Sample
of Pennsylvania Workers' Compensation Law
(Italicized
words are Act 57 amendments)
(Italicized
numbers are 77 P.S. citations)
Sec 306 The following schedule of compensation is hereby established:
(1) For total disability, sixty-six and
two-thirds per centum of the wages of the injured employe as defined in section 309
beginning after the seventh day of total disability, and payable for the duration of total
disability, but the compensation shall not be more than the maximum compensation payable
as defined in section 105.2. Nothing in this clause shall require payment of compensation
after disability shall cease. If the benefit so calculated is less than fifty per centum
of the Statewide average weekly wage, then the benefit payable shall be the lower of fifty
per centum of the Statewide average weekly wage or ninety per centum of the worker's
average weekly wage.
(2) Nothing in this act shall require payment of total disability compensation benefits
under this clause for any period during which the employe is employed or receiving
wages. ((a) amended June 24, 1996, P.L.350, No.57)
Nothing in this act shall require payment of
compensation underclause (a) or (b) for any period during which the employe is
incarcerated after a conviction or during which the employe is employed and receiving
wages equal to or greater than the employe's prior earnings. (a.1) added June 24, 1996,
P.L.350, No.57)
(a.2)
(1) When an employe has received total disability compensation pursuant to clause
(a) for a period of one hundred four weeks, unless otherwise agreed to, the employe shall
be required to submit to a medical examination which shall be requested by the insurer
within sixty days upon the expiration of the one hundred four weeks to determine the
degree of impairment due to the compensable injury, if any. The degree of impairment shall
be determined based upon an evaluation by a physician who is licensed in this
Commonwealth, who is certified by an American Board of Medical Specialties approved board
or its osteopathic equivalent and who is active in clinical practice for at least twenty
hours per week, chosen by agreement of the parties, or as designated by the department,
pursuant to the most recent edition of the American Medical Association " Guides to
the Evaluation of Permanent Impairment."
(2) If such determination results in an impairment rating that meets a threshold
impairment rating that is equal to or greater than fifty per centum impairment under the
most recent edition of the American Medical Association "Guides to the Evaluation of
Permanent Impairment," the employe shall be presumed to be totally disabled and shall
continue to receive total disability compensation benefits under clause (a). If such
determination results in an impairment rating less than fifty per centum impairment under
the most recent edition of the American Medical Association "Guides to the Evaluation
of Permanent Impairment," the employe shall then receive partial disability benefits
under clause (b): Provided, however, That no reduction shall be made until sixty days'
notice of modification is given.
(3) Unless otherwise adjudicated or agreed to based upon a determination of earning
power under clause (b)(2), the amount of compensation shall not be affected as a result of
the change in disability status and shall remain the same. An insurer or employe may, at
any time prior to or during the five hundred-week period of partial disability, show that
the employe's earning power has changed.
(4) An employe may appeal the change to partial disability at any time during the five
hundred-week period of partial disability; Provided, That there is a determination that
the employe meets the threshold impairment rating that is equal to or greater than fifty
per centum impairment under the most recent edition of the American Medical Association
"Guides to the Evaluation of Permanent Impairment."
(5) Total disability shall continue until it is adjudicated or agreed under clause
(b) that total disability has ceased or the employe's condition improves to an impairment
rating that is less than fifty per centum of the degree of impairment defined under the
most recent edition of the American Medical Association "Guides to the Evaluation of
Permanent Impairment."
(6) Upon request of the insurer, the employe shall submit to an independent medical
examination in accordance with the provisions of section 314 to determine the status of
impairment: Provided, however, That for purposes of this clause, the employe shall not be
required to submit to more than two independent medical examinations under this clause
during a twelve-month period.
(7) In no event shall the total number of weeks of partial disability exceed
five hundred weeks for any injury or recurrence thereof, regardless of the changes in
status in disability that may occur. In no event shall the total number of weeks of total
disability exceed one hundred four weeks for any employe who does not meet a threshold
impairment rating that is equal to or greater than fifty per centum impairment under the
most recent edition of the American Medical Association "Guides to the Evaluation of
Permanent Impairment" for any injury or recurrence thereof.
(8)
(i) For purposes of this clause, the term " impairment" shall mean an
anatomic or functional abnormality or loss that results from the compensable injury and is
reasonably presumed to be permanent.
(ii) For purposes of this clause, the term " impairment rating" shall mean
the percentage of permanent impairment of the whole body resulting from the compensable
injury. The percentage rating for impairment under this clause shall represent only that
impairment that is the result of the compensable injury and not for any preexisting
work-related or nonwork-related impairment. (a.2 added June 24, 1996, P.L.350, No.57)
(512)(b)
(1) For disability partial in character caused by the compensable injury or
disease (except the particular cases mentioned in clause (c)) sixty-six and two-thirds
per centum of the difference between the wages of the injured employe, as defined in
section 309, and the earning power of the employe thereafter; but such compensation
shall not be more than the maximum compensation payable. This compensation shall be paid
during the period of such partial disability except as provided in clause (e) of this
section, but for not more than five hundred weeks. Should total disability be followed by
partial disability, the period of five hundred weeks shall not be reduced by the number of
weeks during which compensation was paid for total disability. The term " earning
power," as used in this section, shall in no case be less than the weekly amount
which the employe receives after the injury; and in no instance shall an employe receiving
compensation under this section receive more in compensation and wages combined than the
current wages of a fellow employe in employment similar to that in which the injured
employe was engaged at the time of the injury.
(2) "Earning power" shall be determined by the work the employe is capable
of performing and shall be based upon expert opinion evidence which includes job listings
with agencies of the department, private job placement agencies and advertisements in the
usual employment area. Disability partial in character shall apply if the employe is able
to perform his previous work or can, considering the employe's residual productive skill,
education, age and work experience, engage in any other kind of substantial gainful
employment which exists in the usual employment area in which the employe lives within
this Commonwealth. If the employe does not live in this Commonwealth, then the usual
employment area where the injury occurred shall apply. If the employer has a specific job
vacancy the employe is capable of performing, the employer shall offer such job to
the employe. In order to accurately assess the earning power of the employe, the insurer
may require the employe to submit to an interview by an expert approved by the department
and selected by the insurer.
(3) If the insurer receives medical evidence that the claimant is able to return to
work in any capacity, then the insurer must provide prompt written notice, on a form
prescribed by the department, to the claimant, which states all of the following:
(i) The nature of the employe's physical condition or change of condition.
(ii) That the employe has an obligation to look for available employment.
(iii) That proof of available employment opportunities may jeopardize the employe's
right to receipt of ongoing benefits.
(iv) That the employe has the right to consult with an attorney in order to obtain
evidence to challenge the insurer's contentions. ((b) amended June 24, 1996, P.L.350,
No.57)
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