One of the most frequently asked questions by new clients in a workers compensation case is “What is covered?”. Or, stated another way, “What do I get?”.
The working injured are anxious to familiarize themselves with all of the benefits available under the Workers Compensation Act. However, what is commonly not asked is, “What is not covered?” The following is a list of “8 Things Not Covered by Pennsylvania Workers’ Compensation”.
1. Pain and Suffering for a Work Injury
Pain and suffering are not elements of a work-related injury under the Workers’ Compensation Laws of Pennsylvania. If pain prevents a person from working, they will be paid for their inability to work, but not for the pain and suffering. Remember, it is your inability to work as a result of an injury that is compensated along with your medical treatment, but not the pain and suffering.
2. Disfigurement for a Work Injury Below the Head, Neck, or Face
Currently, the Pennsylvania Workers Compensation Act provides for the payment of disfigurement (scar) benefits of the head, neck, or face, including scars that are the result of surgical procedures, such as cervical surgery. No disfigurement benefits, however, are payable for scars below the head, neck, or face.
This is especially troublesome since many disfiguring scars are the result of surgical procedures to the legs (such as knee surgery). Perhaps this will change in the future but for now, scars below the head, neck, and face are not compensable under the Pennsylvania Workers’ Compensation Act.
3. Quality of Life Issues
A work-related injury can affect your personal life in a significant manner. Athletic activities, hobbies, and family relationships can all be impaired by a work-related injury. However, there is no compensation payable under the Pennsylvania Workers’ Compensation Act for loss of enjoyment of life.
4. Most Psychological Problems
The Pennsylvania Workers Compensation laws significantly limited the ability of a person to be paid for a work-related psychological problem. It is not enough to establish that the psychological problem is work-related. Instead, it must be shown that the psychological problem is the objective result of abnormal working conditions.
Abnormal working conditions are not simply a supervisor who is difficult to get along with and causes mental anguish. Abnormal working conditions must be decided on a case-by-case basis. As a practical matter, these types of claims are very difficult to establish.
5. Reproductive Rights
Sterility, impotency, miscarriages, or most other problems affecting the ability to have children that result from a work-related injury are not compensable under current Pennsylvania Law. Only injuries that affect ones earning power are compensable. It is assumed, at least currently, that the loss of the ability to reproduce does not affect ones earning capacity. Thus, problems such as those listed above resulting from a work injury are not compensable.
However, in some circumstances, medical care that is necessary to allow for reproductive function can be the responsibility of the insurance company.
6. Loss of Consortium
Neither spouse has a claim for loss of consortium whenever a work-related injury disrupts their personal lives. Loss of consortium provides for loss of services if a husband or wife assumes new responsibilities because a spouse is disabled from an injury, and can be claimed in most lawsuits involving negligence, such as in an automobile accident. However, there are no monetary benefits available for a spouse for loss of consortium with a work injury.
7. Consequential Damages
Damages incidental to a work-related injury are known as consequential damages. This would include hiring contractors to paint your house, mow your yard, or do domestic housework because you are no longer able to do so. Even though you have out-of-pocket expenses because you may now need help around the house these expenses are not recoverable under the Pennsylvania Workers Compensation Act.
The only exception to this rule are modifications that need to be made to a house because a work-related injury has resulted in confinement to a wheelchair or the inability to navigate steps or other parts of a house without assistive devices.
8. Vocational Rehabilitation
The Pennsylvania Workers Compensation Act does not provide for mandated vocational rehabilitation services. Although this is probably a good idea, the Pennsylvania Workers Compensation Act does not provide for these benefits. Although vocational rehabilitation services are sometimes available through an agency of the Commonwealth of Pennsylvania, Office of Vocational Rehabilitation, there is no requirement that these benefits be provided to you or paid for by your employer or the workers’ compensation insurance carrier.
What is Covered by Pennsylvania Workers’ Compensation Law?
The Workers Compensation Act is a good law and provides many essential benefits to injured workers. However, like any law, it is not perfect. As indicated in this article, there are many things that are not available to injured workers under current law. As with any law, changes in the future can be mandated.