Moving Out of Pennsylvania While Receiving Workers’ Compensation Benefits
Injured workers receiving workers’ compensation may face challenges concerning their benefits when they move outside Pennsylvania. Issues may involve payments to medical providers and even termination of their benefits. Under the Pennsylvania Workers’ Compensation Act, medical providers that treat an injured worker receive a reimbursement rate. A fee schedule sets forth the provider’s rates, and the bill is submitted to the employer/insurer. The rates apply to medical providers within the state and are not an exact reimbursement. In other words, providers do not receive their full charge.
Through the Workers’ Compensation Act, medical providers are mandated to request payment on a particular form, setting forth their actual charges. The proper amount of payment is then calculated by the employer/insurer. The medical provider receives an explanation of benefits (EOB) and pay within 30 days of receiving the bill.
The issue for those injured workers who move out of state is that a Pennsylvania workers’ compensation carrier or insurance company will pay the reduced rate to medical providers, as set forth under the Act. Out-of-state doctors may not accept this rate. Moving to another state may create payment issues for those workers who continue to require medical treatment outside Pennsylvania.
Another potential difficulty faced by injured workers who move out of Pennsylvania is that it may be easier for employers to terminate their workers’ compensation benefits. There are various methods by which an employer can seek to modify or terminate benefits. One method employers use is demonstrating that there are jobs that are available that you are capable of performing. These jobs must be in the general location (geographically) where the injury took place, which can be hundreds of miles from your new location outside Pennsylvania.
Additionally, injured workers must submit to Independent Medical Examinations every six months. A workers’ compensation carrier may demand that you return to Pennsylvania for these exams, and it would pay your travel expenses. Upon examination by an IME doctor, if it is determined that you are fully recovered, and a Termination Petition is filed against you, it can prove challenging to defeat the petition.
Legal precedent also holds that injured workers who leave the country while receiving workers’ compensation benefits may lose those benefits. Employers may petition to suspend those wage loss benefits, based on the fact that you chose to remove yourself from the workforce within the U.S. By moving, you dispelled the employer’s ability to offer you work within your restrictions. The employer is also unable to show there is work generally available in Pennsylvania with another employer.
The decision to leave the state or the country can bring serious consequences. At Needle Law, our workers’ compensation attorneys can help you understand your legal rights and the potential impact of moving while receiving benefits. Contact our office for a free consultation by calling 570-344-1266 or contacting us online.