Pennsylvania Workers' Compensation Lawyer Blog

February 5, 2019

When the First Day of Disability is not the First Day of Disability – Welcome to the Wacky World of PA Workers’ Comp

In litigating a workers’ compensation case in Pennsylvania, we fight about many aspects of a case. Certainly, we have had disputes over when an injured worker was actually “disabled” from his or her job. As highlighted in a recent decision by the Commonwealth Court of PA, though, sometimes the exact date on which disability begins can have great consequence.

In Valley Stairs and Rails v. Workers’ Compensation Appeal Board (Parsons), the injured worker hurt his back while performing his job, and was taken to the hospital by ambulance, on Friday, March 27, 2015. The employer paid him for the day of the injury, on the paystub calling it “COMP TM.”

On April 13, 2015, the workers’ compensation insurance carrier filed a Notice of Temporary Compensation Payable (NTCP). As we have previously discussed in our blog, this document allows an insurance carrier to begin to pay workers’ compensation benefits while still investigating a claim. The NTCP is valid for a maximum of 90 days (if it is not revoked within those 90 days, it converts into a full Notice of Compensation Payable (NCP), which cannot be revoked). If the NTCP is revoked within those 90 days, the claim can be denied in full.

January 25, 2019

PA Commonwealth Court Sheds Light on Preexisting Conditions and Average Weekly Wage Calculation

by Glenn Neiman

When the Commonwealth Court of Pennsylvania decides a case in the PA workers’ compensation arena, we often get some insight into an aspect of the law, or an interpretation of a section of the Pennsylvania Workers’ Compensation Act (Act). Rarely do we see a case address two areas of significance. So, when the Commonwealth Court issued a decision recently in the Kurpiewski v. Workers’ Compensation Appeal Board (Caretti, Inc.) case, we were very excited. We get to talk about preexisting conditions as well as calculation of the Average Weekly Wage.

Let us start first with the issue of preexisting conditions. There is no doubt that you are entitled to workers’ compensation benefits in PA if your work duties, or work injury, aggravate a preexisting condition, whether that underlying condition is work-related or not. We see this often with asthma, allergic reactions, arthritis and degenerative disc disease in the neck or back. Indeed, this is such a basic concept, and comes up so often, that it is covered in the Medical FAQ section of our website.

Where things get messy is when the workers’ compensation benefits will be terminated. As described in a previous blog post, generally speaking, the Courts will say benefits stop when an injured worker returns back to baseline with the underlying preexisting condition (even if that baseline leaves the injured worker advised not to return to his or her regular job, due to a fear of another aggravation). The exception to the rule is when the underlying condition is also work-related, as in the previous blog about the Little case. In that situation, workers’ comp benefits continue, since it is the work injury (not a non-work-related underlying condition) which prevents a return to the regular employment.

January 17, 2019

An Injured Worker Being Released to Light Duty

by Glenn Neiman

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.

December 18, 2018

One Way to Help Injured Workers is to Prevent Work Injuries

by Glenn Neiman

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:

December 14, 2018

Maximum Rate for PA Workers’ Compensation Set for 2019

by Glenn Neiman

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.

December 11, 2018

Brilliant & Neiman LLC Workers’ Compensation Site Updated for IRE Changes

by Glenn Neiman

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.

November 27, 2018

PA Workers’ Compensation Judges Shuffling

by Glenn Neiman

As we have noted in the past, generally, the Pennsylvania Bureau of Workers’ Compensation does not publicize when Workers’ Compensation Judges (WCJs) move from county to county, or even when they change into a different role in the Bureau. So, it falls to us to share with injured workers what seems to be happening from our view. Since none of this has actually been confirmed by the Bureau, all of what we are saying here is purely rumor.

Perhaps the most significant change is the appointment of Judge Joseph DeRita (who had been hearing cases in Easton and Doylestown) to the role of Director of Adjudication for the Bureau. We offer sincere congratulations to Judge DeRita in his new role. While we will miss his intelligent and patient view from the bench, his leadership will now benefit the entire Bureau of Workers’ Compensation.

It appears that the Easton workers’ compensation hearing office will now feature Judge Brian Puhala, along with Judge Bruce Doman. Judge Thomas Kuzma, who had been in Reading, will assume half a case load in Allentown (and the remainder still in Reading). The Doylestown workers’ compensation hearings will be conducted by Judge Karen Wertheimer (who is the Judge Manager for the Eastern District), and Judge Robert Benischeck, who had been stationed in Bristol.

November 5, 2018

Last Free Workers’ Compensation Seminar – November 29, 2018 at 7:00 p.m.

by Brilliant & Neiman

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.

November 1, 2018

Act 111 Brings Back IRE to PA Workers’ Compensation

by Glenn Neiman

We have been following the status of the Impairment Rating Evaluation (IRE) process in PA closely, ever since the Supreme Court of Pennsylvania declared the IRE process unconstitutional in Protz v. Workers’ Compensation Appeal Board (Derry Area School District). This has included interpretations by the Commonwealth Court of PA in the Whitfield and Timcho cases.

As we long suspected, though, the real response would come from the Pennsylvania legislature. In their ever-present desire to bend to the wishes and desires of the insurance industry, the legislature passed Act 111 (formerly known as House Bill 1840). This was signed into law by Governor Thomas Wolf on October 24, 2018. This immediately reinstates the IRE aspect of the Pennsylvania Workers’ Compensation Act.

Since we have previously discussed what the IRE process involves, we will not again detail that information. If you would like to see more of that discussion, we would suggest reviewing the prior blog entries regarding the Protz, Whitfield and Timcho cases.

October 16, 2018

Injured Worker in PA Can Choose Own Doctors

by Glenn Neiman

Did you know that an injured worker in Pennsylvania can choose his or her own doctor? There is a common misunderstanding in the general public that the workers’ compensation insurance carrier can dictate the medical treatment of an injured worker. While a workers’ comp insurance company MAY be able to have some limitation on the choice of a doctor for an injured worker, that control is narrow.

If an employer posts a valid list of healthcare providers for an injured worker to select (called a “panel posting”), the workers’ compensation insurance carrier may only have to pay for treatment with one of the listed providers (for the first 90 days). This would only be true if the list is a valid one (there are rules of what providers can or cannot be on a list), the list is posted in a prominent location, and the injured worker signs an acknowledgement that he or she has seen the list, both before and after the injury. Employers frequently do not meet all of these requirements, allowing an injured worker to treat with a doctor of his or her own choosing (and having the workers’ comp insurance carrier responsible for payment).

As the PA Bureau of Workers’ Compensation notes on its website, “The PA Workers’ Compensation Act gives employers the right to establish a list of designated health care providers.” Many Employers simply do not take advantage of this “right,” giving them no control over the medical treatment for an injured worker. Again, even if an Employer has a properly posted “panel,” this control over medical treatment only lasts for the first 90 days of treatment.

Pennsylvania Workers’ Compensation Lawyer Blog