Articles Posted in Worker Comp Generally

Our attorneys were out of the office earlier this week, to attend the annual Pennsylvania Bureau of Workers’ Compensation Conference, in Hershey, PA.  While we hate to have our attorneys both unavailable to help our clients, we feel it is important for us to attend these seminars.  This conference is presented by the Bureau itself, so there is an opportunity to obtain information allowing us to stay current on all topics of interest in Pennsylvania workers’ compensation.

While there are not many attorneys, like us, who represent injured workers in attendance, we think listening in is helpful.  Most of the attendees at this conference are not attorneys at all; they are adjusters, risk management and safety officials from all across PA.  Additionally, many of the Workers’ Compensation Judges (WCJs) are in attendance.  We can hear what these folks are being told regarding different aspects of the PA workers’ compensation system.  This can help us anticipate issues and avoid some pitfalls that could pertain to our clients.

Topics addressed at the different sessions ranged from medical issues (including medical marijuana, the future of “telehealth,” and the role of nurse case managers), to internet surveillance, to Workers Compensation Medicare Set-Asides (WCMSAs), to different insights on how WCJs feel about varying issues.

We are not the official workers’ compensation law firm of the NFL.  Or of any major sport.  What does that even mean?  We do not have a slick marketing department, which puts our faces on billboards or TV.  What we ARE is the law firm for injured workers.  Our focus is not on fancy marketing; it is on delivering the best personal attention to your case.

We do not have multiple paralegals for each attorney, nor do we have more attorneys than you can count.  We have two attorneys that will actually handle your case.  What does that mean for you?  It means that both of our attorneys are experienced and certified as specialists in workers’ compensation law.  Each of our attorneys has over 25 years of experience in the field.  You will never have your case handled by a junior attorney with little or no experience.  You can be confident that every step of your case will be handled by an experienced and qualified attorney.

Some firms have paralegals and assistants handle the day-to-day things on a case.  The injured worker doesn’t speak to his or her attorney; the injured worker speaks to the attorney’s “team.”  That is not how we operate.  At Brilliant & Neiman LLC, one of our two attorneys is personally handling your case.  You can speak directly to your attorney to have any concerns addressed or questions answered.

We were talking to a potential client the other day, and the client mentioned in passing about a scar that she had from the work injury.  Like many injured workers, she did not know that a scar can actually be compensable.  She believed, as many injured workers do, that one must be disabled to receive any workers’ compensation benefits in PA.  This is simply not correct.

We have discussed scarring and disfigurement on this blog in the past.  Under the Pennsylvania Workers’ Compensation Act, in Section 306(c)(22), “serious and permanent disfigurement of the head, neck or face, of such a character as to produce an unsightly appearance, and such as is not usually incident to the employment” is compensable, regardless of whether there is or was any disability involved in the work injury.  This is one of the few areas of the law (along with determination of penalties) where a Workers’ Compensation Judge (WCJ) has wide latitude to make an award.  A WCJ can order payment of anywhere from zero to 275 weeks of benefits for disfigurement.

The three key aspects to a disfigurement, or scarring, claim, is that the disfigurement be “permanent,” that it be “unsightly,” and that it be on the head, face or neck.  Generally, we start talking about permanence after about six months.  As to “unsightly,” it can be helpful to simply interpret that as “noticeable.”  And, as noted, scarring on the back, chest, or an extremity is not compensable – the disfigurement must be of the head, face or neck.  The appellate courts in PA have interpreted this to mean the scarring must be above the collarbone.

One of the common questions we hear from injured workers is “What happens if I retire?” or, more than you may imagine, “What happens if I move out of this Country?”  In either case, the answer is that your wage loss benefits are placed in serious jeopardy.  Medical benefits are not impacted by these things; this is just a risk to wage loss (“indemnity”) benefits.

Normally, to reduce or eliminate workers’ compensation wage loss benefits, the insurance carrier must prove that the injured worker’s condition has changed, such that he or she is physically capable of some kind of work, and that this kind of work is available to the injured worker.  The standard is different, however, if the insurance company can prove either that the injured worker has “retired,” or has relocated out of the Country.  If they are able to prove one of these things, a Workers’ Compensation Judge (WCJ) can find that the injured worker has withdrawn from the labor market, leading to a suspension of the wage loss benefits.  One of the tools we have, as attorneys who represent injured workers, is to show that work is not “available” to the injured worker.  In these situations, that is not even relevant.

There are strategies to deal with these situations, provided that the injured worker obtain timely legal advice.  This is yet another instance when acting without legal counsel can dramatically impact your rights.  Once benefits are suspended in these situations, it can be difficult, if not impossible, for us to fix the problem.  The best way to fix the problem, is to avoid it happening.

Once an injured worker in PA establishes a right to workers’ compensation benefits, such benefits can only be stopped by the workers’ comp insurance carrier under certain circumstances.  Two of the most common involve litigation before a Workers’ Compensation Judge (WCJ) – proving to the WCJ that the injured worker is fully recovered from the work injury (termination of benefits), or that work is available to the injured worker at equal to, or higher, wages (suspension of benefits).

An interesting circumstance happens when an injured worker is released back to his or her pre-injury position, without restriction, but the job (for some reason) is no longer available.  What relief is available to the PA workers’ comp insurance carrier in this situation?  Assuming the injured worker has not fully recovered from the work-related injury, there is no relief available to the insurance company.

This issue came up in a recent unreported case, Heartland Employment Services, LLC v. Workers’ Compensation Appeal Board (Ebner) [We should note, as we have covered in a previous blog, that an “unreported” case can be cited to a WCJ for persuasive purposes, but it is not binding on a WCJ, as a “reported” decision would be].  Here, the injured worker suffered a significant injury to the lumbar spine, including a herniated disc and lumbar radiculopathy.  In fact, spinal fusion surgery was required.  However, the medical treatment was successful, and the injured worker was released back to the time of injury job, without restriction.  There was not, however, a full recovery from the work-related injury.

Okay, so you get injured at work.  You get treatment with a doctor, maybe have a course of physical therapy, then you start to feel a little better.  You are not all better yet, and you cannot go back to your regular job, but maybe you could do some kind of work.  So the doctor releases you to light duty work.  What then?

First, let’s talk about what does not happen.  If you are receiving workers’ compensation benefits, as you should be if you are disabled by the work injury, then benefits cannot just be stopped (unless you are being paid under a Notice of Temporary Compensation Payable, which can be revoked within 90 days).  Unless work is shown to be available to you (within your physical restrictions), temporary total disability benefits should continue.

Work could be shown to be “available” to you with your employer, perhaps at a modified version of your former job, or a different job entirely.  Or, work could be shown to be available to you with a totally different employer.  This can be done through a “Labor Market Survey” or “Earning Power Assessment.”  In this situation, the light duty job need not actually be offered to you, it just needs to be generally available (like listed in the “help wanted” section in a newspaper or online).  There is also a tool used by workers’ compensation insurance carriers called “funded employment,” where the insurance carrier actually pays you to work at a charity.

On our blog, and our website, we talk of how to help the injured worker, both through legal rights under the Pennsylvania Workers’ Compensation Act, and through news and developments in the medical field.  But, maybe the most helpful thing is to avoid the work injury in the first place.

While typically, we keep things local to Pennsylvania work injuries, we were contacted by a site in the United Kingdom, which has a guide to help reduce the occurrence of injuries in the workplace.  Obviously, some of the legal and governmental things that are mentioned are not true for PA, but the guide does have some things employers can consider as they try to reduce the frequency of work injuries.

According to the site:

Though the Pennsylvania Workers’ Compensation Act does not have a cost-of-living increase, as seen with Social Security Disability benefits, the maximum workers’ compensation rate does increase every year.  This, of course, does not impact existing injuries, only those that take place in this calendar year.  The PA Bureau of Workers’ Compensation has just announced that the maximum workers’ compensation rate for injuries taking place in 2019 will be $1,049.00 per week.  This is up from the $1,025.00 maximum rate for 2018 work injuries.

Calculating the specific workers’ compensation rate in a case can become complicated.  Essentially, we look at the wages earned by the injured worker in the year prior to the work injury. This year is then split into four quarters, and an average is taken of the highest three of the quarters.  We are then left with the Average Weekly Wage (AWW).  Depending on the figures, the workers’ compensation rate is usually 2/3 of the AWW, though that can vary. For lower wages, the rate can be as high as 90% of the AWW. Those workers earning very high wages, creating a rate that would be above the  maximum compensation rate, will receive less than 2/3 of the AWW.

There can also be confusion over what is allowed to be included in an AWW calculation.  Another job held by the employee (called “concurrent employment”) is certainly includable, as is overtime and most bonuses.  Fringe benefits and self-employment earnings are two things that are not part of the AWW.

Anyone who follows our blog, or the Pennsylvania workers’ compensation system, knows that one of the fastest changing areas these days is that of Impairment Rating Evaluations (IREs).  To keep pace with these changes, and continue our goal of educating the injured worker throughout PA, we have updated the IRE section of our website.  The new page can be accessed here.

For those unfamiliar with the IRE process, this was something the insurance industry lobbied hard for when major changes were made to the Pennsylvania Workers’ Compensation Act (Act) in 1996.  As seen with other States in the Country, an IRE process can change the status of an injured worker from “total” disability to “partial” disability.  While this may not (and in PA does not) change the amount of the weekly benefit received by an injured worker, it does start the clock ticking on the number of weeks of partial disability benefits an injured worker can receive (in Pennsylvania, an injured worker can only receive a maximum of 500 weeks of partial disability benefits; there is no limit to the number of weeks of total disability benefits that can be received).

In 2017, the Supreme Court of Pennsylvania declared the IRE process, as set forth in the Act, unconstitutional.  This set the powerful insurance lobby into full panic mode (though, frankly, the actual financial impact of the loss of the IRE process on the insurance industry is in dispute).  As a result, the PA legislature capitulated to the lobby and passed Act 111, reinstating the IRE process.  To the surprise of very few, the elected representatives chose to side with the insurance industry over the injured worker.

The last free seminar of the Continuing Education Series presented by Brilliant & Neiman LLC will take place on Thursday, November 29, 2018 at 7:00 p.m., at the headquarters of the firm, 260 West Street Road in Warminster, PA.

This program will talk about the medical issues involved with an injured worker, the types of treatment seen with different conditions, and the insurance and billing issues that can arise. We will also address dealing with chronic pain, in the current environment where prescriptions for opioids have drastically dropped.

While the Community Education Series is free, and we want every injured worker (and those who care about him or her) to attend, reservations are required. To reserve a seat for the program on November 29, 2018, call (215) 638-7500 or e-mail gneiman@bnlegal.com.