Providers, hospitals and physicians, are very familiar with submitting claims under state workers’ compensation laws, such as The Pennsylvania Workers’ Compensation Act. But, there are some injuries and conditions affecting groups of employees that are not covered by those state laws. One example is railroad workers. Their work-related injuries fall under a federal law called the Federal Employers Liability Act, which was enacted in 1908 under the power granted to the Federal government by the Commerce Clause of the Constitution. Its purpose was to improve safety, decrease dangers, and deal with the atrocious accident rates of railroad workers performing their jobs.
There are several differences between the Pennsylvania workers’ compensation system and the FELA. That’s why it’s important to recognize when an employee of a railroad company is being treated for a work-related injury.
First of all, a railroad employee must show that the railroad was negligent in some way that caused or contributed to his or her injury. This usually falls under the concept that the employer has a duty to furnish a reasonable, safe workplace. If the employee cannot show negligence on the part of the railroad at all, then he is responsible for his own injury. For example, a track inspector who was driving a work truck and got distracted and rear-ended the sedan in front of him at a traffic light would not be covered under the FELA and his/ her medical treatment would go directly to his general health insurer. But, a track inspector whose foot was run over and crushed by a railcar that moved suddenly and unexpectedly would be covered under the FELA.
The second difference is that a railroad employee can go to court in either state or federal court and sue his employer for damages, including pain and suffering. In many instances, the compensation would be greater than an employee in a state workers’ compensation plan. However, a full recovery can be reduced by the employee’s own contributory negligence.
In contrast, state systems are considered No-Fault plans. Causally related work injuries are compensable within state workers’ compensation systems with no impact of fault or negligence by the employer or employee. So, for example, under The Pennsylvania Workers’ Compensation Act, there is no burden on the employee to prove any fault on the part of the employer. And, any negligence by the employee does not exclude him or her from receiving benefits. In exchange for those benefits, workers are prohibited from suing their employers. Compensation to the worker includes payment of medical expenses and wage loss benefits only. No pain and suffering are assessed.
The third difference is that FELA does not have a statutory fee schedule for payment of medical expenses, whereas the Medical Cost Containment Regulations of The Pennsylvania Workers’ Compensation Act provides a reimbursement fee schedule per Act 44. Generally, under FELA, a compensable claim is paid under special provisions of the employer sponsored health plan including any portioned amount usually attributed to the patient as his responsibility. Keep in mind that there is no reimbursement rate exemption for a Trauma-designated injury under FELA, which is a significant difference from The Pennsylvania Workers’ Compensation Act.
Once a provider recognizes that the patient being treated for a work-related injury is a railroad employee, it should appreciate the differences from its more regularly experienced state workers’ compensation claims and pursue payment of its medical bills accordingly.
If you have any questions or inquiries, please feel free to contact Attorney Charles J. Hilton at 412/ 435-0162.
Law Firm of Charles J. Hilton & Associates, P.C.
Charles J. Hilton, J.D., M.B.A.
Attorney at law
Contributing Author/ Editor
Jamie K. Zurasky, Esquire