Pennsylvania Workers' Compensation Lawyer Blog

January 3, 2018

Is Massage Therapy “Medical Treatment” in PA Workers’ Compensation?

What is “medical treatment”? Though most folks know that medical treatment for a work injury is covered under the Pennsylvania Workers’ Compensation Act (Act), even the courts seem confused as to what constitutes “medical treatment.” In some ways, this issue was recently clarified by the Commonwealth Court of Pennsylvania.

In Schriver v. Workers’ Compensation Appeal Board (Commonwealth of Pennsylvania, Department of Transportation), the injured worker suffered an injury to his low back. For relief, the injured worker began treating with a chiropractor. The chiropractor, in turn, referred the injured worker to a massage therapist in his office. When presented with bills for the massage therapy, the workers’ compensation insurance carrier refused payment, denying that “massage therapy” falls under the category of “medical treatment.”

The injured worker filed a Petition for Review of Medical Treatment/Billing, and a Petition for Penalties. After hearing the evidence, the Workers’ Compensation Judge (WCJ) granted both Petitions and ordered payment of the massage therapy bills, in addition to penalties.

December 11, 2017

Fact That Injured Employee Unsuccessfully Applies For Jobs In LMS Is Relevant, But Not Dispositive, In PA Workers’ Compensation

by Glenn Neiman

One of the tools in the arsenal of the workers’ compensation insurance carrier in Pennsylvania, in their fight to take away benefits from injured workers, is the “Labor Market Survey” (LMS), also known as an “Earning Power Assessment” (EPA). Once an injured worker in PA has shown an entitlement to workers’ comp benefits, then the insurance carrier can use an LMS or EPA to show there are jobs available in the general community that the injured worker could get if he or she wished. A “vocational expert” is used to locate these jobs. This is typically followed by a Petition for Modification, seeking a reduction of workers’ compensation benefits based on the amount these potential jobs would pay.

As we discussed several years ago on this blog, the Supreme Court of Pennsylvania, in Phoenixville Hospital v. Workers’ Compensation Appeal Board (Shoap), found that a defense to one of these Modification Petitions is for the injured worker to show that he or she applied to these supposed “open and available” jobs and did not receive an offer of employment. This is a critical part of defending these Modification Petitions (typically). However, the Court in Shoap did not specify exactly what the injured worker had to show to refute that the jobs were open and available (or how the insurance company could overcome the injured worker not receiving an offer of employment).

This brings us to a recent decision from the Commonwealth Court of Pennsylvania in Valenta v. Workers’ Compensation Appeal Board (Abington Manor Nursing Home and Rehab and Liberty Insurance Company). Here, the injured worker suffered serious damage to her neck and shoulder. In fact, the injured worker required a cervical fusion due to the work injury. After that surgery, the workers’ comp insurance company had a LMS/EPA performed. The injured worker attempted to apply for each of the six jobs that were identified (Though she was only able to contact three of the six potential employers, and only able to actually apply for two of the jobs, she had a vocational expert testify regarding all six jobs). No offer of employment was received by the injured worker.

December 4, 2017

Attorney Glenn Neiman Acting as Moderator for Continuing Legal Education Seminar

by Brilliant & Neiman

We are proud when our attorneys are asked to participate in continuing legal education seminars. Being invited to help educate other lawyers can only be viewed as a tremendous compliment. And, so we are pleased to relay that one of our attorneys, Glenn Neiman, has been invited by the Workers’ Compensation Section of the Bucks County Bar Association to act as a moderator in a continuing legal education seminar the Section is presenting later this month.

The topic of the seminar will be addressing the interplay between the Heart & Lung Act (a benefit program to which police, firefighters and other first responders qualify) and the Pennsylvania Workers’ Compensation Act. Since these two laws can both impact cases in different ways, it is important for attorneys who handle either of these types of cases to be aware of both laws.

November 28, 2017

Injured Workers’ Rights to Medical Treatment in PA

by Glenn Neiman

Just the other day, an injured worker called us, complaining that their employer refused to send them to a “workers’ compensation doctor.” It seems that there is more confusion in this area than in many within the complicated world of Pennsylvania workers’ compensation.

While medical treatment for the work injury is one of the benefits available to an injured worker under the Pennsylvania Workers’ Compensation Act (Act), this is not necessarily treatment with a doctor with any connection to the employer or the employer’s workers’ comp insurance carrier. In fact, the ability to direct and control medical treatment is a BENEFIT to the employer, and a DETRIMENT to the injured worker. As such, this control is only available if an employer complies with specific steps.

Under the Act, an employer may only be responsible for payment to a medical provider on a “panel posting” within the first 90 days of treatment. Such a “panel posting” must be prominently displayed in the work place. To be a valid “panel posting,” the 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 practice. 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.

November 3, 2017

Settling a PA Workers’ Compensation Case

by Glenn Neiman

One of the frequent questions we are asked is regarding the settlement of a Pennsylvania workers’ compensation claim. In fact, there is a page on our website just devoted to settlements. When considering whether to settle his or her case, there are several things an injured worker should consider. Initially, it is important to note that not every workers’ comp case settles. Workers’ compensation benefits can end for a variety of reasons, other than a settlement. Therefore, just because you have had a work injury in PA, do not believe you are simply entitled to a settlement.

The timing of the case is always an important consideration when considering whether to settle a case. We do not mean timing in a strict calendar sense, as there is no magic number of months or years which must go by before a case can settle. Instead, we are looking at the posture of the case. Is the injured worker still in active treatment? Is surgery, or other invasive treatment still being planned? Is there other health coverage available? As to the case legally, we ask whether there is a current threat to the benefits? Whether there is current litigation, and the chances of success? What is the employability of the injured worker? (Considering that encompasses both physical restrictions, as well as educational and work backgrounds). As you can see, there are many factors going into whether now is the right time to settle.

Next, the question may be the value of the case. Again, there is no magic formula. A settlement only works if both sides agree. It has to be voluntary for everyone. Unlike a personal injury case, there is no pain and suffering in a PA workers’ compensation case. A settlement purely reflects loss of earnings, and, if applicable, future medical treatment. Obviously, the settlement figure is something to be negotiated.

October 3, 2017

Employee in the Scope and Course of his Employment at the Time of Death

by Glenn Neiman

Though the phrase “scope and course of employment” does not appear anywhere in the Pennsylvania Workers’ Compensation Act, this is a frequent issue involved with appellate cases. After all, a work injury is only compensable if one was performing his or her job at the time of the injury. This issue often depends on the particular facts of each case. A recent decision by the Commonwealth Court of Pennsylvania continues this concept.

In Rana v. Workers’ Compensation Appeal Board (Asha Corporation), the injured worker (“Claimant”) was a manager-in-training for a Dunkin Donuts franchisee. The franchisee owned locations in Wyncote, Horsham, and Hatfield. Claimant primarily worked as a manager at the Wyncote location, but would be expected to travel to the other locations occasionally for operational issues. One night, after Claimant finished his regular shift at the Wyncote store, Claimant’s boss called him at home at 10:00 pm, and said an employee at the Hatfield location had a medical issue. Claimant told his boss he would go in and see what was happening. While heading to the location, Claimant was in a motor vehicle accident, and unfortunately was fatally injured.

A Fatal Claim Petition was filed by Claimant’s parents, who were dependent upon him. After hearing the evidence, the Workers’ Compensation Judge (WCJ) granted the Fatal Claim Petition, finding that Claimant “was furthering Employer’s business and was on a special assignment for Employer. Thus, Decedent was in the course and scope of his employment at the time of the accident and Claimants were entitled to collect compensation.”

September 25, 2017

UEGF Forms Now Available on WCAIS System

by Glenn Neiman

In past blog posts, we have discussed the Uninsured Employers’ Guaranty Fund (UEGF). This is the safety net available for workers who have been injured while working for an employer who (in violation of Pennsylvania law) fail to carry PA workers’ compensation insurance. While the UEGF does give these injured workers an avenue to pursue to get wage loss and medical benefits, there are hurdles to clear which are not present with a typical PA workers’ compensation case.

Ordinarily, when a worker gets hurt in Pennsylvania, he or she simply files a Claim Petition and can seek benefits from the date of the work injury. When a claim is being made against the UEGF, however, one must first file a Notice of Claim Against Uninsured Employer (the form is LIBC-551). Unless the Notice is filed within 45 days of the injured worker knowing the employer failed to carry PA workers’ compensation insurance, no medical or wage benefits are payable until the Notice is filed.

Once the Notice is filed, the injured worker must wait at least 21 days to file a Claim Petition for Benefits from the Uninsured Employer and the Uninsured Employer’s Guaranty Fund (form LIBC-550). In contrast, there is no requirement (in a typical PA workers’ comp case) of waiting any time before filing a regular Claim Petition.

September 19, 2017

WCAB to Change Oral Arguments

by Glenn Neiman

When a party to a PA workers’ compensation litigation receives a decision of the Workers’ Compensation Judge (WCJ), the party can file an appeal to the Workers’ Compensation Appeal Board (WCAB). If a party is not successful before the WCAB, then the party can file an appeal to the Commonwealth Court of Pennsylvania. The losing party at that level can request an appeal to the Supreme Court of PA, but whether the appeal is accepted by the Supreme Court is discretionary with the Court.

Oral argument is available on every case before the WCAB, even before briefs are submitted (though the parties can waive the right to oral argument if they wish). At the Commonwealth Court and Supreme Court levels, however, the Courts decide whether they want oral argument (typically requested only on novel or complicated issues), and the arguments would be after the briefs are submitted.

At least, that’s how it was. We were just notified by the Pennsylvania Department of Labor & Industry that a change is being proposed to the rules regarding oral argument before the WCAB. There are two basic elements looking to be changed. First, the briefs would be submitted before any oral argument would be done (so the WCAB Commissioners could know the case before hearing the oral arguments cold). Second, mirroring the higher courts, the use of oral argument would be discretionary with the WCAB, reserved for novel or complex issues.

September 11, 2017

Diagnosis Not Dispositive Whether Medical Treatment For PA Work Injury Covered

by Glenn Neiman

The Pennsylvania Workers’ Compensation Act sets forth that medical treatment related to a work injury is to be paid for by the workers’ comp insurance carrier (provided the treatment is reasonable and necessary). If there is a dispute as to whether treatment is related to a work injury, a petition must be filed. If, on the other hand, the dispute is whether treatment is reasonable and necessary, then the Utilization Review process is to be used. Whether treatment is related to a work injury is not a factor in a Utilization Review. A recent decision from the Commonwealth Court of Pennsylvania dealt with this distinction.

In Haslam v. Workers’ Compensation Appeal Board (London Grove Communication), the injured worker (“Claimant”), fell from a building. He suffered fractures to his right ankle, tibia, and fibula, a left calcaneus fracture, and injuries to his neck and low back. After some time, the indemnity aspect (wage loss part) of the work injury was settled by Compromise & Release Agreement. The settlement documents described the work injury as “R and L Foot Fracture.”

After the settlement, the workers’ compensation insurance company filed for Utilization Review against the treating doctor, seeking a ruling of whether ongoing medical treatments, including compound creams, were reasonable and necessary. The Utilization Review Determination found all treatment to be reasonable and necessary.

September 5, 2017

Appealing a PA Workers’ Compensation Decision; Reinstating Accepted Work Injury

by Glenn Neiman

Complicated fact patterns tend to make for complicated blog entries. A recent decision by the Commonwealth Court of Pennsylvania in McNeil v. Workers’ Compensation Appeal Board (Department of Corrections, SCI-Graterford) is one of these situations, but is valuable for the lessons contained within.

In that case the injured worker (“Claimant”) tripped and fell on January 26, 2011, injuring her low back and left shoulder. A Claim Petition was filed. In the interim, a Notice of Compensation Payable (NCP) was issued accepting first left ankle sprain and left shoulder sprain, then later amended to add low back sprain. Eventually, the Claim Petition was granted, so that the accepted work injury included, “left ankle sprain, acute cervical strain, acute back pain, musculoskeletal injury of the left shoulder, mild edema of the left ankle, left shoulder sprain, and tenderness of the Claimant’s left shoulder and upper and lower back.” There was no appeal of this decision.

After the decision was rendered in the Claim Petition, the workers’ compensation insurance carrier filed a Petition for Termination, alleging that Claimant had fully recovered from the work-related injuries. The Petition for Termination was based on a May 21, 2014 “Independent” Medical Examination (IME, though a more realistic term is Defense Medical Examination, or DME). Claimant filed Petitions for Review (to amend the description of injury) and Penalties (for the failure to pay for medical treatment related to the work injury); these Petitions were consolidated with the Petition for Termination.

Pennsylvania Workers’ Compensation Lawyer Blog