Expert Medical Evidence Necessary to Prove Disability in PA Workers’ Comp

A recent decision by the Commonwealth Court of Pennsylvania, Albert Einstein Healthcare v. W.C.A.B. (Stanford), held that an injured worker seeking Pennsylvania workers’ compensation benefits must present expert medical evidence to prove disability. The testimony of the injured worker alone, unless the injury and the disability are obviously connected, will not be enough.

In this case, the claimant testified that she stopped working, due to the work injury, on October 21, 2002. The medical expert who testified in the workers’ comp case on her behalf did not see her until December 17, 2003. The Workers’ Compensation Judge (WCJ) found the testimony of claimant and her doctor both credible, but found that workers’ compensation benefits could not be awarded until December 17, 2003, as there was no competent medical evidence of her disability until that date (when she was seen by the doctor).

On appeal, the Pennsylvania Workers’ Compensation Appeal Board (WCAB) modified that portion of the decision of the WCJ and ordered that PA workers’ comp benefits should start as of October 21, 2002, based on the credible testimony of the claimant.

The Commonwealth Court of Pennsylvania then reversed the WCAB, reinstating the original decision of the WCJ – PA workers’ compensation benefits could not start before December 17, 2003. The Court said that the connection between the injury and the disability was not obvious (and this would certainly vary from case to case, depending on the circumstances in any particular case), and that, therefore, competent medical evidence was required. The only medical evidence in the case was the deposition of claimant’s medical expert, who did not see claimant until she had already been out of work for over a year.

This case highlights the importance of having an attorney who is familiar with all the quirks and nuances of the Pennsylvania Workers’ Compensation Act. This set of laws is quite tricky for any attorney who does not practice in the area of PA workers’ comp on a frequent basis. This is exactly the reason that we at Brilliant & Neiman LLC limit our practice to only handling Pennsylvania workers’ compensation matters.