Case Law Update

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.

April 29, 2008

Impairment Rating Evaluation (IRE) in PA Workers’ Compensation

by Glenn Neiman

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.

April 24, 2008

Workers Compensation Settlement in Pennsylvania Not Final Until Approved by a Workers’ Compensation Judge

by Glenn Neiman

An injured worker in PA can settle both the wage loss and medical parts of his or her case by entering into a Compromise & Release Agreement. This is something which can only be done when both the injured worker and the workers’ comp insurance company agree to settle the case. Neither side can force the other to settle a case. Once the parties agree to the terms of a settlement, a Compromise & Release Agreement must be prepared, detailing the terms of the settlement. Then, before the settlement is final, a hearing must be held before a Workers’ Compensation Judge, who must be satisfied that the injured worker understands the terms and conditions of the settlement.

Recently, the Commonwealth Court of Pennsylvania decided that a Compromise & Release Agreement could not be approved because the injured worker had died before a hearing to approve the settlement could be accomplished. This case, Miller v. W.C.A.B. (Electrolux), was decided on January 4, 2008.

Understand that settling a workers’ compensation case in Pennsylvania is a very complicated process. It is very important that you have an experienced workers’ compensation lawyer working for you, to make sure that you receive the maximum recovery possible, and that your rights be properly protected.

April 22, 2008

IME: Injured Worker in PA Not Required to Get EEG

by Glenn Neiman

We are often asked by injured workers about things related to Independent Medical Examinations (IME). The Pennsylvania Workers’ Compensation Act allows a workers’ comp insurance company to send an injured worker to a doctor of their choosing approximately twice a year. If an injured worker does not attend an IME, the workers’ compensation insurance company can file a petition to suspend workers’ compensation benefits.

Whether the IME is just a visit to be examined by the doctor the insurance company has selected varies by the case, though this does remain the situation in the vast majority of cases. The situation gets more complicated when the IME doctor asks that some additional testing be done on the injured worker. Whether the injured worker has to agree to this additional testing depends on the test at issue and the circumstances in that case.

According to a decision by the Commonwealth Court of Pennsylvania, an IME does include ” . . . all reasonable medical procedures and tests necessary to permit a provider to determine the extent of employee’s disability.” This was in the case of Coleman v. W.C.A.B. (Indian Hosp.), decided in 2004. The Court said the workers’ compensation insurance company must prove the test is necessary, has no more than minimal risk, and is not unreasonably intrusive. In that case, the Court found the injured worker did have to have an MRI done.

April 21, 2008

Injured Worker in PA Jeopardizes Workers’ Compensation Benefits by Taking Pension

by Glenn Neiman

Logic may make you think that if you are permanently disabled from your career as a result of a work injury, you are free to take your pension and continue receiving workers’ compensation benefits. Unfortunately, this is not the case in Pennsylvania, and whether to take a pension in a PA workers’ compensation case is a very important decision, which should only be done after discussing your particular situation with an experienced Pennsylvania workers’ compensation attorney.

When an injured worker starts taking his or her pension in PA, the workers’ compensation insurance company can argue that the injured worker is no longer entitled to workers’ compensation benefits, because the injured worker has “left the workforce.” The injured worker must then show a Workers’ Compensation Judge either that he or she is actually seeking employment or that he or she is not capable of performing any work at all (not just the injured worker’s old job, but any job in the entire labor market) as a result of the work injury. If the injured worker does not prove one of these two things, a Workers’ Compensation Judge can suspend (stop) the injured worker’s wage loss benefits (the weekly or bi-weekly checks). The injured worker’s right to medical treatment for the injury is not affected.

The case I recently saw that brought this situation to mind, Mason v. W.C.A.B. (Joy Mining Machinery), was decided by the Commonwealth Court of Pennsylvania on March 18, 2008.

April 20, 2008

Pennsylvania Workers’ Comp Insurance Pays for Cost of Wheelchair Accessible Van

by Glenn Neiman

In a recent decision favorable to injured workers in PA, the Supreme Court of Pennsylvania said that, under certain circumstances, a workers’ compensation insurance company must pay not only to modify a van to be wheelchair accessible, but to pay for the cost of the van itself. This is an important change in the law, because there had been an older case, finding the workers’ compensation insurance company was only responsible to pay for making a van wheelchair accessible (and not for the cost of the van itself).

The injured worker in this case, who was paralyzed in a work injury, was not able to get out of the house, even to medical appointments, without this special van. Fortunately, the Court saw the unfairness of making the workers’ compensation insurance company pay only to modify the van for a wheelchair, when the injured worker might then not even be able to afford buying the van itself. The Court said, ” . . . the van is crucial to restore some small measure of the independence and quality of life that existed before the work injury.”

This rule is probably limited to cases like this, involving a catastrophic injury. The Court also said the situation of the injured worker in each case needs to be examined. For example, is a new van required? Did the injured worker own a van before the injury? Was any automobile owned by the injured worker before the injury? The answers to these questions, and others, would determine whether the workers’ compensation insurance company would have to pay for the cost of the van in any future case.