January 23, 2014

Attending Seminar on WCAIS to Better Handle Workers’ Comp Cases in PA

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.

July 26, 2013

Brilliant & Neiman LLC Working with PA Bureau of Workers’ Comp on WCAIS

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.

November 8, 2012

PA Workers’ Comp – Panel Physician v. DME

We were recently asked by an injured PA worker, and not for the first time, “Why is my employer making me see another doctor if I am already being treated by the doctor my employer sent me to?” The answer to the question requires that we look at two different parts of the Pennsylvania Workers’ Compensation Act (Act). Essentially, we are looking at the difference between a “panel physician” and an “Independent Medical Examination (IME)” [More realistically termed a “Defense Medical Examination (DME)” since there is often nothing “objective” about it].

Under the Act, an employer may only be responsible for payment to a medical provider on a “panel posting,” for the first 90 days of treatment, provided the panel posting meets the requirements as contained within the Act. Though there is a widely held belief that an employer controls medical treatment for the first 90 days, this is a vast overstatement, and employers frequently have an improper panel (meaning that the injured worker may be able to treat with any provider, and have the employer pay for such treatment, from the start).

A proper panel posting must contain at least six providers, at least three of which are physicians (the remainder could be therapy facilities or other healthcare providers who are not doctors). No more than four of the six on the posting may be from the same “coordinated care organization” (one could simply say “practice”). This posting must be displayed in a prominent location. The employer must have the injured worker sign an acknowledgement, both at the time of hire and as soon as practical after the injury, that the injured worker is aware of the panel posting. All of these requirements can be found in Section 306(f.1)(1)(i) of the Act. Frankly, very few employers actually achieve all of these requirements (yet, sadly, injured workers are unfairly saddled with treatment at a location chosen by their employer because the injured worker is not aware of his or her rights).

Even if the injured worker is treating with a provider that is on the employer’s panel posting, the employer (or more likely, its workers’ comp insurance carrier) has the right to have the injured worker examined by a doctor of its choosing under Section 314 of the Act. This is a DME. The bottom line is that the employer is usually entitled to a DME, whether or not the injured worker is treating with a panel provider. There are, of course, exceptions to every rule, and every injured worker should have the benefit of learning his or her rights by discussing their case with an experienced PA workers’ compensation attorney. As with most workers’ comp attorneys in Pennsylvania, we never charge a fee unless we get results for you.

October 12, 2012

PA Workers Compensation Judges on the Move Again

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.

September 27, 2012

Workers’ Compensation Judge Named for Allentown Workers’ Comp Hearing Office

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.

August 13, 2012

PA Workers Comp Medical Treatment Bills and Fee Review

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.

July 26, 2012

New Threat to Workers’ Compensation in PA

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.

January 18, 2012

Workers’ Compensation Specialty Coming to Pennsylvania

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.

April 27, 2011

PA Supreme Court Accepts Appeal in Robinson

Back in October, we blogged about the decision of the Commonwealth Court of Pennsylvania in City of Pittsburgh v. Workers’ Compensation Appeal Board (Robinson), which addressed what caused a presumption that an injured worker “retired,” entitling the workers’ comp insurance carrier to a suspension of workers’ compensation benefits.

The decision of the Commonwealth Court arguably made a murky area of the law even more confusing, but it also attempted to inject some compassion and logic into an aspect of law short on both.

For better or worse, the Supreme Court of Pennsylvania has accepted an appeal in this matter. Specifically, the issue for the Court to determine is:

“Did the Commonwealth Court err by holding that, in a petition to suspend
compensation benefits based upon an alleged voluntary withdrawal from the
workforce, the employer bears the burden of showing by the totality of the
circumstances that the claimant has chosen not to return to the workforce?”

We will, of course, let you folks know the final result as soon as we are advised.

April 22, 2011

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.

October 19, 2010

Philadelphia Workers’ Compensation Judge Named Judge Manager for Southeastern PA

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.

July 20, 2010

PA Workers’ Comp Judge Agrees Armed Robbery is “Abnormal Working Condition” in Pennsylvania; Employer Appeals

Some time ago, we made a brief deviation from our normal course of not blogging about own active cases, to discuss a liquor store clerk who was robbed at gunpoint. The PA Liquor Control Board (LCB) denied the claim, stating that being robbed at gunpoint was not an “abnormal working condition” for a PA LCB clerk (remember that the next time you think of stepping into a State Store in Pennsylvania – armed robbery is simply accepted as a normal course of a day by management). We filed a Claim Petition on the clerk’s behalf and litigated the case.

We are pleased to report that the Workers’ Compensation Judge (WCJ) did not buy Defendant’s argument, and did not believe that society has degraded far enough such that a clerk can expect armed robbery on his or her normal day at work. In granting our Claim Petition, the WCJ rejected the Defendant’s attempt to expand the Commonwealth Court of Pennsylvania’s disastrous decision in of McLaurin v. Workers’ Compensation Appeal Board (SEPTA), wherein the Court, in its infinite wisdom, found that a SEPTA driver’s normal workday includes being assaulted by a gun-wielding teen (sending the message, as we understand it, that anyone foolish enough to step on a SEPTA vehicle can expect to face such consequences).

Undaunted, however, the PA LCB has filed an appeal with the Pennsylvania Workers’ Compensation Appeal Board (WCAB). It appears the PA LCB’s argument is that the WCJ was incorrect and Pennsylvania liquor stores are just as deadly as SEPTA vehicles (how very proud they must feel while making these arguments). We find it amazing, not to mention disheartening, that our own governmental agencies would be stooping to such disgraceful antics to deny a case. Rather than address what they clearly view as a “normal working condition,” perhaps by improving security methods, the PA LCB instead is trying to use its stubborn ignorance and incompetence as a basis to deny an injury to one of its own employees. How can one put any word other than “disgraceful” on that?

May 19, 2010

New PA Workers’ Compensation Judges Announced

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.

November 5, 2009

PA Workers‘ Compensation Appeal Board Reduced

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).

March 10, 2009

Appeal to PA Supreme Court Sought in PGW v. Workers’ Comp Appeal Board

As you may recall, in a recent blog entry, we mentioned the case of PGW v. Workers’ Compensation Appeal Board (Amodei). This was the case where the Commonwealth Court of Pennsylvania stated, unequivocally, that credit against pension benefits in PA workers’ comp is to be done on the net amount of the benefit, rather than the gross.

It has now come to our attention that the workers’ compensation insurance carrier in this case has filed a Petition for Allocatur with the Supreme Court of Pennsylvania, asking the State‘s highest Court to accept an appeal in this matter.

As always, we will keep everyone posted on developments in this, and any other, PA workers’ comp matter. We also want to remind folks that we are happy to answer questions regarding any Pennsylvania workers’ compensation issues. You can contact us by telephone or e-mail, through our firm website.

January 15, 2009

Termination Petition Requires Proof of Actual Change of Condition in PA

As a Claimant’s lawyer, practicing exclusively in PA workers’ comp, I was thrilled when the Supreme Court of Pennsylvania decided Lewis v. Workers’ Compensation Appeal Board (WCAB) in 2007. The Court in Lewis limited a PA workers’ comp insurance company’s ability to continually file petitions to terminate a claimant’s workers’ comp benefits. Specifically, the Court held that a workers’ compensation insurance carrier in PA had to prove there was an actual change in condition from the previous adjudication of disability (again, for this case to be important, the injured worker had to have previously defended a Termination Petition).

There was some concern, however, with how the Commonwealth Court of Pennsylvania would interpret the Lewis decision. As we posted in a previous blog entry, the Commonwealth Court initially did properly follow Lewis. Last month, the Commonwealth Court of Pennsylvania set claimant’s workers’ comp attorneys’ minds at ease, when they issued a decision in Delaware County v. Workers’ Compensation Appeal Board. Here, like in Lewis, the workers’ comp insurance company lost a Termination Petition, then filed another Termination Petition. Finding the workers’ compensation insurance carrier’s doctor credible when he testified the injured worker had fully recovered from the work-related injury, the Workers’ Compensation Judge (WCJ) granted the Termination Petition.

On appeal, the Commonwealth Court of PA, vacated the termination and remanded to the WCJ (sent the case back to the WCJ for additional findings). The Court found that the WCJ had granted the Termination Petition in error, because it was not enough to simply find the workers’ compensation insurance carrier’s doctor was credible when he testified that the injured worker had fully recovered from her work injury. Instead, the Court said the WCJ must first decide whether the workers’ comp insurance company proved that the claimant’s condition had changed from the time of the first Termination Petition to the time of the second. Only after that finding is made can the WCJ decide whether the workers’ compensation insurer proved the injured worker had fully recovered.

November 28, 2008

Injured Worker in PA Barred From Coverage for Additional Work Injuries

Generally speaking, an injured worker in PA can ask a Workers’ Compensation Judge (WCJ) to review an accepted description of a work injury “at any time” (within the statute of limitations, of course) to amend those conditions for which the workers’ compensation insurance carrier should be responsible. In other words, usually, an injured worker, under the Pennsylvania Workers’ Compensation Act, can try to add more injuries to an accepted workers’ compensation case.

However, a recent decision by the Commonwealth Court of Pennsylvania put a significant hurdle in the path of an injured worker. On November 25, 2008, the Court decided Weney v. Workers’ Compensation Appeal Board (Mac Sprinkler Systems, Inc.).

In this case, the workers’ comp insurance company accepted a “left shoulder strain.” The injured worker filed a Petition to Review, to add a tear of the anterior labrum with large glenohumeral joint effusion, tendonitis or a partial tear of the supraspinatus/infraspinatus, minimal impingement, and biceps tenosynovitis, all in the left shoulder. The workers’ compensation insurance carrier agreed, and the parties executed a stipulation, providing that the work injury now included this more descriptive injury.

Mr. Weney then filed another Petition to Review, this time to add herniated discs in his cervical spine to the work injury. Since the records showed that Mr. Weney had neck problems at the time he was litigating the first Review Petition, the Court held that he was barred from litigating this second Review Petition.

This concept is called “technical res judicata” or “claim preclusion.” It happens when an identical issue, between identical parties, has already been decided. The troubling aspect of this case for us, as attorneys representing the injured worker, is that the neck problem was never litigated, or decided, in the first Review Petition. And, frankly, there was no reason to address the neck at that point, since the workers’ comp insurance carrier was agreeing to the left shoulder problem, and that problem was the immediate concern of Mr. Weney at that time.

The Court took pains to observe that technical res judicata applies to those claims actually litigated, as well as those that should have been litigated. This is a dangerous precedent, as it may mean that when we file a Petition to Review for a client, we may have to litigate every single condition which may be related to the work injury, or risk being barred from doing so in later litigation. Ultimately, it seems this will increase the complexity of litigating a Review Petition, which will just cause more of a strain on the workers’ compensation judicial system.

September 29, 2008

Unreasonable Contest Attorney Fees in PA Workers’ Comp

Under the Pennsylvania Workers’ Compensation Act, a workers’ comp insurance carrier has 21 days to accept or deny a claim. During that period, the workers’ comp insurance carrier is to investigate the claim. This both fair and clear.

The award of attorney fees under the PA Workers’ Compensation Act is supposed to be the rule. Only when the workers’ comp insurance carrier demonstrates that the they had a reasonable basis to deny the claim is an award of fees to be denied. This is how the law sets forth the process. Again, this seems both fair and clear.

Unfortunately, the reality is that unreasonable contest attorney fees are rarely ordered against the workers’ compensation insurance carrier. Even though the PA Workers’ Compensation Act, and the cases from PA Courts, show the workers’ comp insurance carrier must have a basis to deny a claim at the time the decision is made to deny the claim, Workers’ Compensation Judges (WCJs) rarely apply the law this way.

On September 26, 2008, the Commonwealth Court of Pennsylvania decided Hansen v. Workers’ Compensation Appeal Board, in which unreasonable contest attorney fees were denied. In this case, at the time the decision was made to deny the claim, the workers’ comp insurance carrier had five progress notes from the injured worker’s doctor. One of these notes made mention of the injured worker’s occupation, in discussing her carpal tunnel syndrome. None of the notes specifically stated the carpal tunnel was work-related. The workers’ comp insurance carrier denied the claim. The WCJ granted the claim, but denied unreasonable contest attorney fees. The injured worker appealed the denial of attorney fees.

On appeal to the Commonwealth Court, the decision of the WCJ, denying the unreasonable contest attorney fees was affirmed. The Court reasoned that the workers’ comp insurance carrier had a factual basis to deny the claim since the progress notes were vague, and the injured worker had performed similar work for other employers in the past. The Court apparently had no problem with the fact that the workers’ comp insurance carrier did not request the injured worker attend an Independent Medical Examination (IME) until after a lawyer was retained and litigation was begun.

To us, as lawyers who regularly practice in the area of PA workers’ comp, the Court has now switched the burden to the injured worker to show clear evidence of a work injury to the workers’ comp insurance carrier. Previously, based on the actual language of the Pennsylvania Workers’ Compensation Act, we believed the workers’ comp insurance carrier had a duty to investigate an injury once report of the injury had been received (since this is what the Act specifically states in Section 406.1). It now appears the workers’ compensation insurance carrier has much less of a duty to investigate report of a work injury than is written in the Act.

September 26, 2008

PA Workers' Comp Verification Forms

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.

September 3, 2008

Reinstating in PA Workers’ Comp After Benefits are Terminated

One of the most difficult burdens an injured worker in Pennsylvania faces is when he or she is trying to reinstate PA workers’ compensation benefits after a Workers’ Compensation Judge (WCJ) has terminated such benefits. Since the granting of a Termination Petition means that the WCJ has found the claimant fully recovered from the work injury, there is a logical problem to later show the same injured has “recurred.”

A recent decision by the Commonwealth Court of Pennsylvania, National Fiberstock Corp. v. Workers’ Compensation Appeal Board (Grahl), shed some light on the actual burden a claimant faces in this situation. In short, the claimant must prove that, after the date the WCJ found there was a full recovery, there was a change (a worsening) of that physical condition. A previous workers’ comp decision by the Court noted that this change must be proven “by precise and credible evidence of a more definite and specific nature than that upon which initial compensation was based.”

Obviously, this is a very difficult burden for the injured worker to reach. But, as the Grahl decision shows, the burden is hardly impossible. In the Grahl case, the injured worker won her case by proving her carpal tunnel syndrome had recurred, using the doctor’s physical examination (which showed atrophy, or shrinking of the muscle) and electrodiagnostic testing (EMG test). It is this type of objective proof of the change in her condition which won the case.

One of the arguments made by the workers’ comp insurance company was that Ms. Grahl’s doctor was not capable of testifying, because he did not see her until after the Termination Petition was granted by the WCJ (so he could not have known her condition at that time). The Court rejected this argument, since the doctor accepted and assumed that claimant was fully recovered when so found by the WCJ.

It is also important to note that this difficult burden flies both ways, as the Court also observed. When a workers’ comp insurance carrier loses a Termination Petition, the workers’ comp insurance company must prove a change in condition to win a later Termination petition. For more on this burden on the workers’ comp insurance carrier, see Lewis v. Workers’ Compensation Appeal Board (Giles & Ransome, Inc.)

August 8, 2008

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.

July 22, 2008

Termination of Workers’ Compensation Benefits in PA May Require Change of Condition

Not that long ago, a Pennsylvania workers’ compensation insurance company could terminate the benefits of an injured worker anytime they found a doctor to say the injured worker had fully recovered from his or her work injury. This encouraged the workers’ compensation insurance carriers to file Termination Petition after Termination Petition, until they found a doctor the Workers’ Compensation Judge believed. Fortunately, this is no longer the case in PA. The case that allowed such a luxury by the workers’ compensation insurance carrier, King v. WCAB, was overruled by the Pennsylvania Supreme Court in Lewis v. WCAB.

The law now, confirmed by the Commonwealth Court of Pennsylvania in Prebish v. WCAB, decided on July 14, 2008, is that the workers’ comp insurance company must have an opinion that the condition of the injured worker has changed since the last termination was adjudicated. This keeps the workers’ compensation insurance carriers from harassing the injured worker by filing an endless stream of Termination Petitions. To learn how to avoid being the victim of continued litigation by the workers’ compensation insurance carriers, contact an experienced Pennsylvania workers’ comp attorney.

June 7, 2008

Expanded Description of Injury No Benefit to Injured Worker, Says Commonwealth Court of PA

In a very disturbing decision by the Commonwealth Court of Pennsylvania, in Watson v. W.C.A.B. (Special People in Northeast), reported by the Court on May 30, 2008, the injured worker was denied reimbursement of litigation costs, even though the injured worker was successful in part of her Claim Petition.

Claimant filed a Claim Petition three days after her injury (a fact for which the injured worker was chided by the Court, who, seemingly would prefer the injured worker sit and wait with no assurance her claim would ever be accepted by the workers’ comp insurance carrier). An Answer was filed by the workers’ comp insurance carrier admitting Claimant suffered a head contusion in the work injury.

The Workers’ Compensation Judge eventually found the doctors offered by the workers’ comp insurance carrier more credible and denied the wage loss aspect of the Claim Petition (Under the Pennsylvania Workers’ Compensation Act, no wage loss benefits are payable unless there are more than seven days of disability; here the Workers’ Compensation Judge found only three days of disability).

As to the medical benefits, the Workers’ Compensation Judge found medical benefits were payable until the date the workers’ comp insurance carrier’s medical expert said Claimant was fully recovered from her injury. The Workers’ Compensation Judge found, based on the workers’ comp insurance carrier’s medical expert, that the injury was a concussion (not a contusion). Since the Claimant won, at least in part, the Workers’ Compensation Judge awarded Claimant reimbursement of litigation costs.

Both sides appealed the decision of the Workers’ Compensation Judge. The Workers’ Compensation Appeal Board (WCAB) affirmed the majority of the decision, but reversed the award of litigation costs.

Under the Pennsylvania Workers’ Compensation Act, Section 440(a), litigation costs are to be reimbursed by the workers’ comp insurance carrier when Claimant is successful in the litigation “in whole or in part.”

The Commonwealth Court of PA affirmed the decision of the WCAB. The Court found no appreciable difference between a head contusion and a concussion in this case (an opinion, I doubt, would be shared by anyone who has suffered a concussion). Indeed, since the Court found there would be no medical treatment needed for one that was not done for the other in this case, “Claimant does not assert that the injury description resulted in any financial benefit to her.” I do not recall any requirement in the Pennsylvania Workers’ Compensation Act that medical benefits lead to a “financial benefit” to the injured worker. This seems to be just another example of the battle faced by the injured worker in PA.

June 4, 2008

PA Injured Worker Can Lose Workers’ Comp Benefits When Receiving a Notice

Many injured workers in Pennsylvania know not to sign a document they receive from the workers’ compensation insurance company without checking first with an experienced workers’ compensation attorney. Unfortunately, few injured workers are aware that some documents exist in the Pennsylvania Workers’ Compensation Act which can cause workers’ comp benefits to be reduced, or stopped, even if the documents are NOT signed by the injured worker.

When an injured worker returns to work in PA, he or she is still entitled to workers’ compensation benefits if there is still a loss in earnings (maybe the modified job pays less per hour, or offers fewer hours). The workers’ compensation insurance company must take some action if it wishes to reduce, or stop, weekly compensation benefits. In the old days, the workers’ compensation insurance company would have to file a Petition for Modification or Suspension, and litigate the issue. This is no longer the case.

These days, the workers’ compensation insurance company can simply file a Notification of Modification or Suspension, which contains an affidavit that the injured worker has returned to work, whether at pre-injury or reduced wages. If the Notification of Modification or Suspension is not “challenged” (appealed) by the injured worker, the Notification of Modification or Suspension has the same legal effect as if the injured worker signed a Supplemental Agreement, agreeing that the injured worker did return to work at those wages.

The challenge of the Notification of Modification or Suspension must be filed by the injured worker within 20 days of when the injured worker received the Notification of Modification or Suspension. According to a recent case in the Commonwealth Court of PA, Wawa v. W.C.A.B. (Seltzer), the date the injured worker received the Notification of Modification or Suspension is a finding of fact to be made by the Workers’ Compensation Judge (and will not be disturbed on appeal, if supported by “substantial evidence”).

This is yet another danger to the injured worker, who may be unaware that valuable rights can be lost simply by not taking action. It is very important that the injured worker be fully informed of the potential pitfalls contained within the Pennsylvania Workers’ Compensation Act.

June 2, 2008

Supreme Court of PA accepts Appeal on Amending Description of Injury on NCP

In an earlier blog entry, I explained the process of workers’ compensation appeals in Pennsylvania. Since the Supreme Court of PA can accept only those appeals it wishes, very few workers’ compensation cases are heard by the Supreme Court of Pennsylvania.

Unfortunately, on May 19, 2008, the Supreme Court of Pennsylvania announced that they have accepted the appeal in Cinram Manufacturing, Inc. v. W.C.A.B. (Hill), which had been decided last year by the Commonwealth Court of Pennsylvania. I say “unfortunately” because the decision had been favorable to injured workers, and seemed based on common sense.

In making its decision, the Commonwealth Court of PA found that a Workers’ Compensation Judge in Pennsylvania had the power to add to the description of injury, even if the injured worker did not file a Petition to Review the Notice of Compensation Payable (NCP). For example, in this case, a Petition for Termination was the only petition filed.

Previous decisions of the Supreme Court of Pennsylvania, in years’ past, suggested that a Petition to Review the NCP would have to be filed for the Workers’ Compensation Judge to be able to amend the description of injury. On the other hand, many cases have also noted that the form of the pleadings is not fatal in PA workers’ comp, and that a Workers’ Compensation Judge is usually able to decide the case based on the evidence presented, generally without regard to the petitions actually pending.

Creating more strict requirements only makes PA workers’ compensation more dangerous for the unwary. We will keep you posted on this, and other decisions, as they happen.

May 26, 2008

Northeast Philadelphia Workers’ Compensation Office Moving to Electronic Filings

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.

May 23, 2008

Bankruptcy of Workers’ Compensation Insurer in Pennsylvania Does Not Preclude Claim

A common fear with an injured worker is the impact of his or her employer, or the workers’ compensation insurance carrier, filing for bankruptcy. In Pennsylvania, an injured worker need not be concerned with such a development. Whether it is the bankruptcy of the employer, or the workers’ compensation insurance carrier, in PA, workers’ compensation benefits should not be disturbed.

When a party files for bankruptcy, which is governed by Federal law, the main purpose (or at least the immediate purpose) is the protection of the “automatic stay,” provided by Section 362(a)(1) of the Federal Bankruptcy Code, 11 U.S.C. §362(a)(1). The “automatic stay” causes any collections efforts (including any litigation) to be stopped. A creditor usually must apply for permission with the bankruptcy court, in order to have the stay lifted. Only if the request is granted, and the stay is lifted, can the creditor take any action on the debt (including litigation). The automatic stay allows payments from the bankrupt party to stop. This would, of course, be catastrophic for an injured worker who relies on Pennsylvania workers’ comp benefits.

Workers’ compensation laws are State laws, as opposed to Federal law, such as bankruptcy. One of the exceptions to the “automatic stay” is an exercise of a State’s “police powers,” under 11 U.S.C. §362(b)(4). The Commonwealth Court of Pennsylvania has recently confirmed that “the administration of worker’s compensation claims by the State … is a valid exercise of a governmental unit’s regulatory power, and is exempt from the automatic stay.” Pope & Talbot v. W.C.A.B. (Pawlowski), decided on May 21, 2008. Therefore, workers’ compensation benefits in PA are usually to be paid regardless of the filing of bankruptcy. Similarly, litigation in workers’ compensation cases in Pennsylvania may continue, despite the bankruptcy filing.

In years past, if an employer in PA failed to carry Pennsylvania workers’ compensation insurance (which is a crime in Pennsylvania), and that employer filed for bankruptcy, the injured worker may have been left out in the cold. Fortunately, as part of Act 147, passed by the Pennsylvania Legislature in 2006, the Uninsured Employers’ Guaranty Fund (UEGF) was created. The UEGF, funded by payments from all workers’ comp insurance companies in PA, steps in when there is a claim against an uninsured employer (regardless of whether that employer is bankrupt). This fund provides a measure of security for the injured worker who, unknown to the worker, is employed by a company who fails to carry the required workers’ comp insurance.

May 19, 2008

Mandatory Mediation in PA Workers Compensation

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.

May 15, 2008

Job Referrals Must Be Actually Available to PA Workers’ Compensation Claimant

Experienced Pennsylvania workers’ compensation attorneys frequently are involved in cases where an injured worker, no longer able to perform his or her pre-injury job, is referred to other jobs in the community by a vocational counselor, at the request of the workers’ compensation insurance carrier. As lawyers who limit our practice to PA workers’ comp, we love to see cases reduce the power of the workers’ compensation insurance carriers to abuse this process.

Recently, on May 12, 2008, the Commonwealth Court of Pennsylvania decided PA Department of Corrections v. WCAB (Zvara). In this case, the claimant, who does not drive, was referred to five jobs, which were said by the workers’ compensation insurance carrier to be within the physical limitations of claimant. Claimant did not apply for any of the jobs (Often, the failure to apply for any of the referred jobs is nearly certain to cause the case to be lost). In this situation, however, the Court found that the workers’ compensation insurance carrier did not meet its burden of proof. Specifically, the workers’ compensation insurance carrier failed to prove public transportation was compatible with the hours of the offered jobs, or that the prospective employers would modify the hours of the jobs to accommodate the schedules of public transportation. The mere fact that the referred jobs were accessible by public transportation, without more, was not enough. Since the workers’ compensation insurance carrier did not meet its burden of showing jobs “available” to the claimant, the burden never shifted to claimant, to prove he or she applied for each job in good faith. As such, the Petition for Modification was denied.

May 13, 2008

Specific Loss Benefits Require Medical Evidence in PA Workers’ Comp

An injured worker in Pennsylvania is generally entitled to be compensated for his or her lost wages (called “indemnity” benefits), and have medical expenses related to the work injury paid. When an injured worker loses the use of certain parts of the body, payment can also be obtained (this is called “specific loss” benefits). Included in “specific loss” benefits is compensation for scarring, or “disfigurement,” on the head, face or neck.

Under the Pennsylvania Workers’ Compensation Act, in Section 306(c), there is a list of body parts, and how many weeks of workers’ compensation benefits an injured worker would receive for the loss of each. For example, the loss of a hand leads to a payment of 335 weeks of workers’ compensation benefits. A foot is 250 weeks. Other amounts are listed for forearm, leg, lower leg, eye and more. Payment for fingers depends upon which finger is involved (from 100 weeks for a thumb to 28 weeks for the little finger). The Act also includes some period of additional compensation, called a “healing period.” For example, the lost hand adds a healing period of 20 weeks and the lost foot leads to an additional 25 weeks. Compensation for scarring on the head, face or neck is completely within the discretion of the Workers’ Compensation Judge, who can award from zero to 275 weeks, depending on how disfiguring the scarring is felt to be.

To obtain specific loss benefits in PA workers’ compensation, an injured worker must show that the part of the body at issue has been “permanently” lost “for all practical intents and purposes.” The quoted portions above are usually where disputes exist, often requiring the decision of a Workers’ Compensation Judge.

While the testimony of the injured worker is important in determining whether there is a loss of use “for all practical intents and purposes,” according to a recent case decided by the Commonwealth Court of Pennsylvania, medical evidence must also be presented in support of the injured worker. In Jacobi v. W.C.A.B., decided by the Court on February 12, 2008, the claimant testified about how he is limited in using his right middle finger (which had been caught in a freight door and subject to three surgeries, the last of which involved the placement of a screw), but the claimant did not present any medical evidence which stated that the use of the finger has been lost “for all practical intents and purposes.” The Court reversed the decision of the Workers’ Compensation Judge, who had awarded benefits to the claimant.

May 8, 2008

Workers' Compensation Appeal Process in Pennsylvania

Even when an injured worker receives a decision from the Workers’ Compensation Judge (WCJ) in Pennsylvania, the case is not over. Either side may appeal the decision to the next level, the Workers’ Compensation Appeal Board (WCAB). Such an appeal must be filed within 20 days of the decision of the WCJ.

An appeal must allege that the Workers’ Compensation Judge committed an “error of law” or that the decision issued by the Judge is not a “reasoned decision.” Simply disagreeing with the decision is not a proper basis of appeal. An appeal cannot challenge who the Judge believed (called “determination of credibility”), since this is solely at the discretion of the Judge.

The WCAB schedules oral argument at various locations throughout the year. At the time oral argument is made, the WCAB also expects a brief to be filed by the appealing party (though a party can request additional time to submit a brief).

Once the decision of the WCAB is made, the losing party can then appeal to the Commonwealth Court of Pennsylvania. This appeal must be filed within 30 days of the WCAB decision. Oral argument is rarely done at this level and the matter is usually decided just on the written arguments filed by the parties.

The decision of the Commonwealth Court of Pennsylvania can be appealed to the Supreme Court of PA, though the Supreme Court only hears cases it chooses. The appealing party files a petition for “Allocatur” with the Supreme Court of PA, which the Court then grants or denies. If the Court grants allocatur, it accepts the appeal and will decide the issue. If the Court denies allocatur, the decision of the Commonwealth Court of Pennsylvania becomes final.

May 6, 2008

Employer Need Not Show Job Not Available to Injured Worker in PA

One of the tools a workers’ compensation insurance company has in PA to reduce, or “modify,” workers’ compensation benefits is the Labor Market Survey (LMS) (Also called “Earning Power Assessment” (EPS)). This is used when the injured worker has physical limitations which prevent a return to the injured worker’s previous occupation.

As you can see by looking at Section 123.301 in the Regulations issued by the Pennsylvania Bureau of Workers’ Compensation, before an Employer can resort to using an LMS, the Employer must demonstrate that there is no job available with the Employer within the physical limitations of the injured worker . . . or maybe not.

Recently, the Commonwealth Court of Pennsylvania decided the matter of Rosenberg v. W.C.A.B. (Pike County), which dealt with this issue. The Court held, in a narrow 4-3 decision, however, that an Employer only had to address this issue if the injured worker offered evidence (which could just be testimony of the injured worker) that a job was indeed available with the Employer. Once that evidence was presented, then the Employer had the burden of proof to show no such job existed.

As the three Judges who dissented pointed out, this logic is blind to the fact that it is much easier for the Employer to show an absence of a suitable job than it is for an injured worker to show a job existed. One must wonder how an injured worker would know what is happening within the Human Resources department of their Employer (while the injured worker is home recovering from an injury yet).

This seems yet another case where the injured worker in PA gets the short end of the straw. Unfortunately, such a result seems to be happening all too frequently.

April 29, 2008

Impairment Rating Evaluation (IRE) in PA Workers' Compensation

To answer an often asked question, in Pennsylvania, there is no limit to how long an injured worker can receive total disability workers’ compensation benefits. However, as a practical matter, it is difficult to receive total disability benefits in PA for more than two years. After an injured worker in Pennsylvania has received total disability benefits for 104 weeks, the workers’ compensation insurance company can request the injured worker attend an Impairment Rating Evaluation (IRE).

An IRE is somewhat different than an Independent Medical Examination (IME), as the doctor who performs an IRE is selected by the Pennsylvania Bureau of Workers’ Compensation (the workers’ compensation insurance carrier selects the doctor in an IME). The doctor who performs the IRE will examine the injured worker and review records. Subsequently, the doctor will decide what percentage the injured worker is impaired from the work injury. This percentage is determined by guidelines developed by the American Medical Association.

If the injured worker is found to be less than 50% impaired by the work injury, the workers’ compensation insurance carrier may be able to have the status of the disability changed from “total” to “partial.” While this change does not effect the amount of workers’ compensation benefits the injured worker receives, it does put a time limit on how long the benefits can be received. An injured worker in PA can only receive partial disability benefits for a maximum of 500 weeks.

You will notice that I said the workers’ compensation insurance company “may” be able to change the status. If the workers’ compensation insurance carrier requests the IRE within 60 days of when the injured worker has received 104 weeks of total disability, the workers’ compensation insurance company need only file a Change of Status form and the status of benefits automatically changes from total to partial.

However, the situation is very different if the workers’ compensation insurance carrier requests the IRE after the 60 day period (after the 104 weeks of total disability). In that case, according to a recent decision by The Commonwealth Court of Pennsylvania, apparently, the workers’ compensation insurance carrier must actually prove some form of job availability to have the status changed to partial. This decision, in the case of Diehl v. W.C.A.B. (IA Construction), filed on April 28, 2008, makes the question of when the IRE request was made very important.