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DELVACCA presents

DELVACCA presents. LIMITING EXPOSURE IN WORKERS’ COMPENSATION June 3, 2010. DELVACCA thanks BWH for their sponsorship of this event. LIMITING EXPOSURE IN WORKERS’ COMPENSATION. Introduction: Thomas C. Kelly, Esquire Burns White & Hickton

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DELVACCA presents

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  1. DELVACCA presents LIMITING EXPOSURE IN WORKERS’ COMPENSATION June 3, 2010 DELVACCA thanks BWH for their sponsorship of this event

  2. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Introduction: • Thomas C. Kelly, Esquire • Burns White & Hickton • At Burns, White & Hickton, we are committed to representing our clients with excellence. In fact, it was the pursuit of excellence that prompted us to establish our firm in 1987, focusing on transportation, litigation, and business law. Our ideal was and still is to abolish old-school thinking and to apply creative solutions to enhance their bottom-line results.

  3. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Not WC 101 • Focus on what we as lawyers can do to avoid litigation and to limit exposure once a case is in litigation.

  4. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Issuance of initial bureau documents • Notice of Temporary Compensation Payable (NTCP) • Medical Only NTCP • Notice of Compensation Payable (NCP) • Notice of Workers’ Compensation Denial • Statement of Wages

  5. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Notice of Temporary Compensation Payable (NTCP) and Medical Only NTCP (LIBC 501) • Allows employer 90 days to conduct investigation • Automatically converts after 90 days • Usually used if possible factual issue or degree of medical issue is involved • Good tool if claim is likely compensable (but be careful)

  6. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Notice of Compensation Payable (NCP)(LIBC 495) • Claim is accepted as compensable • Once this is issued the employer/carrier cannot stop payment until either an agreement of the parties or judge’s order • One exception – Notice of Suspension or Modification (LIBC 751) • Description of injury and compensation rate generally dictate overall value of claim

  7. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • NCP continued • Description of injury / Medical benefits • May also invite litigation • Indemnity benefits • Calculation of average weekly wage (AWW) and corresponding compensation rate. • Concurrent employment.

  8. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Notice of Workers’ Compensation Denial (Denial) (LIBC 496) • Usually invites litigation • If there is an injury, even if not severe, it must be recognized • Penalty Petition for failing to recognize injuries (LIBC 686) • Factual contests easier to defend than medical ones • Initial investigation crucial

  9. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Claim Petition (LIBC 362) • Claim now in litigation • Claimant’s burden • Remedial Act

  10. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • “Yellow Freight” (Yellow Freight Sys., Inc. v. WCAB (Madara), 423 A.2d 1125 (Pa.Comwlth. 1981)) • Untimely Answer to Claim Petition (more than 20 days) • Factual allegations deemed admitted • Claimant must still prove degree of disability

  11. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Limiting exposure • Termination Petition • Suspension Petition • Modification Petition • Notification of Suspension or Modification • Supplemental Agreement

  12. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Termination Petition (LIBC 398 (Multiple Use)) • Legal standard (Employer’s burden) • Must prove that disability has ceased (change in medical condition) or that any present disability is not related to work injury (Daniels v. (WCAB Tristate Transport, (753 A.2d 293 (Pa.Cmwlth. 2000)) • Purely medical issue • Judges are very claimant oriented (Remedial Act) • Medical questions almost always lose • Costs involved with Termination Petition must be considered • Litigations cost awarded if Employer looses

  13. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Suspension Petition (LIBC 398 (Multiple Use) • Legal standard (Employer’s burden) • Return to work (RTW) at wages greater than or equal to pre-injury wage (Ede v. Ruhe Motor Corp., 136 A.2d 151 (Pa.Super. 1957)) • Claimant needs to be released to RTW in Some capacity • Less difficult to obtain • Judges are more open to cutting off indemnity benefits if medical can remain open • Best if used in conjunction with termination petition • Judges more prone to grant lesser relief

  14. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Modification Petition (LIBC 398 (Multiple Use) • Legal standard (Employer’s burden) • RTW with a wage loss • Employer responsible for 2/3 of difference (medical benefits remain open) • Least difficult to obtain (again, best if used with another petition - lesser relief) • Job offer with pre-injury employer (work availability) • Problem is that claimant may just show up. • Labor Market Survey (work generally available) (“Kachinski”) • Practically difficult

  15. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Modification Petition Continued • Labor Market Survey • Kachinski v. WCAB (Vepco Const. Co., 532 A.2d 374 (Pa. 1987) • Four prongs • Employer must produce medical evidence of change in condition (ability to work) • Employer must then produce referrals to then open jobs (within geographical areas, physical and educational limits) • Employee must prove good faith effort to apply for jobs • If no job results benefits continue

  16. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Notification of Suspension or Modification (LIBC 751) • Unilateral tool • Good tool if claimant back to work, is a good employee, and is expected to remain • Claim is in suspended status (Medical still open) • Burden is on Claimant to come back and show wage loss • Reinstatement Petition • Employee Challenge • Special Supersedeas hearing

  17. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Supplemental Agreement (LIBC 337) • By agreement of parties • Can be difficult to administer if repeated agreement necessary • Can be helpful in determining value of a claim for settlement • Burden on Claimant to show a recurrent loss of wage • Reinstatement Petition

  18. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Supersedeas Fund • Termination / Suspension / Modification Petitions • Always request • Application for reimbursement (LIBC 662)

  19. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Settlement (Compromise and Release) (LIBC 755) • Typically between three and four years • Comp rate of $500 per week equals $26,000 annually • $78,000.00 – $104,000.00 • Max Comp rate for 2010 is $845 • Three years of benefits at the max comp rate in 2010 is $131,820

  20. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Impairment Rating Evaluation (IRE) • Limits exposure to 500 weeks if less than 50% impaired. • Entitled to an IRE after 104 weeks (No burden of proof needs to be met) • Small window of opportunity (? Weeks) • After that the case must be tried and Claimant is given the opportunity to rebut findings. • If impairment rating is over 50% Claimant is entitled to ongoing benefits (unless you can reduce rate by way of another petition)

  21. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Rationale: • Assuming an IRE comes back with a rating of less than 50%, the employer is still on the hook for another 9.5 years worth of benefits, settlement at even four years of indemnity benefits greatly lowers that exposure • Settlement will usually absolve the employer from future medical treatment as well. • More than one way to skin a cat • It is possible to leave medical benefits open for a period of time arrived at during settlement negotiations.

  22. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Medicare considerations • Can be cost prohibitive (but we can help) • Open Medical benefits can circumvent this

  23. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Cost of a fully litigated claim • Typically about $5,000 • Cost of an open claim • Can be into the hundreds of thousands

  24. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Unreasonable contest • Claimant’s counsel can seek “reasonable attorney’s fees if Employer prosecutes petition with insufficient evidence • Penalties • Claimant can seek up to 50% of back owed benefits or medical costs if penalty assessed

  25. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • Mediations • Not really good for employers • Nature of the Act is remedial • Judges are mostly claimant oriented • Basically two against one • Once a judge puts a number on a case the Claimant will never come off of it

  26. LIMITING EXPOSURE IN WORKERS’ COMPENSATION • The bottom line is that once a claim is accepted as compensable we need to make every effort to obtain an opinion that the claimant can work in some capacity and offer them a position • Employers’ best chance of truly limiting exposure is to get the indemnity portion of the claim reduced by way of a job offer and subsequent suspension or modification petition • Once a favorable determination is obtained the value of the case is greatly diminished and claimants’ counsel will usually settle the case for a fraction of what it would be worth without a reduction

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