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Pennsylvania Commonwealth Court Decision Reviews Workers’ Compensation Independent Rating Evaluation

In Pennsylvania workers’ compensation cases, medical expert testimony and impairment rating evaluations guide whether or not an injured worker receives benefits, how much those benefits are, and whether or not a modification is appropriate. A recent Commonwealth Court decision, IA Construction Corp. v. Rhodes, demonstrates the need for aggressive representation when modifications are sought by the employer or insurance company. A defendant’s assertion may be flawed, but those flaws must be highlighted by counsel representing the injured person.

A construction worker had previously been granted his claim petition for various injuries, including traumatic brain injury, memory impairment, post traumatic headaches, impaired balance, and myofascial neck and back injuries. Three years after the award, the employer sought a modification based on an impairment rating evaluation performed by a medical doctor that asserted that the injured only had a 34 percent whole person impairment rating and had reached maximum medical improvement.

The Workers’ Compensation Judge who presided over the initial hearing for the modification rejected the doctor’s rating. The judge found that the doctor who performed the evaluation chose to ignore some of the originally accepted injuries and questioned the categories they were placed under in the American Medical Association (AMA) impairment rating guides. The judge also questioned the records that were reviewed and referred to in his report, with only one record reviewed in the prior year. The judge was also unpersuaded by the doctor’s credentials to review an injured worker with traumatic brain injury. The IRE doctor was a physical medicine and pain management physician, but he did not have much evidence to show that he regularly treated patients with traumatic brain injuries.

The Workers’ Compensation Appeal Board affirmed the judge’s opinion. In its review, the Commonwealth Court looked at the standards guiding the qualifications of the evaluator and found that the doctor was qualified under those set forth in the Workers’ Compensation Act. The Court pointed out that the judge is not allowed to impose greater standards on the evaluator than what is set forth in the statute. The Commonwealth Court pointed out that, while the judge has discretion in what testimony to accept or reject, the basis must be found within the record. The Court pointed out that there was not any cite of the AMA Guides or evidence provided by the claimant that would have directed her to her reasoning. In the absence of a rebuttal by the injured worker, there was not enough to overcome the otherwise qualified medical physician’s testimony.

A footnote in the decision revealed one dissenting board member’s opinion, which lined up with the Court’s ultimate conclusion. The board member did not necessarily disagree with the judge’s conclusion that the reviewing physician should have sent out part of the evaluation to a more qualified physician. However, the board member felt that the fact that the correct procedures were followed and the lack of rebuttal evidence did not override the ultimate assessment. This footnote and the Commonwealth Court’s opinion show that even a flawed evaluation can stand, as long as it passes enough of the requirements in the workers’ compensation review process.

This case reflects the need to have an attorney who can also push back against the defenses or motions to modify made by an insurance company. The Pennsylvania workers’ compensation attorneys at Needle Law, P.C. have the experience you need to aggressively pursue all the damages you deserve. If you or a family member has been injured on the job, call us for a free, confidential consultation at 570-344-1266.

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