What Does a PA Workers’ Comp Insurance Company Get When an Injured Worker is Released to His or Her Full-Duty Job? Not a Thing!
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.
The workers’ comp insurance carrier argued that the release to full duty work was equivalent to a full recovery, and that the WCJ made an error in not terminating the benefits of the injured worker. The Commonwealth Court of PA reinforced the concept that a termination of benefits requires a finding by the WCJ that there has been a full recovery from the work injury. Simply being released back to work, even unrestricted, is not remotely the same thing as being fully recovered.
Meanwhile, though not directly addressed in this case, an insurer also cannot obtain a suspension of benefits (the stoppage of wage loss checks) without proving to a WCJ that work is available. Again, the mere fact that an injured worker has been released to work is not enough.
These technical distinctions may seem small, but to an injured worker, who continues to have to deal with the lingering effects of a work injury, they can be the difference between being able to provide for a family and not.