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Commonwealth Court of Pennsylvania Affirms Workers’ Compensation Appeals Board Decision to Modify Benefits

Pennsylvania provides laborers some assurance in challenging times through the Workers’ Compensation Act.  The Act provides benefits to injured workers when an injury occurs, regardless of whether it was caused by a co-worker’s or employer’s negligence.  Temporary benefits are often awarded until maximum medical improvement is reached.  Once the worker reaches a plateau in her or his recovery, a determination is made regarding an award of benefits for permanent partial disability.  This award can include loss of future earning capacity, medical payments, and vocational rehabilitation. 

In Simmons v. Workers’ Compensation Appeals Bd., the Commonwealth Court reviewed whether it was appropriate for the Appeals Board to modify benefits based on the injured person’s working capacity.  The worker sustained a totally disabling closed head injury while at work and was diagnosed with post-concussive syndrome. The worker’s symptoms included headaches, unsteadiness, memory problems, reduced activity, reduced social interaction, and depression.  Following the injury, the worker underwent several independent medical examinations.  Twice, the employer  sought to terminate the worker’s benefits, arguing that the injured worker’s condition had changed.  

The employer’s last petition to modify benefits was accompanied by a medical report of a neuropsychologist who examined the injured worker and reviewed the medical records and prior tests.  Upon his own examination, the doctor determined there was evidence of malingering, where the worker faked or exaggerated certain physical and mental skills throughout his examination.  The doctor pointed to massively different test results for the same test administered repeatedly in one session, and reasoned that the condition should produce consistent results within the same session.  Even though he acknowledged that prior tests were valid, he recommended the injured worker return to employment.  The employee was considered for positions within the employer’s labor mark survey, which included more sedentary or stationary positions like  call center representative, hotel front desk clerk, and restaurant dishwasher.  The only job excluded by one of the examining doctors was the position of security guard.  

The employee argued that he could not function at any of these jobs, whether part-time or full-time, due to his continued difficulties with memory, concentration, and headaches.  The Workers’ Compensation Judge (WCJ) adopted the argument and evidence provided by the employer at the second hearing to modify benefits, noting her own observed changes in the employer.  The WCJ reduced his weekly temporary total disability compensation to $20.41 a week based on his projected earning capacity of $320.00 a week.  

The Commonwealth Court reviewed case law and statutes that require the employer to demonstrate medical evidence that the employee’s physical condition has changed since the date of the last adjudication.  Any change in the claimant’s physical well-being that affects the ability to work is admissible.  The difference does not have to equate a full recovery, and it can include an improvement in symptoms to the point where the employee can gain meaningful employment.  The Commonwealth Court agreed that the employee’s symptoms improved enough to return to work, and it affirmed the WCJ’s reduction of benefits.

If you have been injured while working, or have a question about your workers’ compensation claim, call the experienced Pennsylvania workers’ compensation attorneys at Needle Law Firm at 570-344-1266 for a free, confidential consultation.

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