It is with mixed emotion that we received word of the retirement of Workers’ Compensation Judge (WCJ) Carl Lorine. Judge Lorine was a member of the judiciary in the Upper Darby Workers’ Compensation Hearing Office, which is located in the Southeastern District. Prior to becoming a WCJ, Judge Lorine served as Director of the Pennsylvania Bureau of Workers' Compensation. We wish Judge Lorine great health and happiness in his retirement, but we will miss his presence on the bench in Delaware County.
When an injured worker in Pennsylvania discovers that it may take a year or more to get a decision in his or her PA workers’ compensation case, the client is often, understandably, distraught. We often explain that our job is to maximize the chances that the case is litigated properly, but we are not able to make it go any faster. This, of course, does not help pay the client’s bills while the litigation continues.
So, we are certainly aware of the hardships that injured workers face while awaiting a decision in their cases. At the same time, we are also aware of what is required in the litigation of a case. In most cases, the injured worker will testify, there will be a deposition from at least one medical expert on each side, and, often, either testimony or a deposition from a fact witness, or a different kind of expert (such as vocational). Once we take all of that evidence, we write briefs (which are anything but “brief”) and then it goes to the Workers’ Compensation Judge (WCJ) to await a decision. Depending on the complexity of the case, this can take well over a year to have all of this completed.
We have been told recently by a few WCJs that the PA Bureau of Workers’ Compensation is now quietly insisting that cases be tried, and decided, within a year. They are labelling this new push as the “Rocket Docket.” While this can have some beneficial aspects, by having cases decided sooner, it also carries significant costs, such as the WCJs rushing cases, or by multiple attorneys having to handle a file due to frequent conflicts (less common with a smaller firm like ours, but still a risk).
We hope this push by the Bureau was triggered by concern for the injured worker, and not simply an effort to justify a new expensive computer system (WCAIS). While we would absolutely welcome discussions with the Bureau, and the WCJs, to see how we can make the process faster and more efficient, a blanket rule with limited time is not in anyone’s best interests.
On Friday, January 24, 2014, our offices will be closed for part of the day so our attorneys, and our staff, can attend a seminar regarding the usage of the new computer system recently installed for the Pennsylvania Bureau of Workers’ Compensation. Called the WCAIS system, this program went live back in September.
Though we were involved in the early testing of the WCAIS system, each day has brought changes to the new program. To best handle our cases with the Bureau of Workers’ Compensation, we felt it important that we, and our staff, attend a seminar held to review the current status of WCAIS, and how best to use the system. The seminar is scheduled to have Hon. Elizabeth A. Crum, Director, Workers' Compensation Office of Adjudication in Harrisburg, Hon. Susan B. Caravaggio, Central District Judge Manager for the Workers’ Compensation Office of Adjudication, and three of the lead programmers who worked on, and refined, the system.
While we apologize for any inconvenience caused by us closing the firm, we believe our attendance at this seminar this will better enable us to represent injured workers throughout Southeastern and Central Pennsylvania.
One of the few recent laws passed in Pennsylvania which helped injured workers was the creation of the Uninsured Employers Guaranty Fund (UEGF). This fund was designed to be used in cases where the injured worker was employed by someone who (in direct violation of PA law) failed to carry workers’ compensation insurance coverage. The UEGF was designed to provide medical treatment, and lost wages, to those workers who, under the previous system, would be left with no recourse. This, of course, was a saving grace which embodied the supposed “humanitarian objectives” of Pennsylvania’s Workers’ Compensation Act.
Because the problem of uninsured employers in PA is so prevalent, funds allocated to the UEGF have exhausted at a faster pace than was budgeted. The legislature was then left to decide how best to fix the problem. In an astonishing declaration of indifference to injured workers throughout the State, the Pennsylvania Senate created Senate Bill 1195. Rather than simply replenish the UEGF, and allow injured workers to receive benefits they desperately need, the Senate has elected to simply gut the UEGF to reduce the number of successful claims. This is a truly sad decision being made by those who are supposed to represent us all.
Instead of coming down harder on uninsured employers, and simply reducing claims by reducing the true offenders, the Senate has decided the burden should fall on the injured workers, who are only the innocent victims. First, the worker gets injured, then they get victimized by their employer having no insurance (in violation of Pennsylvania law). It is a double punishment that simply is neither fair nor just.
Specifically, Senate Bill 1195 would:
1) Require injured workers employed by an out-of-state employer to be stuck with using any other state's workers’ compensation plan that does cover that employer/employee. This can cause the injured worker to be stuck with a much less generous system than the one other injured workers in Pennsylvania use.
2) No interest is payable on benefits from the UEGF. Considering one already cannot obtain unreasonable contest or penalties against the UEGF, every claim is litigated to a ridiculous level (because the UEGF has nothing to lose). Therefore, injured workers already face having to wait a year or more to obtain benefits (including medical treatment). To deny interest on top of that is just absurd.
3) The timing restrictions of filing claims, and what triggers the timing provisions, would be tightened. This most directly will make some injured workers simply unable to pursue any claim at all. Considering the timing limits for other injured workers in PA (120 days to provide notice of an injury, then three years to file a claim [potentially even more with the discovery rule]), the limits here of, for example, 120 days to file a claim after notification, is decidedly extreme.
4) The UEGF would be able to establish panel providers for each County, restricting compensable medical treatment for the first 90 days to that panel. Unlike with normal insured employers, however, the injured worker will not be aware of this panel. To believe an uninformed employee will know to look for a panel for the UEGF is just silly.
5) The injured worker will not be able to prove a loss of earnings by his own testimony. Instead, the injured worker needs documentation. Of course, many times the uninsured employer violates laws by paying his or her employees in cash without deductions, so there is no documentation (through no fault of the injured worker). In an astounding twist, the uninsured employer, the one who violated, at least, PA law by failing to have workers’ comp insurance, is able to testify as to wages. It is curious the Senate considers the employer, admittedly breaking the law, as the more reliable source.
6) In case of future budgeting problems, rather than replenish the UEGF, this bill gives authority to the department to unilaterally cut benefits to all beneficiaries under the UEGF.
The combination of all of these changes would essentially make UEGF cases impossible to pursue in Pennsylvania. That means any injured worker who, often unknowingly, works for an uninsured employer risks becoming severely injured and having no recourse at all. This because your elected representatives in the PA Senate appear to value the insurance industry over and above the rights and interests of the citizens.
As scheduled, the Workers' Compensation Automation and Integration System (WCAIS) went live for the Pennsylvania Bureau of Workers’ Compensation on September 9, 2013. Having been in on the ground floor of this massive undertaking, we watched this transition with great interest. While we are excited with the possibilities this new system will offer, the change in systems did not start without some issues.
For several days after the launch, the system was shut down. Since the previous system had been stopped, in anticipation of WCAIS starting, this caused the workers’ comp system in PA to grind to a halt. Fortunately, WCAIS does appear to now be functioning (in fact, today we received our first Notices of Hearing using the system). Whether the system is fully functional is unknown to us.
Problems do remain to be addressed. One Workers’ Compensation Judge (WCJ) told us that there is no functioning scanner in that workers’ compensation hearing office. This means that no evidence received by a WCJ in that office can be entered into the system. A WCJ in another hearing office advised parties to use bench orders when pursuing a Compromise & Release (settlement), as that WCJ was not sure when the system would allow WCJs to issue decisions through WCAIS.
It is certainly expected that there would be some adjustment difficulties in moving to the new system, but with the efficiency offered by WCAIS, the future handling of workers’ compensation cases in Pennsylvania undoubtedly looks bright.
As we mentioned before, both of the partners of Brilliant & Neiman LLC, Dina Brilliant and Glenn Neiman, were invited to appear on a television show hosted by Injured Workers of Pennsylvania. This show was aired live on August 19, 2013, and broadcast throughout the Berks County region of PA. The website for Berks County Television has a copy of the show in its archives, and it can be viewed on the internet by clicking here.
We at Brilliant & Neiman LLC thank Injured Workers of Pennsylvania for giving us this opportunity to speak to the public on issues regarding workers’ compensation in Pennsylvania. The primary topic was the status of House Bill 1636, which would eliminate choice of doctor for all injured workers in Pennsylvania. One of the jobs we, as attorneys representing injured workers, have is to educate the public, so injured workers know their rights under the Pennsylvania Workers’ Compensation Act.
As we mentioned previously, the Pennsylvania Legislature is planning another attack on injured workers in PA in 2013. This notion has now taken the form of House Bill 1636, which seeks to forever deny injured workers in PA the right to select their own physician.
Under the current provisions of the Pennsylvania Workers’ Compensation Act, if an employer follows the correct procedures and posts a proper list of at least six health care providers (at least three of which must be physicians), then the employer is only responsible for payment of medical treatment with the listed panel providers for the first 90 days of the injury.
If this Bill becomes law, however, an employer may list as few as a single Coordinated Care Organization (CCO) on a panel. Then, the injured worker would have to treat with this single organization, not for the first 90 days, but for the entire duration of the injury. That’s right – the legislature seeks to deny injured workers in PA from ever getting to select their own physicians.
Once limited to those with very few rights, like convicted felons in prison, injured workers would be denied the simple right of choice. Many of these CCOs use the role of a Physician Assistant (PA); this is a person who takes the place of a real doctor, but without the education, training or experience required of a physician. It is, of course, much cheaper for the CCO to pay this individual than a qualified physician. What if an injured worker is only allowed by the CCO to see a PA? Tough luck. What if the CCO takes three months to schedule an appointment? So sorry. What if the PA, or perchance even a doctor, provides care the injured worker feels is not sufficient? Too bad.
That the legislature would take such a dramatic step is puzzling and disturbing. As we have reported, workers’ compensation insurance rates in PA have been decreasing. If the motivation for this legislation is not to address rising insurance costs, what motive could these politicians have for trying to remedy a problem that does not even exist? Could they be trying to fill the pockets of insurance carriers even more? At the expense of their constituents?
We urge everyone to contact their State Senator and Representative, and express concerns over the harsh and unfair effects of House Bill 1636. Injured workers did not ask to be hurt, to be disabled, to have their lives turned upside down by a devastating work injury. When speaking to the legislators, each person should ask that legislator if he or she is limited to a single healthcare facility, regardless of their satisfaction level.
As a leading workers’ compensation firm in Pennsylvania, Brilliant & Neiman LLC has worked with the PA Bureau of Workers’ Compensation on issues, such as the mediation process, in the past. The Bureau is now getting ready to institute the final part of its overhaul, transitioning into the online Workers' Compensation Automation and Integration System (WCAIS). Initially, last September, the Bureau started the transition to WCAIS, by putting the Workers’ Compensation Appeal Board (WCAB) onto the system. This next, and final, step will be to bring the rest of the Bureau, and the entire adjudication process, into WCAIS.
It was no surprise, then, that the attorneys at Brilliant & Neiman LLC were again invited by the Bureau to be among a select group of attorneys and legal professionals from across the State of Pennsylvania to assist the Bureau with the final stages of this development. This partnership is beneficial to the Bureau, by having the attorneys work on the new system under the watch of the Bureau – to further tweak the process and refine its efficiency, as well as to the attorneys involved, by having an early exposure to the new system and gaining valuable experience.
The WCAIS system will streamline the workers’ compensation process in PA, centralizing the filing of petitions, the scheduling of hearings and the entire litigation of cases. Currently, the system is scheduled to go live on September 9, 2013. This new process should greatly increase the efficiency of both the Bureau, and the parties involved in litigation. We at Brilliant & Neiman LLC were excited and honored to share our time and experience with the Bureau, to help make the system better for all involved.
It is with a heavy heart, and great sadness, that we relate that the Pennsylvania Workers’ Compensation community has lost a valued member. Workers’ Compensation Judge Mark Peleak passed away while bicycling on July 7, 2013. Judge Peleak presided in the Wilkes-Barre Workers’ Compensation Office, which is in the Central District. Our thoughts and prayers go out to his family and his many friends and admirers. He will be missed.
One of the most difficult decisions faced by an injured worker in PA is how to decide who to hire as their worker’s compensation attorney. Many sites, or publications, have a list of attorneys they tout. Maybe they are called “Super” attorneys or “Awesome” lawyers, or some other cleaver marketing name. What standards do they use? Are they objective? Is there really merit in being named? Who knows. Now, however, there is an objective, regulated selection process authorized by the Pennsylvania Supreme Court.
As we mentioned before, Pennsylvania has created a Workers’ Compensation Law Certification process. First, an attorney is screened to be certain he or she possesses the requisite experience to sit for the examination (a minimum of five years practicing in workers’ comp is required). Specific cases must be provided, including briefs and written arguments. The attorney must certify that at least half of his or her practice is devoted to PA workers’ comp matters. Only then is the attorney even allowed to sit for the examination test.
This test was given for the first time in March, 2013. The grueling four hour assessment covered every aspect of PA workers’ compensation law, thoroughly testing each applicant’s knowledge of the workers’ comp system. Both multiple choice and essay questions were involved.
Brilliant & Neiman LLC is proud to report that both of its attorneys, Dina Brilliant and Glenn Neiman, qualified for, and then passed, the examination process. Each is now “Certified as a specialist in the practice of workers’ compensation law by the Pennsylvania Bar Association’s Section on Workers’ Compensation Law as authorized by the Pennsylvania Supreme Court.”
Importantly, at Brilliant & Neiman LLC, no client is handled by an associate, or anyone other than one of the two partners. No matter whether you are represented by Ms. Brilliant or by Mr. Neiman, you are certain to receive the level of care which can be expected by an attorney certified as an expert in the field. Whether they are “Super” or “Awesome” may be a subjective conclusion; however, it cannot be debated that Ms. Brilliant and Mr. Neiman are now certified as specialists in the practice of workers’ compensation law.
Mediation is a growing area in Pennsylvania workers’ comp. As we have previously discussed, a mediation is when an independent party, in this context usually a Workers’ Compensation Judge [WCJ] (other than the assigned WCJ), meets with the parties in an informal setting in an effort to resolve the differences between the parties. The ultimate goal is to achieve a settlement to the case (usually done by “Compromise & Release Agreement”).
Since we at Brilliant & Neiman LLC work with injured workers every day, having constant contact with the Pennsylvania workers’ compensation system, we are well-versed in most aspects of how the system functions from day to day. We are proud that our knowledge and experience will be used by the PA Bureau of Workers’ Compensation, as the Bureau adjusts the system to change with the times.
Since the start of “Mandatory Mediation,” added to the Pennsylvania Workers’ Compensation Act in the 1996 amendments to the Act, the system has been relatively stagnant. Recently, the Bureau has sought a small working group to evaluate the mediation system and see what, if any, changes could be beneficial to the mediation process.
In the near future, a small group of attorneys will meet with Elizabeth Crum, the Bureau’s Director of Adjudication, The Honorable David Cicola (Judge Manager for the Western District), The Honorable Joseph Hagan (Judge Manager for the Southeastern District [Philadelphia and Upper Darby (Delaware and Chester Counties)]) and The Honorable Karen Wertheimer (Judge Manager for the Eastern District [Allentown (Lehigh County), Bristol (Bucks County), Lancaster (Lancaster County), Malvern (Montgomery County), and Reading (Berks County)]).
Both attorneys of Brilliant & Neiman LLC, Dina Brilliant and Glenn Neiman, will be involved in this meeting. The intention of the meeting will be to have an open discussion about the mediation process, where thoughts and concerns of the attorneys can be voiced and addressed, hopefully leading to the entire mediation system being improved.
Sometimes, one thing naturally follows another. Day follows night. Spring follows Winter. The relationship between the two things makes sense. Then we enter politics, and, as usual, logic and reason seem to trail behind.
We mentioned in previous postings that both the Pennsylvania insurance industry, and the Chamber of Commerce, has been heavily lobbying PA representatives and senators for reform to the Pennsylvania workers’ compensation system. Specific proposals and issues have been raised. One could reasonably draw from this angst that PA workers’ compensation insurance rates were steadily rising out of control. Indeed, one would imagine, given the effects of inflation, that the rates must be significantly increasing beyond normal inflationary levels.
It is most curious, then, that the Insurance Commissioner in Pennsylvania, Mike Consedine, recently proclaimed that workers’ comp insurance rates would actually DECREASE 4.01 percent as of April 1, 2013. For those imagining that this decrease must have followed some enormous increase, Commissioner Consedine noted that this “is the second workers’ compensation decrease in a row.”
Obviously, a decrease in workers’ compensation premiums will reduce the cost of doing business in the State of Pennsylvania, a result to the benefit of employers, employees and citizens of PA. According to the information provided by the Pennsylvania Insurance Department, this reduction in premiums represents a savings of $110 million to employers in PA.
So, given the decreasing cost of workers’ comp insurance in PA, one might ask why
the insurance industry and the Chamber of Commerce remain so focused on taking away the rights of the injured worker in Pennsylvania. Perhaps it is that they are so fixated on reforming workers’ comp in general that they failed to even notice rates are declining? Or, could it be that they value the health and safety of their employees so little that saving even more dollars is a higher priority?
People ask us why our firm limits its practice to representing the injured worker in Pennsylvania. The behavior of the Pennsylvania insurance industry, and the Chamber of Commerce, in trying to fix what isn’t broken, at the expense of their own employees, is the reason. Somebody has to stand behind those who have been injured. We want to be the ones to protect the injured worker from the insurance industry and the Chamber of Commerce.
Last month, we mentioned that the Northeast Philadelphia Workers’ Compensation Hearing Office was now closed, forcing all residents of Philadelphia to have their cases heard in Center City Philadelphia. This change forced the Workers’ Compensation Judges (WCJs) at this location, and their staffs, to relocate as well. Though we cannot say they was any connection to the move, we have now learned that WCJ David Slom, who heard cases in the Northeast Philadelphia site, announced his retirement and has left the bench.
We have been aware of WCJ Slom since his days working for the State Workers’ Insurance Fund (SWIF), prior to becoming a Judge. Whether this dates him, or us, more is a matter of conjecture. On many occasions, over the ensuing years, we have been before Judge Slom. His meticulousness and diligence will be missed. We wish him a happy, healthy and peaceful retirement.
Even prior to the relocation of the Northeast Philadelphia Workers’ Compensation Hearing Office there has been some recent attrition to the field of WCJs stationed there. Before WCJ Slom retired, WCJ Ida Louise Harris and WCJ Michael Snyder stepped down. These two openings had been filled, unofficially, by WCJ Holly San Angelo and WCJ Marc Harrison.
Much to our consternation, the PA Bureau of Workers’ Compensation does not report or publish additions, or subtractions, to the WCJ ranks. There is never an “official” statement or notice. We are left to discover such information through the proverbial grapevine. To keep our readers informed, and to best serve our clients, we are always listening to the chatter, to determine any movement of WCJs.
Though we handle PA workers’ comp cases primarily in Southeastern and Central Pennsylvania, we still like to keep a watch on the entire PA workers’ compensation system. It was in this regard that we learned Workers' Compensation Judge Nathan Cohen, who presided in Pittsburgh, retired from the bench yesterday.
We wish Judge Cohen a happy and healthy retirement, and congratulate him on his long and successful career on the bench.
A few months ago, we learned that the Northeast Philadelphia Workers’ Compensation Hearing Office would be closing shortly. We were advised that all hearings for Philadelphia would then be held at the Center City Philadelphia Workers’ Compensation Hearing Office located at 110 North 8th Street.
Today, I had a hearing in Northeast Philadelphia and learned that today was the last day of hearings for this office. When hearings resume, after the New Years holiday, this office will be closed.
We are saddened with this development, as we know folks who live in Northeast Philadelphia have no great desire to venture into Center City Philadelphia unless it is absolutely necessary. As you are crawling along on I-95, journeying to your hearing, know that we are stuck in the same traffic, feeling your pain!
It has certainly been a busy time for Workers’ Compensation Judges (WCJs) in Pennsylvania. We just recently discussed filling the vacancy in the Allentown Workers’ Compensation Hearing Office, and now we have learned of three additional WCJs on the move.
Leaving the bench will be The Honorable Nancy Goodwin, who had been stationed in the Philadelphia Workers’ Compensation Hearing Office, and The Honorable Thomas Hines, from the Malvern (Montgomery County) Workers’ Compensation Hearing Office. We have further learned, all of this unofficially, that The Honorable Kelly Melcher will be moving from the Reading Workers’ Compensation Hearing Office to the Malvern office to replace Judge Hines. We have not heard any information regarding a replacement for Judge Goodwin.
We wish Judge Goodwin and Judge Hines well in their retirements, and we thank them for their years of dedicated service to the PA workers’ comp community. We also congratulate Judge Melcher on the move, and wish her well in Malvern.
Several months ago, we reported that four PA Workers’ Compensation Judges (WCJs) had stepped down from the bench, while only two new WCJs had been named by the Pennsylvania Bureau of Workers’ Compensation. This left a difficult void in some hearing offices, such as that in Allentown.
We are now pleased to report that a new WCJ has been named to the bench in Allentown. She is The Honorable Cathleen A. Sabatino, who most recently was practicing as a Senior Associate at the law firm of Del Collo & Mazzanti LLP in Paoli, PA. Since graduating from Villanova University School of Law, Ms. Sabatino has been active in the Workers’ Compensation section of the Philadelphia Bar Association where she has served as chair of the section’s annual charity auction. In her community, Ms. Sabatino volunteers as an adult mentor with Spring-Ford Community Theatre’s Youth Ensemble (She holds a B.A. in Theatre from DeSales University).
It is with warm thoughts that we greet The Honorable Cathleen A. Sabatino, and we wish her well in her new career as a WCJ in Allentown.
For some time now, the Pennsylvania Bureau of Workers’ Compensation has been working on a new electronic system to make interacting with a Workers’ Compensation Judge (WCJ) and the Workers’ Compensation Appeal Board (WCAB) a more efficient and accessible process. The Bureau is unveiling the process, known as the Workers' Compensation Automation and Integration System (WCAIS), in two stages.
The first stage, which went “live” on September 17, 2012, deals just with the WCAB. As the Bureau stated, with this release:
"Parties will be able to file appeals, petitions and documents online with the WCAB and to upload documents, and search, view and obtain information on the status of appeals in WCAIS."
The second part of the plan, scheduled for completion in the Fall of 2013, will extend the ability to interact with cases pending before the WCJs, and conduct business generally with the Bureau.
Anyone using this system, including the attorneys, will have to go through the registration process. As attorneys who limit their practice to PA workers’ compensation cases, we are thrilled with the efforts of the Bureau to make the process more efficient and manageable. We commend those at the Bureau with the foresight to bring this plan to its successful completion.
In a surprising development, we have learned that the Pennsylvania Bureau of Workers’ Compensation will be closing the Northeast Philadelphia Workers’ Compensation Hearing Office (currently located on Grant Avenue in Northeast Philadelphia). This decision came as somewhat of a shock, since only a couple of weeks before, a high ranking source in the Bureau had mentioned that the Northeast Philadelphia office was one of the busiest hearing offices in the entire State. Indeed, that source had revealed that a plan was being discussed to divert some cases from that office to the Center City Philadelphia Hearing Office.
Instead, the Bureau has now elected to close the Northeast Philadelphia office entirely. This means that injured workers who reside in Northeast Philadelphia will have to travel to the hearing office in Center City Philadelphia (at 8th and Arch Streets, not far from the Philadelphia Convention Center).
While this decision is now known to those practicing in the PA workers’ compensation community, no announcement has been publicly made by the Bureau. We are not yet aware of the time frame for the closing of the office. As always, we will notify our loyal readers as soon as additional information is discovered.
As attorneys who represent injured workers in PA, we are often told by our clients that their doctor or physical therapist is not being paid by the workers’ compensation insurance carrier. Moreover, the client is receiving bills from the provider, maybe even notices from a collection agency. This is a sticky area, since the rules are in place, but not easily enforceable.
The Pennsylvania Workers’ Compensation Act is very specific on this topic. Right in the Act, Section 306 (f.1)(7), it says:
“A provider shall not hold an employe liable for costs related to care or service rendered in connection with a compensable injury under this act. A provider shall not bill or otherwise attempt to recover from the employe the difference between the provider’s charge and the amount paid by the employer or the insurer.”
Well, that’s great! The provider can’t do what they are doing. Now what? This is where the problem lies. The legislature said what cannot be done, but neglected to put in anything that can be used to enforce this language. While a Penalty Petition can be filed against the employer or the workers’ compensation insurance carrier, one cannot be filed against the medical provider. Plus, considering the injured worker often needs the support and cooperation of the medical provider in litigation, antagonizing the medical provider is not usually in the best interests of the injured worker.
We try to educate the medical provider. We truly want the medical providers to be paid; they are providing a valuable service to our clients and deserve to be compensated. But, at the same time, we want any collections efforts against the injured worker to be stopped.
The proper way for a medical provider to bill for treatment related to a work injury in PA is for the provider to submit their bills on the proper forms (LIBC-9 and HCFA forms), and submit these with supporting documentation (like the office or treatment notes). The workers’ compensation insurance carrier then has 30 days to either pay the bill or submit the bill to Utilization Review (the tool available if they want to dispute whether the treatment is reasonable or necessary).
If the bill is not paid by the workers’ compensation insurance carrier in the proper time, or in the proper amount, the medical provider must file a form with the Bureau of Workers’ Compensation for “Fee Review” (LIBC-507). This is the step far too many medical providers ignore, by just jumping to the (unlawful) practice of billing the injured worker.
Once an administrative process issues a decision in the Fee Review, it can be appealed and heard before one of several Workers’ Compensation Judges (WCJ) who hear such actions. The medical provider need only file another form (LIBC-606) to have the process start. Our firm, among others, is perfectly willing to represent medical providers in these actions. What we are not willing to do, however, is have our clients pay the price for medical providers who are not following the proper procedures to be paid.
When we attended the Annual Workers' Compensation Conference in Harrisburg, presented by the Pennsylvania Bureau of Workers’ Compensation, more was discussed than just the status of workers’ compensation laws in PA.
Though we did certainly have sessions regarding many topical issues with the Pennsylvania Workers’ Compensation Act, including scope and course of employment, positive work rules, undocumented workers, Medicare Set-Asides, recent legal developments, along with other various medical and legal issues, time was also taken to share the importance of Kids’ Chance, a charity “dedicated to helping our kids who need it most - those who need assistance for college or vocational education because a parent was killed or injured in a work-related accident.”
We would urge injured workers, and families of injured workers, to avail themselves of this valuable resource.
Through the efforts of concerned citizens, and attorney groups united to support injured people, such as the Pennsylvania Association for Justice, there has been no legislation really harmful to the injured workers in Pennsylvania passed since 1996. Unfortunately, it appears there is now a new threat on the horizon, and we call on every injured person, and anyone who cares about the injured worker in PA, to make their concerns known to their State Representatives and State Senators.
The Pennsylvania Chamber of Commerce has a new “wish list” for the reform of the workers’ compensation system in PA. The changes desired by the Chamber primarily impact the medical providers, rather than the injured workers directly. Obviously, however, this will impact the injured worker by narrowing the treatment options open to injured workers in Pennsylvania, and generally add another layer of difficulty to what is already a minefield for those unfamiliar with the process.
One of the primary changes that the PA Chamber of Commerce would have made is to increase the time an injured worker in PA is required to treat with a company “doctor” from 90 days to 180 days. Any injured worker who has experienced substandard medical care in those first 90 days, or the difficulties of having a medical provider more concerned with a return to work than a cure, understands the significance of this expansion. No mention was made by the Chamber of the developing practice we are seeing where the injured worker is stuck with a nurse practitioner for that captive period, effectively denying the injured worker from even being evaluated by a medical doctor.
Other changes the Chamber supports include preventing the injured worker from using a pharmacy of his or her choice, and having to rely on a claims adjuster to get the medication (a scary proposition when we consider how frequently the claims adjusters cannot even process checks in a regular fashion); severely limiting the type and duration of medical treatment based on a diagnosis made by the insurance company; reducing what the doctor can get paid for treating an injured worker impacting access to necessary care; and, finally, having a treating doctor’s care reviewed by a nurse with no right to appeal that review to a Workers’ Compensation Judge.
We, of course, will be fighting this battle in Harrisburg, along with the Pennsylvania Association for Justice. But, we cannot win this alone. We need you to help us protect the injured worker in PA. Please take a few minutes to make your State Representatives and State Senators aware that you, as a voter, care about the injured worker in Pennsylvania, and that you are against the changes being proposed by the Chamber of Commerce.
PA Workers’ Compensation Judges (WCJs) are like other employees in many ways. Just like we see turnover in any industry among its work staff, we see WCJs leave the bench for retirement or other opportunities. Recently, we discussed two new WCJs being named to the bench by the Pennsylvania Bureau of Workers’ Compensation. Perhaps we were remiss, however, in neglecting to mention the reason for the openings on the bench, and honoring those who served the workers’ comp arena so admirably.
As we have previously discussed, workers’ comp hearings in PA are generally conducted in the county in which the injured worker resides. These workers’ compensation hearing offices are spread throughout the State of Pennsylvania. Over the past several months, four of the WCJs have left the bench. From the Northeast Philadelphia Workers’ Compensation Hearing Office, Judges Ida Louise Harris and A. Michael Snyder have stepped down. The Malvern Workers’ Compensation Hearing Office (Montgomery County) has lost Judge Seymour Nathanson. And, just recently, we were told by Judge Geoffrey Dlin, that he would be stepping down as WCJ from the Allentown Workers’ Compensation Hearing Office (Lehigh County).
We want to wish all of these former members of the PA workers’ comp judiciary the best of luck in their future endeavors. As with the entire Pennsylvania workers’ compensation community, we want to thank these wonderful individuals for their service to the Bureau.
Though no formal announcement has been made by the Pennsylvania Bureau of Workers’ Compensation, we have learned that Holly San Angelo and Lawrence Beck have been named as new Workers’ Compensation Judges in PA. As we have previously mentioned, workers’ comp cases in Pennsylvania are typically held in the County in which the injured worker resides. Workers’ compensation hearing offices are spread throughout the State of Pennsylvania.
Judge San Angelo will be assigned to the Northeast Philadelphia Hearing Office (on Grant Avenue in Northeast Philadelphia) and Judge Beck will be in the Philadelphia Hearing Office (at 8th and Arch Streets in Center City Philadelphia). Having litigated cases against both of the new Judges in the past, we can safely say that the bench will improved by the presence of these two members.
As attorneys who limit their practice to representing the injured worker in PA workers’ comp cases, we are thrilled by the recent announcement that the Supreme Court of Pennsylvania has approved the process of creating a “certified workers’ compensation attorney” in Pennsylvania (or, in other words, a workers’ compensation specialist).
We have seen the damage done to cases when an injured worker trusts a general practitioner to handle a Pennsylvania workers’ comp case. The Pennsylvania Workers’ Compensation Act is a complicated piece of legislation. As loyal readers of our blog know, this is a frequent topic of cases decided by the appellate courts in PA. Trusting a workers’ compensation case to an attorney not experienced in that area of law is akin to having an orthopedist handle your coronary artery bypass surgery. Just not a good idea.
A work-related injury can cause tremendous disruption, and loss, to both the injured worker and his and her family; we are thrilled that in the near future, that injured worker can have the confidence that he or she is selecting a “certified workers’ compensation attorney.” We, of course, look forward to becoming “certified workers’ compensation attorneys” as soon as the process for the testing and certification is completed.
Today, I received an e-mail from a Workers' Compensation Judge (WCJ) in the Philadelphia Workers' Compensation Hearing Office, indicating the Pennsylvania Bureau of Workers' Compensation has now announced that certain correspondence can be sent to the WCJ by e-mail, rather than through the U.S. Postal Service. While the correspondence a party can send to a WCJ is limited (primarily routine correspondence, such as requesting a continuance of a hearing), this option is beneficial, not only to attorneys who practice in the area of PA workers' comp, but also to helping reduce the amount of paper being used unnecessarily in the litigation process.
As mentioned in our blog previously, the Workers’ Compensation office in Allentown, PA, has moved. No longer will hearings be held at 160 Hamilton Street. Now, the Pennsylvania Bureau of Workers’ Compensation has opened up the new Allentown location at 7248 Tilghman Street, Allentown, PA. The new offices feature four hearing rooms, along with several attorney conference rooms and mediation rooms. Our compliments go out to the Bureau on the spacious new quarters.
On June 30, 2011, Governor Tom Corbett signed House Bill 440, bringing the measure into law. While the Pennsylvania Bureau of Workers' Compensation labelled this a "reform bill," it appears it will have no real impact on injured workers in PA. Rather, the aim of the new law is to expand the availability of workers' compensation insurance coverage to small businesses.
On many occasions over the years, we have addressed the Utilization Review (UR) process in Pennsylvania workers’ compensation cases. This is the process either party, usually the workers’ comp insurance carrier, uses to obtain a determination as to whether a treatment at issue is “reasonable and necessary” such that the insurance company must pay for the treatment.
What is sometimes lost in this abstract analysis is the impact a UR has on real live people. When a Request for Utilization Review is filed by a workers’ compensation insurer, the insurance carrier is immediately relieved of payment of bills for the treatment at issue, unless and until the treatment at issue is found to be “reasonable and necessary.”
Being in business for profit, or at least to make a living, not all providers are able, or willing, to continue to provide treatment once a UR is filed. One of the most dangerous areas this problem hits home is with medications.
Many medications cannot be suddenly stopped without risk of very severe consequences. Yet, when a UR is filed, frequently retail pharmacies will refuse to fill prescriptions, leaving the injured worker without the medication he or she desperately needs.
This is one of those flaws in the Pennsylvania Workers’ Compensation Act that seems so clear, and so basic, that the PA Legislature would have to fix it, right? That is what we keep thinking, but we have thus far been unsuccessful in having this issue resolved. Sadly, it may take widespread media coverage of a tragic event before things are made right.
The Allentown Workers’ Compensation Hearing Office has been located at 160 Hamilton Street, in Allentown, for several years now. We have just been advised by one of the Workers’ Compensation Judges (WCJ) at that office that the hearing location for Allentown will be moving shortly. The plan is for the move to take place in July, 2011. We are told the new location will be closer to the Allentown exit, off of the Pennsylvania Turnpike.
As we have discussed in previous blog entries, in PA, a workers’ compensation hearing is typically held in the County in which the injured worker resides. We will provide more information, including the new address, when we are advised by the PA Bureau of Workers’ Compensation.
PA Bureau of Workers’ Compensation Issues New Notice of Compensation Denial; Employers No Longer Able to Accept Claims by Using Denial
Readers of this blog, from previous blog entries, know our frustration with the developing practice of workers’ comp insurance carriers “accepting” medical-only claims by issuing a Notice of Denial (NCD).
Aside from the logical problem, there are procedural issues this creates for attorneys representing injured workers in PA. For example, this practice lets the workers’ comp insurance carrier deny the wage aspect of a claim and avoid unreasonable contest fees, and would often wreak havoc with an injured worker’s attempt to obtain medical treatment for the work injury. There is also concern that the NCD would not stop the statute of limitations, meaning a claim could be barred if the injured worker did not know to file a Claim Petition within three years of the injury.
The PA Bureau of Workers’ Compensation recognized the problem years ago, and created a medical-only Notice of Compensation Payable (NCP). This document would properly preserve the statute of limitations, and let everybody know the true status of the claim. The Courts in Pennsylvania, however, as noted in our previous blog entries above, continued to allow workers’ comp insurance carriers to “accept” claims by using an NCD, making the medical-only NCP useless.
We are pleased to report that the Pennsylvania Bureau of Workers’ Compensation has now revised the NCD, which appears will stop this abuse by the workers’ comp insurance carriers. As you can see by clicking here, the new NCD does not permit the acceptance of the claim by use of this document.
We applaud the Bureau for closing this loophole, which the Courts had created. This change will benefit injured workers across the State of Pennsylvania.
Last week, we attended a PA Workers’ Compensation seminar in Hershey, Pennsylvania. This is the “Fall Section Meeting of the Pennsylvania Bar Association’s Workers’ Compensation Section.” For years, workers’ comp attorneys from across the entire State of PA have gathered at this seminar to learn and discuss new cases and trends in PA workers’ compensation.
As you know, from reading our blog, we stay very current on workers’ comp cases coming out of the Commonwealth Court of PA and the Pennsylvania Supreme Court. But, we recognize the importance of attending seminars like this one, so that we can interact with other workers’ compensation attorneys across PA, as well as the Workers’ Compensation Judges, and stay on top of trends and developments.
We believe it is this desire to stay current in all aspects of PA workers’ compensation law which makes Brilliant & Neiman LLC able to help injured workers as well as possible. Sometimes, general practice attorneys, who do not limit their entire practice to PA workers’ comp cases, as we do, are not able to stay as current on all aspects of cases they handle. We believe this is the primary benefit to us limiting our practice to just representing injured workers in their PA workers’ compensation cases.
In the Summer 2010 issue of News & Notes, published by the PA Bureau of Workers’ Compensation, Workers’ Compensation Judge (WCJ) Joseph Hagan was named to be Judge Manager for the Southeastern District of Pennsylvania. Judge Hagan has been a WCJ in this district, working from the Philadelphia Workers’ Compensation Hearing Office, since 1988. The Southeastern District covers the Northeast Philadelphia, Center City Philadelphia and Upper Darby Workers’ Compensation Hearing Offices.
WCJ Karen Wertheimer remains Judge Manager for the Eastern District of PA. This includes the Allentown, Bristol, Lancaster, Malvern, Northampton and Reading Workers’ Comp Hearing Offices. Interestingly, this District also has two “informal” or “unlisted” locations – an injured worker who resides in Quakertown, Doylestown or other parts of the Central/Upper Bucks County will have hearings held in the Doylestown Courthouse, while an injured worker who lives in the eastern portion of Montgomery County will have hearings held in Dresher.
The Central District of PA, encompassing Harrisburg, Hazleton, Pottsville, Scranton, Wilkes-Barre and Williamsport, is headed by Judge Manager Susan Caravaggio, and the Western District is led by Judge Manager David Cicola.
As discussed in a previous blog entry, PA workers’ compensation proceedings are usually held in the County in which the injured worker resides. Counties are then grouped by “Districts.” In the State of PA, there are four Districts: Eastern, Southeastern, Central and Western.
Hearings for the Eastern District are located in Allentown, Bristol, Lancaster, Malvern and Reading (also, though not officially listed on the Bureau of Workers’ Compensation official website, some hearings take place in Doylestown and Dresher). The Southeastern District sees hearings in Northeast Philadelphia and Center City Philadelphia, in addition to Upper Darby. Harrisburg, Hazleton, Pottsville, Scranton, Wilkes-Barre and Williamsport comprise the Central District. Throughout the State of Pennsylvania, there are now a total of 95 Workers’ Compensation Judges (WCJ).
This number includes four new WCJs who have just been introduced by the Bureau of Workers’ Compensation. In the Philadelphia Workers’ Compensation Hearing Office (Southeastern District), Timothy Bulman and Sandra Craig have been added. Robert O’Donnell has joined the Lancaster Workers’ Compensation Hearing Office (Eastern District). The Western District, Johnstown Workers’ Compensation Hearing Office, has added Steven Minnich.
More information on the division of workers’ compensation hearing offices across Pennsylvania, and on the Workers’ Compensation Judges in PA, is available on the PA Bureau of Workers’ Compensation office website.
When an aggrieved party wants to appeal a decision of a Workers’ Compensation Judge in PA, the first step is to the Pennsylvania Workers’ Compensation Appeal Board (WCAB). Until recently, the WCAB was comprised of a total of 15 commissioners, who would travel throughout the State of Pennsylvania, holding oral arguments in Philadelphia, Pittsburgh, Harrisburg, Scranton, Johnstown and Erie.
Unfortunately, due to budget difficulties faced by PA, the total of 15 commissioners on the WCAB has been drastically reduced. Right now, only five commissioners remain. Apparently, there will be another three commissioners named, when they are approved by the PA Senate.
This reduction in staffing is almost certain to have a negative effect on the speed with which WCAB decisions are issued. While we would love to provide a link for more information, there has been no official word on this development from the PA Bureau of Workers’ Compensation (other than to change the listed commissioners to the current total of five).
The Pennsylvania Workers’ Compensation Act was last amended (at least in a significant way) by Act 147 in late 2006. As noted in a previous blog entry, these changes were very beneficial to the injured worker in PA. These amendments included the Uninsured Employers Guaranty Fund (to give PA injured workers a way to get workers’ comp benefits if their employer had no Pennsylvania workers’ compensation insurance), mandatory mediation, and Resolution Court.
Resolution Court is a process to make the settlement of PA workers’ compensation cases faster. Most workers’ comp cases in Pennsylvania are settled by Compromise & Release Agreement. This requires a hearing before a Workers’ Compensation Judge (WCJ), when the injured worker testifies that he or she understands and accepts the terms and conditions of the Compromise & Release Agreement. If convinced the injured worker does truly understand and accept the terms and conditions of the Compromise & Release Agreement, the WCJ will approve the settlement. Resolution Court is intended to have the hearing scheduled more quickly, so the settlement can be approved faster.
The State of Pennsylvania is divided by the PA Bureau of Workers’ Compensation into four Districts: Eastern, Southeastern, Central and Western. Each of these Districts then has an office in each County it services. For example, the Eastern District serves Lehigh County (with an office in Allentown), Bucks County (Bristol and Doylestown offices), Lancaster County (Lancaster), Montgomery County (Malvern and Dresher) and Berks County (Reading). The Southeastern District handles Philadelphia County (with offices in Center City Philadelphia and Northeast Philadelphia) and Delaware County (Upper Darby).
Each of these Districts has its own Judge Manager, and makes the rules for Resolution Court. In a letter distributed by the PA Bureau of Workers’ Compensation in April, 2009, the Resolution Court Procedures were given for the counties of Bucks, Delaware, Montgomery and Philadelphia.
You can read more about the settlement process in PA workers' compensation cases on our website by clicking here.
As we have mentioned in previous posts, the Philadelphia Workers' Compensation Hearing Office has been in the process of moving. We are pleased to now report that the new hearing office has opened on schedule. Hearings on workers' compensation cases will no longer be held at the State Office Building, 1700 Spring Garden Street, Philadelphia, PA. Hearings now will be held in the new office, located at 110 North 8th Street, Philadelphia, PA 19107.
Claimants receiving, or attempting to receive, workers' compensation benefits in PA are required to report receipt of various income. There are three what we call "verification forms," which workers' compensation insurance companies can send to these claimants. If these forms, which were approved by the Pennsylvania Bureau of Workers' Compensation, are not completed by the claimants, and returned to the workers' comp insurance carrier within 30 days, workers' compensation benefits can be stopped.
On the other hand, I recently received a copy of a "Claim Status Report," which was sent by the workers' comp insurance carrier to my client. Some of the questions were similar to those on the forms approved by the Pennsylvania Bureau of Workers' Compensation, but there were other questions which a claimant would have no obligation to answer.
This is just another instance of why every Claimant should have access to an experienced PA workers' comp attorney. Any time something is received by a workers' compensation claimant, there should be a discussion with the attorney. There are so many rights and responsibilities the injured worker should know, that it just makes sense to have someone to watch their back.
In a developing situation we have discussed here back in May 2008, and then again in July 2008, the Philadelphia Workers' Compensation Hearing Office will be moving to a new location. In our July 2008 blog entry, we told you of the new address of the Philadelphia Workers' Comp Hearing Office (110 North 8th Street, Philadelphia, PA 19107). We have now been advised of the date this relocation is scheduled to take place.
We have been told that the move to the new Philadelphia Workers' Compensation Hearing Office will take place the week of November 17, 2008. Hearings will not be held from November 17, 2008, through November 30, 2008. The new office is then scheduled to open for business on December 1, 2008. We are told that any hearings currently scheduled for the Philadelphia Workers' Comp Hearing Office from November 17, 2008 through November 30, 2008, will be cancelled and rescheduled.
Since the site of the current Philadelphia Workers’ Compensation Hearing Office, The State Office Building at Broad and Spring Garden Streets, has been sold, we previously mentioned that the Philadelphia Workers’ Compensation Hearing Office would be moving.
We have now been advised by the Judge Manager for the Philadelphia Workers’ Compensation Hearing Office, The Honorable Karen Wertheimer, that the new location will be 110 North 8th Street, Philadelphia, PA 19107.
Though the time of the relocation remains unknown, we do expect it to take place in the near future. We will, of course, advise you when the change actually takes place.
On May 14, 2008, the Workers’ Compensation Section of the Philadelphia Bar Association received an e-mail that all pleadings (including briefs and stipulations resolving disputes between parties) addressed to Workers’ Compensation Judge Aida Louise Harris, in the Northeast Philadelphia Workers’ Compensation Office must be submitted on CD in Microsoft Word format, 12 point font.
Though this new procedure was revoked in a later e-mail on May 19, 2008, this is clearly the direction that office is taking. Indeed, the e-mail revoking the new procedure specifically stated that the procedure was being revoked only because “due to technological issues, the electronic submission initiative cannot be implemented as yet.”
Other courts, in recent years, have been moving to electronic submissions, so this is not a surprising development. We will, of course, keep you up to date if this new procedure does go into effect. Also, be aware that you can review the procedures of any participating Workers' Comp Judge at the website of the Pennsylvania Department of Labor & Industry.
On November 9, 2006, the most recent amendment to the Pennsylvania Workers’ Compensation Act, known as Act 147 of 2006, was signed into law. Several of the provisions of Act 147 were designed to quicken the litigation process in PA workers’ comp. One of those provisions created what is known as “Mandatory Mediation.”
Mediation, generally speaking, is a process where an independent person meets with the parties to a dispute and helps the parties reach a resolution to their quarrel. This is a process used in all types of litigation, and even in disputes outside of litigation. Usually, this is a very informal process. The mediator will meet with the parties separate and together, working to try and bring them together on common ground. There is no court reporter present, and things said in mediation are not admissible in the litigation (encouraging the parties to be honest about the strengths and weaknesses of their position).
Mediation has been used in Pennsylvania workers’ compensation matters as long as I can recall. In the past, mediation only happened in PA workers’ comp when the parties so requested. The process was entirely voluntary, and did not occur that often.
Act 147 made mediation mandatory, in every case, unless the Workers’ Compensation Judge felt that mediation would be futile. As a result, we are seeing much more mediation in Pennsylvania workers’ comp than in years past. In turn, the increased mediation seems to have led to workers’ compensation settlements becoming more frequent in PA.
Mandatory mediation is not binding. That means that if a settlement cannot be agreed upon by all parties, then there is no settlement. Usually, there is little to lose by engaging in mediation. If a settlement cannot be reached, nothing is lost other than the time spent by the parties (and even then, some issues in the litigation may get resolved, narrowing the disputes which remain).
As with Act 147 generally, mandatory mediation appears to be a beneficial change to the PA Workers’ Compensation Act for the injured worker. I am proud to have participated in meetings working on this litigation, with the Pennsylvania Trial Lawyers Association (now known as Pennsylvania Association for Justice). As a PA workers’ comp attorney, I salute the hard work of the Pennsylvania Association for Justice in having such fair legislation passed.
Typically, in Pennsylvania, workers’ compensation hearings are held in the County in which the injured worker lives. Many Counties in PA have a single hearing location (Allentown for Lehigh County, Reading for Berks County, Easton for Northampton County), while others have multiple locations. For instance, in Montgomery County, hearings are divided between hearing offices in Malvern and Dresher. Similarly, in Bucks County, there are hearing offices in Bristol and Doylestown.
Another County with multiple locations is Philadelphia County, where there is an office in Northeast Philadelphia and one in Center City Philadelphia. The Center City hearing office has been in the State Office Building at Broad and Spring Garden Streets for as long as I can remember (and I have been handling workers’ compensation cases in PA for over 15 years). As you may have heard, however, the State Office Building has been sold and the Philadelphia workers’ compensation hearing office will be moving.
Though details are hard to come by, we believe the new Philadelphia workers comp office will be located at 8th and Arch Streets in Center City Philadelphia. The move is expected to take place by the end of 2008. We will certainly be updating this information as we learn more!
Did you know that you can read the entire Pennsylvania Workers' Compensation Act online? While certainly not fun reading material, the PA Workers' Compensation Act can provide valuable information. This is not a substitute for having an experienced workers' comp attorney, but is another resource an injured worker can use to learn and protect his or her rights.
Under certain circumstances, injured workers in Pennsylvania are required to submit to a vocational evaluation (a meeting with a vocational counselor). Until recently, the injured worker would usually then hear nothing . . . until a petition was filed by the workers’ compensation insurance carrier to reduce the injured workers’ benefits based on a “Labor Market Survey” (Basically a listing of jobs said to be available to the injured worker). This “hiding” of the vocational evidence made it more difficult for the injured worker to fight the petition.
In June, 2007, new regulations were passed by the Pennsylvania Bureau of Workers’ Compensation, requiring vocational counselors to provide a copy of their initial report, as well as any additional reports, including the Labor Market Survey, to the injured worker, and his or her attorney within certain time frames. This makes the battle to protect an injured worker’s benefits much more fair.
When a workers’ compensation insurance carrier requests the injured worker have a vocational meeting, this should be a clear signal to the injured worker that his or her benefits are in jeopardy. It is at this time, if not before, when an injured worker should seek a workers' compensation attorney.