Pennsylvania Workers’ Compensation Benefits for “Specific Loss” of Finger Require Medical Opinion Regarding Permanency
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’ compensation 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.
A treating physician had observed that the worker had “effectively lost function” of his finger “for all intents and purposes.” However, the insurance carrier doctor, who had performed an independent medical examination (IME) of the injured worker, opined that the injured worker did not need further therapy or surgery. The employer had submitted a report from this doctor that made clear that the injured worker did not suffer a total loss of his right hand. In fact, the doctor stated that the worker had limited but functional mobility of his index finger.
The judge heard all of the evidence and found that the injured worker and his medical evidence were more credible than that offered by the workers’ compensation insurance carrier. They awarded him specific loss benefits.
However, when the decision was appealed, the Workers’ Compensation Appeal Board reversed the decision awarding specific loss benefits for the injury to the worker’s right index finger. The Board found that while the worker’s physician had determined that the worker had lost the function of his index finger for all intents and purposes, the physician had not addressed the permanency of the loss. The worker, therefore, did not meet his burden of proof.
The Commonwealth Court then agreed with this decision, finding that the worker had not presented evidence that his injuries would be permanent. The Court stated that factual medical evidence, which can constitute substantial evidence, is different from legal conclusions. Here, the Court stated that the worker’s medical records and his physician’s report did not contain facts regarding the permanency of his injury. Instead, the worker was asking the court to assume the worst from the diagnoses and conclude that this meant the injury was permanent. The Court stated that they could not speculate and that it was the worker’s burden to provide information concerning the “future functionality” of his finger.
The skilled Pennsylvania workers’ compensation attorneys at Needle Law understand the legal requirements necessary to secure benefits and compensation for workers hurt in the course and scope of their employment. We help employees seeking benefits and provide a free consultation with a dedicated attorney. Call 570-344-1266 or reach us online to speak with an attorney in our office.