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Reevaluating Pennsylvania Worker’s Compensation Disability Compensation

If a Pennsylvania worker has received total disability compensation under the workers’ compensation law for 104 weeks, the worker must submit to a medical examination (IRE) to determine how impaired he is based on his work-related injury. The degree of impairment must be based on a physician’s evaluation. The physician should be board-certified and active in his clinical practice for at least 20 hours per week.

In a recent opinion that was not reported, the Commonwealth Court of Massachusetts reviewed a Workers’ Compensation Appeal Board decision with regard to an injured employee of a high school. The case arose when Francis Allison (worker) had a slip and fall on the wet steps of the school while working. He experienced a cerebral concussion, and hurt his head, neck and back.

Seven years later, his employer petitioned a workers’ compensation judge, arguing that the benefits should have been modified because the claimant had reached maximum medical improvement from his work injury. The petition included deposition testimony from a physician board-certified in physical medicine and other disciplines.

The physician had evaluated the worker and reviewed his records. He testified that the results of the worker’s test results came back normal with no acute distress, normal vital signs, and a normal gait. He noted some residual symptoms and limited range of motion in the neck and spine. However, he was of the opinion that the worker had reached maximum medical improvement. He found the worker had an impairment rating of 8% of his whole body.

The worker denied the allegations of his employer’s petition. The workers’ compensation judge accepted the physician’s testimony as credible. However, the physician was not active in a clinical practice at least 20 hours per week, as required for an IRE (examination) under section 306(a.2)(1). Therefore, the judge found the employer hadn’t met its burden of proof. The employer appealed to the Board.

The Board reversed. It found that the IRE physician had testified he keeps an active clinical practice of 20 or more hours weekly. The physician had testified similarly on cross-examination. The worker petitioned the Commonwealth Court for review.

The worker argued on appeal that the judge’s finding was supported by substantial evidence. He found that the Board had usurped the judge’s role as fact-finder in determining that the physician kept a clinical practice for at least 20 hours weekly.

The Commonwealth Court explained that the phrase “active in clinical practice” refers to providing preventive care and evaluating medical conditions on a regular basis. The Board in this case hadn’t taken any extra evidence. Therefore, the judge’s determinations on credibility and evidentiary weight were conclusive.

In this case, the worker argued that the testimony didn’t show the physician maintained an active clinical practice for 20 hours a week as required, but rather that he averaged 20 hours a week overall. Therefore some weeks, the physician’s practice was less than the 20 hour a week minimum.

The Commonwealth Court found that the entirety of the IRE physician’s testimony showed he did satisfy the statutory requirements. He performed several IREs per month at the Bureau’s request. The Bureau had asked him to evaluate the worker in this case.

The IRE had signed a statement attesting to his maintaining an active clinical practice of at least 20 hours per week. He had offered his opinion to a reasonable degree of medical certainty that the worker reached maximum medical improvement. The employer had met its burden to show that the worker had an impairment rating of less than 50% of his body. The court affirmed the Board’s order modifying the worker’s disability status to partial.

If you are injured at work, an experienced Pennsylvania workers’ compensation attorney can evaluate the facts of your particular case if you are injured on somebody else’s property and bring a lawsuit on your behalf if appropriate. Contact the attorneys at Needle Law Firm at 570-344-1266 or via our online form for a free consultation.

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