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Workers’ Compensation Handbook

Section Seven: Personal Injury Claims

Third-Party Claims

Often, employees who have been injured at work may have a second claim against an additional party or entity that is not the employer. These claims are known as
third-party claims. An employee may be able to bring a separate claim against the third party for injuries sustained during the course of employment. In the circumstance of a work-related injury, potential third parties who may be liable would be a
manufacturer of an unsafe product that caused the injury, an
outside contractor who created an unsafe condition at the work site, or a
distributor or manufacturer of an unsafe and toxic chemical that an employee used at work. If you are required to operate a car or truck as part of your job and you are injured by another driver in an accident, you may have additional remedies against the other driver.

Benefits available under third-party claims include benefits for pain and suffering, which are not included in workers’ compensation claims. Always keep this in mind when an accident occurs at work. It is important to preserve any product or piece of equipment that has been involved in an injury in the event that it can be used as evidence in the future.

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Car Accidents

Many people do not know what to do or who to notify when they are involved in an car accident. Anytime you are involved in an car accident, you should call the police and exchange names, addresses, car registration information, license plate numbers, driver’s license numbers and insurance information with the other driver. In addition, you should also seek medical treatment if you are hurt, notify your insurance agent or company of the accident, and take pictures of your vehicle if it is damaged because of the accident.

There are also certain things that you should not do when you are involved in an car accident. You should not move your car until the police arrive, unless you are blocking traffic, never admit fault, and do not leave the accident scene. If the other driver leaves the scene, be sure to get a police report. Do not be afraid to get medical attention even if you are not sure whether you are injured. It is better to be safe. In addition, do not give a recorded statement to the insurance company or anyone representing the other driver without seeking the advice of an attorney.

When you seek medical treatment for injuries sustained in an car accident, your car insurance is responsible for your medical expenses as part of your
first-party benefits. The amount in medical expenses your insurance is responsible for depends on the amount listed on your insurance policy. Generally, when your car insurance policy has paid the limit in medical benefits, your personal health insurance then pays the remaining amounts. If your vehicle was damaged in the accident, who is responsible for fixing it or paying its value, if the vehicle is deemed a total loss, depends on who caused the accident. If the other driver caused the accident, that driver’s insurance company is responsible to cover the cost of your vehicle. If you caused the accident, then you or your insurance company are responsible for the cost of your vehicle. Sometimes, when the other driver causes the accident, your insurance company will cover the cost of your vehicle, however, you will have to pay your deductible first. In these instances, generally your insurance company will eventually obtain the costs they gave to you for your vehicle, as well as your deductible, from the other driver’s insurance company.

When deciding on car insurance, which is mandatory in Pennsylvania, you have a choice between full tort and limited tort. People often choose limited tort because the monthly premium is lower than with full tort. However, if you choose limited tort, you may be giving up your right to make a claim for compensation due to any injuries you may sustain in an car accident, unless you sustain “serious injury,” the driver who caused the accident was drunk at the time, from out of state, not insured or caused harm while intending to injure himself or another person, or you were not in a private passenger motor vehicle at the time of the accident. According to Pennsylvania Statute, “serious injury” is defined as “personal injury resulting in death, serious impairment of body function or permanent serious disfigurement.”

Therefore, you should always choose full tort.

You have two (2) years from the date of the car accident to file a claim for compensation due to injuries sustained in the accident.

Although it is a state law to have car insurance, there are still many drivers that do not have automobile insurance or only have minimum coverage. Therefore, it is important for you to have uninsured and underinsured coverage included in your insurance policy. This will give you protection in the event you are in an accident with another driver who does not have insurance or does not have adequate coverage. If you own more than one vehicle, you can stack this coverage to gain more coverage. You should never waive your right to stack coverage.

*Legal issues regarding the Workers’ Compensation Act and other employment-related matters can be very complex. This booklet is designed to assist workers with questions they may have if they are injured on the job. However, this booklet cannot replace the advice of an experienced attorney. If you have any questions regarding workers’ compensation or other legal matters, do not hesitate to contact RUDBERG LAW OFFICES, LLC. 1-866-306-2667*

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Medical Malpractice

A report issued by the Institute of Medicine states that as many as 98,000 deaths occur each year as a result of PREVENTABLE medical errors. This is more than those killed by breast cancer, prostate cancer and drunk driving combined, and the equivalent of two 737s crashing daily.

Many of these errors are unknown by the patient or the patient’s family, and the errors often are unreported by the doctors.

Preventable errors can be the basis of a Medical Malpractice Claim. Types of medical negligence include:

Diagnosis

  • Delay in diagnosis
  • Failure to take necessary tests
  • Failure to act on test results
  • Failure to follow accepted standards in the emergency room

Treatment

  • Medical care that is not appropriate and does not meet the standard of care
  • Substandard performance of an operation or procedure that causes injury or death
  • Medication not given or given incorrectly
  • Unneccessary delay in treatment that worsens the patient’s condition
  • Birth Injuries – failure to provide timely and proper care to a mother and baby during childbirth

Preventative

  • Not following the standard of care for prevention
  • Failing to monitor or follow up
  • Equipment failure that causes injury to the patient
  • Objects unintentionally left in the body during surgery.
  • Failure to take the necessary steps to prevent a patient from falling.

The above are just some examples of medical negligence. A patient injured by medical negligence is entitled to compensation. If you have questions about treatment you or a family member received, please contact Rudberg Law Offices, LLC.

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VA Disability Benefits

A veteran may be entitled to VA compensation benefits if he/she has a service–connected medical disability. “Service-connected” in this instance means that the “disability was incurred or aggravated, or that the death resulted from a disability incurred or aggravated, in line of duty in the active military, naval, or air service.” 38 U.S. Code §101(16).

Following the initial application for compensation benefits, the veteran’s Regional Office will issue a decision. If the decision is not completely favorable, you have one year from the date of the decision to file an appeal to the Board of Veterans’ Appeals. An appeal can be filed for any reason though the two most common basis for appeal are: (1) VA denied benefits for a disability that began in, or was aggravated by, service; and (2) VA failed to appropriately rate the disability.

The veteran has to prove, by a preponderance of the evidence, that his/her medical condition incurred while in service or that the service aggravated a pre-existing medical condition. In service and post-service medical records and physician opinions are often used to meet this burden of proof. In some cases, symptoms of a medical condition, although incurred in service and known to be connected to service do not manifest until a year or more after discharge. With some of these such conditions, if the veteran becomes symptomatic within a specific number of years after discharge, it is presumed that the condition is service-connected if the veteran demonstrates that he/she is at least 10% disabled by that condition within the required time frame. In addition, there are cancers and other diseases that are presumed to be service-connected regardless of when the symptoms manifest, depending on whether the veteran is a former prisoner of war, exposed to radiation while in service, or exposed to Agent Orange during the Vietnam War.

Should the Regional Office find the veteran’s condition service-connected, the degree of disability the condition causes the veteran is important. The percentage of disability dictates the amount of compensation to be paid to the veteran, as well as whether other benefits are available to the veteran.

To file an appeal of the Regional Office’s Decision, a Notice of Disagreement must be filed within one year of the date the Regional Office mailed the veteran its decision. From there the veteran can have the Decision Review Officer (DRO) hold an informal hearing on the claim with the hope that the DRO will issue a favorable decision, or proceed with the appeal. To proceed with the appeal, the Regional Office will provide the veteran with the Statement of the Case and VA Form 9, Substantive Appeal Form, which the veteran must complete within 60 days of the date the Regional Office mailed the veteran the Statement of the Case, or within one year of when the Regional Office mailed the original unfavorable decision, whichever is later. A member of the Board of Veterans’ Appeal will hold a hearing on the appeal and eventually issue another decision.

*Legal issues regarding the Workers’ Compensation Act, Personal Injury, and other employment related matters can be very complex. This booklet is designed to assist workers with questions they may have if they are injured on the job. However, this booklet cannot replace the advice of an experienced attorney. If you have any questions regarding workers’ compensation or other legal matters, do not hesitate to contact RUDBERG LAW OFFICES, LLC. 1-866-306-2667*

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