Articles Posted in Workers’ Compensation

Supreme CourtThe Pennsylvania Supreme Court issued a landmark ruling this summer in the area of workers’ compensation. That ruling has effectively ended the process of forcing injured workers to undergo medical impairment evaluations whose results were governed by a set of American Medical Association guidelines that often produced poor results for workers seeking to qualify for total disability. This major change in the law is just one more example of why, when you’re facing a workers’ compensation issue, you need knowledgeable Pennsylvania workers’ compensation attorneys working on your side who are up-to-date on all of the aspects of the law.

The plaintiff in that Supreme Court case, Mary Ann, worked as a hall monitor for a western Pennsylvania school district. One day, she fell while working and suffered a knee injury as a result of her fall. At first, the employer voluntarily paid her temporary total disability payments. Some time thereafter, the school district had the employee undergo an “impairment-rating evaluation,” a common step in the process. The doctor who examined the monitor gave her an impairment rating of 10%. The doctor, in making that conclusion, relied upon the AMA Guides to the Evaluation of Permanent Impairment, as required by the law.

Since that rating number was below 50%, the school district sought to convert Mary Ann’s status to partially disabled, which would have capped the length of time when she would have received workers’ compensation payments.

According to Pennsylvania law, the “coming and going rule” maintains that workers who are commuting to and from their place of employment, and suffer injuries, are not entitled to compensation.  This rule has been maintained throughout the Commonwealth, but there are exceptions that may apply. If an exception does apply, an experienced Pennsylvania workers’ compensation attorney can petition for the court to in fact hold that the commute was “within the course of employment.” The injured worker would then be eligible for benefits under the law.

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Exceptions to the general rule that workers injured during their commute are not eligible for benefits were analyzed in a recent case.  The court there held that the claim for benefits should be denied, since the employee in that case was injured while dispatched to one of several potential work sites.  The court held that she did not have no fixed place of work, within the meaning of the exception for the “going and coming” rule.

In fact, the exceptions to the going and coming rule are:

Recently, the Occupational Safety Health Administration (OSHA) of the United States Department of Labor issued a news release indicating that the Administration had fined a Pennsylvania hospital $32,000 for exposing employees to workplace violence and other hazards. These findings were a result of the agency’s inspection, conducted over the course of more than one year. OSHA had received a complaint that made clear employees had been exposed to workplace violence and did not have clear access to restrooms.

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Under the General Duty Clause, OSHA cited the Psychiatric Hospital for violations. This clause indicates that every employer must provide a workplace free of recognized hazards that are likely to cause death or injuries. Additionally, the Clause requires that employers comply with occupational safety and health standards and rules, according to the OSH Act of 1970.

Specifically, the investigation of the psychiatric hospital by OSHA found that the hospital had a number of incidents in which violence had been committed by patients against employees. In some cases, the employees were bit, scratched, or punched, and in other situations, they were struck with objects, often leading to serious injuries. According to the citations, nurses and mental health technicians who provided inpatient care were exposed to serious physical injuries.

A “specific loss” benefit is available to workers who lose a body part, according to the Pennsylvania Workers’ Compensation Act, “for all practical intents and purposes.”  For injured workers, it can be challenging to prove a specific loss injury, which is a permanent injury.  It is considered a question of fact, to be determined by a workers’ compehandnsation judge, whether an injury has led to the permanent loss of the use of a member, including a hand.  Then, to determine whether the loss is permanent, for all intents and purposes, requires looking at the law and assessing medical evidence supporting such a loss.

A recent Pennsylvania workers’ compensation case dealt with this exact issue, when a worker had hurt his thumb, index, and middle fingers while he was using a table saw in the course and scope of his employment.  He sought benefits from his employer, including for the specific loss of his index fingers.

Supporting evidence in a workers’ compensation claim may include the worker’s own testimony, hospital records, and medical testimony.  In this specific case, the injured worker had provided his own testimony, as well as hospital records that showed he significantly injured his index fingers.  While the worker had retained his finger, it had received two pins that were eventually removed.  His finger was greatly damaged and had limited use.  The worker explained that he could not do “almost anything” with his right hand and that he could not perform construction work.

medical officeIn their list of Frequently Asked Questions, the Pennsylvania Department of Labor and Industry makes clear that whether an employee has a choice of health care provider depends upon whether their employer has accepted their claim and posted in the workplace a list of providers.  According to the Workers’ Compensation Act, Pennsylvania law requires that employers post a listing of health care providers that are not necessarily doctors, and the listing must meet certain requirements.  Provided the employer has met this requirement, treatment may be covered for the first 90 days.

A “proper” listing of health care providers, also deemed a “panel posting,” must have at least six providers. Of the total providers, at least three must be doctors, with their identifying name, address, contact info, and specialty stated.  Providers listed must be in the nearby vicinity, accessible to injured employees.  Additionally, the specifics regarding the list state that it must be prominently displayed, and the employer must have the worker’s signature that they were made aware of the list at the time they were hired or after their injury.

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Work-related injuries can cause financial distress for an employee and their family.  While workers’ compensation benefits are available, according to Pennsylvania law, they do not entirely replace the worker’s income. A Pennsylvania workers’ compensation attorney can make clear exactly how workers’ compensation benefits are structured and adjusted according to the employee’s wages.

travel

For those employees who suffer financial hardship following a work-related injury, additional expenses required to travel to medical appointments can prove extremely challenging.  State law concerning whether the employer’s workers’ compensation insurance carrier will reimburse travel costs to medical appointments has been greatly influenced by the Commonwealth Court decision of Helen Mining Co. v. WCAB, 616 A.2d 759.

This important case changed the law concerning whether travel expenses are reimbursed for injured workers receiving workers’ compensation.  Generally, the rule is that when necessary medical treatment is not available in the location near the injured worker, in many situations, medical expenses will be reimbursed.  According to this decision, there are factors to be considered in reimbursing travel fees, and there are exceptions that exist, entitling the claimant to travel expenses.

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Serious work-related injuries can affect an individual’s ability to return to their employment and greatly affect their quality of life.  While common, work injuries can be extremely serious and result in loss of limbs.  The Pennsylvania Workers’ Compensation Act is designed to provide protections and benefits to employees hurt at work in an accident or suffering from work-related conditions or illnesses. After suffering catastrophic harm, including disfigurement or the loss of a limb, these workers may be eligible for compensation.

wheelchair

OSHA, the Occupational Safety and Health Administration, revealed in a 2016 evaluation that in 2015, there were 2,644 work-related reported amputations.  While the construction industry accounted for a large percentage of these injuries, OSHA noted the surprising rise of reported amputations among workers in supermarket delis and restaurants. Specifically, these workers reported fingertip amputations due to severe hazards.  This surprising trend led OSHA to take steps to reduce future injuries. OSHA also noted that when employees promptly report their injuries, it provides the employer with an opportunity to address the known hazard and prevent future injuries.

Pennsylvania law helps workers who have suffered a permanent injury, such as an amputated limb.   Benefits provided under the Pennsylvania Workers’ Compensation Act provide for payments apportioned in accordance with the employee’s average weekly wage, termed “specific loss benefits.” Section 306(c) of the Act maintains a schedule that clearly indicates compensation for the permanent loss or the loss of use of certain limbs or functions of the body.

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Workers’ compensation judges make the ultimate determination on a witness’ credibility. When a decision has been appealed, Pennsylvania courts analyze whether there has been an error of law. A reviewing court cannot assess a determination of credibility. However, appellate courts in Pennsylvania may analyze whether there has been an error of law or whether the judge made  a “reasoned decision.”

justice

Courts have explained that it is difficult to determine what is a “reasoned decision” made by a workers’ compensation judge.  The Commonwealth Court of Pennsylvania had analyzed a decision by a WCJ and determined, in that particular case, that the judge had not provided a reasoned decision. There, the WCJ had found that the testimony of a treating physician was not convincing.  Instead, the WCJ found the expert witness provided by the workers’ compensation insurance carrier was more credible.  The WCJ had decided that the employee’s treatment for severe trauma, including thoracic, lumbar, and rib fractures, was not reasonable and necessary.  In this particular case, the reviewing court remanded back to the WCJ to explain his reasons for determining credibility. The court held that simply because an opinion was “not convincing” was not acceptable, in terms of providing enough information, for the Court to determine whether there was a sufficient basis for the finding.

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Pennsylvania workers’ compensation laws provide benefits to those who suffer injuries in the course and scope of employment.  Often, industrial accidents lead to physical injuries that are compensable.  The definition of “injury” is critical to an injured employee’s claim for benefits. Significantly, an “injury” under the Pennsylvania Workers’ Compensation Act may manifest in different ways.  Physical injuries are one form of harm, but the Act provides compensation for mental harm, as well as suffering due to a disease.

chemical exposure

According to Pennsylvania workers’ compensation laws, medical conditions stemming from diseases can be compensable when they are caused or aggravated at work.  After filing a workers’ compensation claim, injured employees may set forth testimony to support their argument that exposure to conditions at work caused the disease. In some cases, there need not be a more obvious proof of exposure. Witness testimony may be enough to support a petition for workers’ compensation benefits.

Recently, the Commonwealth Court of Pennsylvania held that the term “injury” includes “hurtful or damaging effect(s) which may be suffered by anyone.” In the case at hand, the issue was whether the widow of an employee who had allegedly been exposed to harmful chemicals at work could receive compensation following the death of her husband.  Her husband had worked as an electrician for his employer, at a plant, and had been diagnosed with metastatic bladder cancer, eventually passing away.

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Workers’ compensation provides benefits for employees injured in the course and scope of employment.  Employers that maintain workers’ compensation insurance are generally protected, or immune, from personal injury lawsuits filed by their employees.  In other words, in exchange for giving up their right to pursue a civil claim against their employer, employees are provided lost wages and accident-related medical costs through a no-fault system.

shattered windshield

As a no-fault system, the Pennsylvania Workers’ Compensation Act entitles employees to assistance in the form of compensation and benefits, regardless of who was at fault for causing the underlying accident and injuries.  There are numerous rules and requirements in order for a workers’ compensation claim to be accepted, including properly reporting the injury to the employer.  In many cases, initial claims are denied by the employer or their insurance carrier but can be appealed.

Third-Party Claims May Provide Another Form of Recovery

When a third party, rather than your employer, causes your workplace injury, you may pursue a claim against them for the damages.  For example, if a defective power drill at work caused your injuries, you may bring a claim against the manufacturer of the saw. Third-party claims are legal claims against non-employers who may be responsible for work-related injuries. There are various situations in which an employee may have an appropriate third-party claim against an individual or entity, including equipment malfunctions, car accidents, and errors by outside contractors.

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