Settlement in Pennsylvania work comp is an agreement by the parties to end a case in exchange for a lump sum payment. The parties involved are a claimant- the injured worker, and the employer and its insurance company or third party administrator (which is like an insurance company but it does not spend its own money). Usually, the injured worker, or his or her attorney (it is recommended to use an attorney as settlement can involve many complex issues) makes a “demand” for settlement. The insurer/employer then makes an initial offer and negotiations continue. Once an agreement is reached, the parties must have the settlement codified in what’s called a Compromise & Release Agreement and the settlement must be approved before a Pennsylvania workers’ compensation judge at a hearing on the record. Some settlements, which are not global (ie, that simply resolve an issue in the case) can be submitted to a work comp judge in what’s called a Stipulation. In these situations, at least one aspect of the case remains open so that the case continues.
The answer depends on many factors. It is recommended that you consider speaking with an experienced and Certified PA work comp lawyer to evaluate the factors in your case. Some of the factors include the extent of disability, the pre-injury average weekly wage, the age of the injured worker, the residual earning power of the injured worker, the amount of years the injured worker has been receiving benefits, whether there is litigation pending, and whether there exists an Independent Medical Exam which offers an opinion different than that of the treating physician, whether Medicare needs to approve the settlement, etc. Settlements in Pennsylvania for workers’ compensation can vary considerably but the vast majority of settlements are under $250,000.00. Pain and suffering is NOT an available benefit in PA workers’ comp. Some cases settled for $500 and some settle for $500,000. Every case is different. Injured workers should avoid comparing their case to a neighbor’s or co-workers. Remember, if there is litigation pending, it often means that there are doctors with different opinions. While settlement is not mandatory, it is always wise to explore settlement because the Judge is often confronted with opposing medical or factual evidence which he or she has to resolve, leaving one party with a victory and one with a defeat. Even if you believe your case is a strong one, nothing is guaranteed in litigation.
Yes. In fact, in most cases, a mandatory mediation is now scheduled after the first hearing if there is litigation. Even if no litigation is pending, the parties can agree to a voluntary mediation where they agree to use a certain judge as the mediator. No one, not even a judge, can force an injured worker to settle. They, along with the attorney, simply provide their opinions and recommendations.
Once the Pennsylvania workers comp judge approves the Compromise & Release Agreement, he or she will issue an order approving it. Once the order is entered, the employer/insurer/TPA has a maximum of thirty days in which to make the payments. This is assuming the parties waive the twenty day appeal period at the Compromise and Release Hearing. Note that some PA workers’ compensation settlements keep medical benefits open for a period of time- or indefinitely. However, even with open medical, the insurer/employer is able to file Utilization Review which is a process to determine if certain treatment is “reasonable and necessary”. Regardless of the Utilization Review Determination, each party has a right to challenge the initial determination by filing what’s called a Petition to Review which puts the case before a PA work comp judge “de novo”, which means that the Judge can make his or her own decision as to whether the treatment is reasonable and necessary.
You can file a Penalty Petition seeking additional money for the late payment(s). The workers’ compensation judge has discretion to award up to 50% of the amount in controversy. A 50% penalty, however, is rare. The amount of the penalty generally depends on how late the settlement money was paid, whether there was an adequate explanation for the late payment, etc. Having practiced in PA workers’ compensation law for many years, I can say it is pretty infrequent that the employer or insurer doesn’t pay the proceeds timely. Employers and insurers don’t like Penalty Petitions.
