Friday, October 17, 2008

Specific Loss Benefits in the Pennsylvania Workers’ Compensation System

Most employers and employees know that if a worker is injured on the job, he or she is entitled to benefits for lost wages in addition to medical treatment related to the injury. But many people do not realize that there is a subset of wage loss benefits, called “specific loss” benefits, that are payable to injured workers even if they do not miss any significant time from work after their injury.

Specific loss worker's compensation benefits are available for amputations or injuries resulting in the permanent “loss of use” of a certain body part “for all practical intents and purposes.” This latter phrase is defined as a loss more severe than one that would allow the injured worker to use the injured body part in his or her employment. It does not mean that the body part is completely useless. The determination of “loss of use” is a question of fact for a Workers’ Compensation Judge to decide and is shown through the testimony of the injured worker, his doctors and/or physical therapists, and even family and friends. The question of whether the loss of use is “for all practical intents and purposes” is also a question for the Judge to decide, but is based upon an interpretation of the law surrounding this types of claims.

Section 306(c) of the Act, §77 P.S. 513, outlines the body parts for which specific loss worker's compensation benefits are payable. These include fingers, toes, hands, legs, arms, eyes, etc. Benefits are also payable for hearing loss attributable to the injured worker’s employment, and disfigurement benefits are payable for scarring of the face, head or neck which is serious, permanent, results in an unsightly appearance and is not usually incident to the claimant’s employment. The intricacies of these two categories are beyond the scope of this article, but are vitally important details in ascertaining an injured worker’s right to redress for his or her injury.

The date from which specific loss worker's compensation benefits and the healing period benefits are payable begins upon the day the Judge finds the injury to be a specific loss pursuant to the above definition. This determination is usually obvious for amputations, but not necessarily so for other injuries resulting in the permanent loss of use of a body part. Accordingly, it is critical to research both medical and factual information surrounding the injured worker’s ability to use the body part in question.

The amount of a specific loss award (including the amount of the healing period award) is determined by using the tables outlined in Section 306(c) of the Workers’ Compensation Act to determine the number of weeks payable for a particular specific loss, and multiplying by the injured worker’s weekly compensation rate (typically two-thirds of the worker’s pre-injury average weekly wage). Specific numbers of weeks are set forth in the Act for losses of each listed body part.

To illustrate these concepts, let us discuss the case of Ernie Exampleman. Ernie worked for a company installing hardwood floors, and earned $900.00 per week. While working one afternoon at a customer’s home in January of 2006, the saw Ernie was using caught on a knot of wood and kicked backward, cutting off his index finger and thumb on his left hand. Despite the best efforts of several doctors, Ernie lost his entire left index finger, but they were able to save his thumb. Unfortunately, Ernie was left with very little use of his thumb.

According to the Act, Ernie is clearly entitled to specific loss worker's compensation benefits for his lost index finger. Section 306(c)(10) awards 50 weeks of benefits for this loss and an additional six weeks attributable to a healing period under Section 306(c)(25). Assuming Ernie is out of work for the full six weeks as a result of this injury, he would receive 56 weeks of benefits at his weekly compensation rate of $600.00 ($900.00 x 2/3). In total, Ernie will receive $33,600.00 for his lost index finger.

What about his thumb injury? The question to be determined is whether he has permanently lost the use of his thumb for all practical intents and purposes. As stated previously, this is a question for a Judge to decide. For the sake of argument, say the Judge finds that the thumb is compensable as a specific loss award. How does this finding affect the overall amount of benefits Ernie will receive for his injuries?

Logically, we might assume that Ernie would be entitled to two specific loss awards and two healing period awards. But that is not the case. The Act awards Ernie both of the specific loss awards (50 weeks for the finger and 100 weeks for the entire thumb), but only the longer of the two healing periods – 10 weeks for the thumb. In total, Ernie will receive 160 weeks of benefits for this injury.

The law of specific loss worker's compensation benefits has many twists and turns. Each individual case is unique and must be investigated in detail to determine the proper amount of compensation payable to the injured worker. Employers who have questions regarding their injured workers’ rights to benefits should contact their workers’ compensation insurance carrier or the defense attorney assigned to the worker’s case by the insurance company. Injured workers should their injuries with an attorney well-versed in Pennsylvania workers’ compensation law.

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5 comments:

lawluvr said...

Very informative! Thank you and please post more.

Lonnie the Girl said...

Thanks for describing and then giving an example. Very helpful.

Crystal Laker said...

cool resource!!! will this blog cover other topics?

Cam Barnes said...

whoa, i didn't realize you had been posting since Oct. Keep it up!

The Dude said...

Your firm really knows their stuff when it comes to workers compensation cases in PA