Worker Comp Generally

December 17, 2012

Utilization Review Reform Apparently on the Radar of PA Legislation

Back in July, we warned about potential legislation which is being pushed by the Pennsylvania Chamber of Commerce, and PA insurance carriers, to reform the Pennsylvania Workers’ Compensation System. We discussed several areas which we anticipate will be targeted. Proposed legislation is likely to appear in early 2013.

One area we did not mention seems to be getting more traction. That is the process of Utilization Review (UR), the tool either party can use to have a determination made as to whether the medical treatment at issue is reasonable and necessary. As the process now stands, on appeal from an initial UR, a Workers’ Compensation Judge (WCJ) considers the UR determination made by the Utilization Review Organization (URO). The WCJ is not bound by the determination made by the URO. This makes sense, since other evidence is required to determine whether treatment is reasonable or necessary, predominantly the testimony of the injured worker.

The proposal being raised by the insurance industry and the Chamber of Commerce appears to be that the WCJ would be bound by the determination of the URO, effectively making the UR reviewer the ultimate finder of fact, a role the PA Workers’ Compensation Act strictly leaves to the WCJ. Moreover, since the UR reviewer only assesses records, and never actually examines the injured worker personally, the injured worker would effectively be removed from the entire evaluation. This result would be ludicrous, given that whether the treatment relieves symptoms or provides greater function to the injured worker is, and should be, a critical element to determine whether medical treatment is truly reasonable and necessary.

December 14, 2012

PA Workers’ Compensation Seminar

by Brilliant & Neiman

As mentioned here previously, Glenn C. Neiman, Partner at Brilliant & Neiman LLC, was featured in a seminar yesterday in Center City Philadelphia. The seminar was presented by renowned CLE provider Lawline. While Lawline typically specializes in internet CLE programs, this presentation was live (as well as webcast). The program, discussing updates in PA workers’ comp law as well as trends in Pennsylvania workers’ compensation, was done with Lawline’s program attorney, Kyle Robinson, in an interview format. The program will shortly be added to Lawline’s online course catalog, where attorneys from around the Country will have access.

November 22, 2012

Glenn Neiman Slated to Speak at Lawline.com Seminar in Philadelphia

by Brilliant & Neiman

Lawline.com has announced its speakers for the seminar the organization will be holding in Philadelphia on December 13, 2012. Discussing current trends in Pennsylvania workers’ compensation, and providing an update on decisions from PA Courts on such issues, will be Brilliant & Neiman LLC partner, Glenn Neiman. This will be the third speaking engagement for Mr. Neiman with Lawline.com, a well-respected continuing legal education provider. As was done in the previous seminar, Lawline.com’s program attorney, Kyle Robinson, will do an interview-style presentation with Mr. Neiman. The prior effort, from July 2011, was extremely well-received, garnering a 97% recommendation from seminar participants

November 21, 2012

Injured Workers Under Watch on Black Friday?

by Glenn Neiman

The holiday season means many things to many people. To most of us, it means creating lasting memories with friends and family. It means the joys of exchanging gifts and good will. And, of course, it means eating too much of the wonderful food which surrounds us during the holiday season.

To others, it means a chance to trap an unsuspecting injured worker. One investigative firm sent out an e-mail to its potential customers, noting that “Black Friday is the weekend to hire a P.I. for surveillance.” We all tend to overdo things during the holiday season, whether it is shopping or eating. Often, we pay the price for either the next day.

Unfortunately, however, a surveillance tape only shows that day. A Workers’ Compensation Judge (WCJ) will not see the injured worker in bed for the next three days because he or she was trying to live a somewhat normal life for a day. Many in the insurance industry feel that if a worker is disabled, he or she must be bed-ridden. They fail to realize the toll a work injury takes, not only on the injured worker, but on his or her entire family.

November 19, 2012

Federal Workers’ Comp System Differs from State Systems

by Glenn Neiman

While most employees in PA are covered by the Pennsylvania Workers’ Compensation Act, there are some who are not. One group of employees not covered under Pennsylvania’s system are workers employed by the United States Government. Federal employees are instead covered by the Federal Employees’ Compensation Act (FECA), administered by the Office of Workers’ Compensation Programs (OWCP).

As the PA Workers’ Compensation Act differs from the laws in other States, the Federal Workers’ Comp system is a completely different set of laws. There are major differences in the type and amount of benefits available, as well as in the procedures necessary to obtain such benefits.

November 8, 2012

PA Workers’ Comp – Panel Physician v. DME

by Glenn Neiman

We were recently asked by an injured PA worker, and not for the first time, “Why is my employer making me see another doctor if I am already being treated by the doctor my employer sent me to?” The answer to the question requires that we look at two different parts of the Pennsylvania Workers’ Compensation Act (Act). Essentially, we are looking at the difference between a “panel physician” and an “Independent Medical Examination (IME)” [More realistically termed a “Defense Medical Examination (DME)” since there is often nothing “objective” about it].

Under the Act, an employer may only be responsible for payment to a medical provider on a “panel posting,” for the first 90 days of treatment, provided the panel posting meets the requirements as contained within the Act. Though there is a widely held belief that an employer controls medical treatment for the first 90 days, this is a vast overstatement, and employers frequently have an improper panel (meaning that the injured worker may be able to treat with any provider, and have the employer pay for such treatment, from the start).

A proper panel posting must contain at least six providers, at least three of which are physicians (the remainder could be therapy facilities or other healthcare providers who are not doctors). No more than four of the six on the posting may be from the same “coordinated care organization” (one could simply say “practice”). This posting must be displayed in a prominent location. The employer must have the injured worker sign an acknowledgement, both at the time of hire and as soon as practical after the injury, that the injured worker is aware of the panel posting. All of these requirements can be found in Section 306(f.1)(1)(i) of the Act. Frankly, very few employers actually achieve all of these requirements (yet, sadly, injured workers are unfairly saddled with treatment at a location chosen by their employer because the injured worker is not aware of his or her rights).

October 12, 2012

PA Workers Compensation Judges on the Move Again

by Glenn Neiman

It has certainly been a busy time for Workers’ Compensation Judges (WCJs) in Pennsylvania. We just recently discussed filling the vacancy in the Allentown Workers’ Compensation Hearing Office, and now we have learned of three additional WCJs on the move.

Leaving the bench will be The Honorable Nancy Goodwin, who had been stationed in the Philadelphia Workers’ Compensation Hearing Office, and The Honorable Thomas Hines, from the Malvern (Montgomery County) Workers’ Compensation Hearing Office. We have further learned, all of this unofficially, that The Honorable Kelly Melcher will be moving from the Reading Workers’ Compensation Hearing Office to the Malvern office to replace Judge Hines. We have not heard any information regarding a replacement for Judge Goodwin.

We wish Judge Goodwin and Judge Hines well in their retirements, and we thank them for their years of dedicated service to the PA workers’ comp community. We also congratulate Judge Melcher on the move, and wish her well in Malvern.

September 27, 2012

Workers’ Compensation Judge Named for Allentown Workers’ Comp Hearing Office

by Glenn Neiman

Several months ago, we reported that four PA Workers’ Compensation Judges (WCJs) had stepped down from the bench, while only two new WCJs had been named by the Pennsylvania Bureau of Workers’ Compensation. This left a difficult void in some hearing offices, such as that in Allentown.

We are now pleased to report that a new WCJ has been named to the bench in Allentown. She is The Honorable Cathleen A. Sabatino, who most recently was practicing as a Senior Associate at the law firm of Del Collo & Mazzanti LLP in Paoli, PA. Since graduating from Villanova University School of Law, Ms. Sabatino has been active in the Workers’ Compensation section of the Philadelphia Bar Association where she has served as chair of the section’s annual charity auction. In her community, Ms. Sabatino volunteers as an adult mentor with Spring-Ford Community Theatre’s Youth Ensemble (She holds a B.A. in Theatre from DeSales University).

It is with warm thoughts that we greet The Honorable Cathleen A. Sabatino, and we wish her well in her new career as a WCJ in Allentown.

September 24, 2012

PA Bureau of Workers’ Compensation Unveiling New Electronic Process

by Glenn Neiman

For some time now, the Pennsylvania Bureau of Workers’ Compensation has been working on a new electronic system to make interacting with a Workers’ Compensation Judge (WCJ) and the Workers’ Compensation Appeal Board (WCAB) a more efficient and accessible process. The Bureau is unveiling the process, known as the Workers’ Compensation Automation and Integration System (WCAIS), in two stages.

The first stage, which went “live” on September 17, 2012, deals just with the WCAB. As the Bureau stated, with this release:

“Parties will be able to file appeals, petitions and documents online with the WCAB and to upload documents, and search, view and obtain information on the status of appeals in WCAIS.”

August 13, 2012

PA Workers Comp Medical Treatment Bills and Fee Review

by Glenn Neiman

As attorneys who represent injured workers in PA, we are often told by our clients that their doctor or physical therapist is not being paid by the workers’ compensation insurance carrier. Moreover, the client is receiving bills from the provider, maybe even notices from a collection agency. This is a sticky area, since the rules are in place, but not easily enforceable.

The Pennsylvania Workers’ Compensation Act is very specific on this topic. Right in the Act, Section 306 (f.1)(7), it says:

“A provider shall not hold an employe liable for costs related to care or service rendered in connection with a compensable injury under this act. A provider shall not bill or otherwise attempt to recover from the employe the difference between the provider’s charge and the amount paid by the employer or the insurer.”