers compensation benefits because they did not report the work injury the same day it occurred.  They are wrong!

Generally, you must tell your employer about the work injury within 21 days of the injury.  It is important to inform your employer that not only did you sustain an injury, such as a shoulder injury, but that it was caused by your job.   Reporting the injury within 21 days provides potential eligibility for wage loss benefits back to the day you stopped working.  If you fail to report the work injury within 21 days, you can still provide notice within 120 days.  If you report the work injury after 21 days, then it delays payment of wage loss benefits to the date you provided notice to your employer, instead of the date you went out of work due to the injury.  Failure to report the injury within 120 days may forever bar your workers compensation claim.

The best way to avoid pitfalls on filing a claim is to contact Mooney & Associates when you are injured at work.  Our consultations are FREE.  Your rights when injured at work are simply too important to leave to guessing or to rely on what your employer or adjuster tells you.   Your interests are paramount to us, your employer’s interest are paramount to them.  Call today at 717-200-HELP.  We have 15 convenient offices throughout Central Pennsylvania and seven of those offices hold evening hours throughout the week in various locations.

Mooney & Associates expands law firm ownership

The Ownership of a regional Central Pennsylvania law firm, Mooney & Associates, has expanded.  Founding Attorney John J. Mooney III has added Attorney Jason Imler of Hanover, Attorney George Swartz II of Hanover, and Attorney Mark Buterbaugh, of Shippensburg, as equal owners of the regional firm.

The law firm announced the expansion via a press release, as picked up here by the Central Pennsylvania Business Journal.

For purposes of this Blog, I am proud to be part of the new ownership group of Mooney & Associates.  We are looking forward to working together, collaboratively, to take this successful law firm to even new heights.  As for injured workers and disabled clients throughout the midstate and Northern Maryland, we will continue to strive to provide you excellent client service and effective legal representation.

Mooney & Associates operates 15 offices through Central Pennsylvania and Northern Maryland and offer General Practice and Personal Injury     Fully staffed office are in Chambersburg, Shippensburg, Carlisle, Harrisburg, York, Hanover, and Gettysburg.  Mooney & Associates also offers evening hours at our various office locations throughout the week.  For more information on the firm’s and it’s client services, visit us on the web at http://www.mooney4law.com.

 

Bilateral Avascular Hip Necrosis found to be Aggravated by Work Injury

Mooney & Associates recently won a case for an injured Pennsylvania worker that included bilateral avascular necrosis.  The claimant had both left and right hips replaced and the insurance carrier was forced to pay for both hip replacements.

Generally, avascular necrosis of the hip (AVN) is a degenerative condition that is not completely understood by the medical community.  Essentially, avascular hip necrosis is a dying bone condition within the hip that in most cases will lead to a hip replacement.   It is not a condition that is caused by a traumatic injury, such as falling or getting hit in the hip with an object.  However, it is also a condition that many injured workers may have, but have no previous knowledge of such condition and no prior hip pain.

These types of non-traumatic conditions will almost always lead to the issuance of a workers compensation denial from your employer’s workers compensation insurance carrier.   Any ‘pre-existing condition’ such as degenerative disk disease, a prior surgery, a prior work injury, or a condition like AVN, will always trigger a denial.  That is a given.  That DOES NOT mean that your pain is not work-related, despite what your employer may tell you.

Every story is different.  Did you have pain or symptoms in that area prior to your work incident?  Have you gone a significant period of time with no treatment for a prior injury or surgery?  What does your doctor say?  There are many complex questions to be asked when dealing with a pre-existing condition.  There are strategies to be developed and positions to take.  Mooney & Associates has a strong track record in winning aggravation/exacerbation cases, just like our gentleman from Hanover, Pennsylvania with the bilateral hip necrosis.

Don’t let your employer tell you that you did not experience a work injury because of a pre-existing condition or because you are an older worker.  You do not need to take that.  Call Mooney & Associates today at 717-200-HELP to schedule your FREE CONSULTATION with Attorney Mark Buterbaugh or email him direct at mab@mooney4law.com.  We stand ready to protect and defend Pennsylvania injured workers!

Mooney Is A Full Service Social Security Disability Practice

Mooney & Associates has beefed up our Social Security disability staff.  We always filed appeals to denials and effectively represent our clients in appeal hearings in front of the Office of Adjudication and Review (ODAR) in Harrisburg. However, with staffing changes, we are now able to expand that practice.

Not only can Mooney represent you in your appeal hearing for your denial, but we now can do the initial application process as well.  You will always stand a better chance of winning your appeal hearing with legal expertise and with an experienced Social Security Disability attorney on your side, fighting for you.

However, the one question we get from many people is how to file the initial application for Social Security Disability benefits.  They simply do not know how.  We addressed the ways to apply right here.  It is even easier now.  If you believe you are disabled and believe you have adequate medical provider support, call Mooney & Associates today at 717-200-HELP.  We can now take your initial application for you and get it filed with SSA.  We represent disabled clients through Pennsylvania and Maryland for Social Security Disability.  You can also check out the video below in which Attorney Buterbaugh discussed Social Security Disability with Channel ABC-27 in Harrisburg, Pennsylvania.

 

Happy Easter from Mooney & Associates

Mooney & Associates wishes our employees, our clients, and those we do business with, a very Happy Easter.

We take pride in our representation of those in vulnerable situations due to injuries from work accidents, motor vehicle accidents, slip and falls, dog bites, and our clients who are disabled and need Social Security Disability.  We value our clients and hope they can enjoy the Easter holiday.