The fallout from the decision rendered by the Supreme Court of Pennsylvania in the Protz case is only just beginning.  Since this decision will change how workers’ compensation cases are handled in PA (at least for the moment), the PA Bureau of Workers’ Compensation has now issued a statement on the front page of its official website (WCAIS).  In its entirety, the statement reads:

On June 20, 2017, the Pennsylvania Supreme Court issued its decision in Protz v. WCAB (Derry Area School District), Nos 6 WAP 2016, 7 WAP 2017, holding that Section 306(a.2) of the Workers’ Compensation Act (77 P.S. § 511.2) is an unconstitutional delegation of legislative authority.  The Court’s opinion makes clear that the entirety of Section 306(a.2) is unconstitutional.  Therefore, effective immediately, the Bureau of Workers’ Compensation will no longer designate physicians to perform Impairment Rating Evaluations.”

As the Protz decision has rocked the PA workers’ compensation system, we will be closely following developments.  Check our blog often for updates!

We have written volumes about the Impairment Rating Evaluation (IRE) process.  It would now appear all of those words just became moot with the decision rendered by the Supreme Court of Pennsylvania, which ruled the entire IRE provision to be unconstitutional.

Back in September of 2015, we talked about the decision rendered by the Commonwealth Court of PA in Protz v. Workers’ Compensation Appeal Board (Derry Area School District).  In that decision, the Court found that the IRE provision within the Pennsylvania Workers’ Compensation Act (Act) was unconstitutional in that the impairment rating was to be determined by the latest version of the American Medical Association (AMA) Guide to Disability.  The Court believed this to be an impermissible delegation of power.  While this delegation of power was struck down by the Court, the case was remanded (sent back) to the Workers’ Compensation Judge (WCJ), to perform the IRE using the 4th edition (this was the edition which existed when the IRE provision was added to the Act).

The Supreme Court of Pennsylvania has now ruled that the Commonwealth Court was only correct in part.  Yes, said the highest court in the State, the delegation of power was indeed unconstitutional.  But, the Act does not contain any mention of using the 4th Edition of the AMA Guides.  A Court cannot rewrite a law.  Therefore, without a version of the AMA Guides to use, to measure an impairment rating, the entire IRE provision must be struck from the Act.

House Bill 18 has made it out of committee and is expected to be voted on early next week (Tuesday).  This bill would drastically change how injured workers in Pennsylvania would get their medications (and what medications they could get).  Basically, the Bill introduces “Evidence-Based Medicine” to PA workers’ compensation prescriptions.  This means that patients of a work injury would no longer be able to have care (or at least medicine usage) dictated by treating physicians; instead, the use of medications would be through established guidelines (amassing statistical data).  This, of course, ignores the simple fact that every patient is different and requires different care.  One cannot treat every person identically the same.

This could just be the first step in making “Evidence-Based Medicine” the care for every aspect of a work injury.  Imagine that your treating doctor is powerless to order care as he or she feels best, but is instead limited to what statistics say should be done for the majority of patients.  It is an absolute disgrace that Pennsylvania legislators think so little of injured workers to subject them to this kind of dangerous and substandard care.

Call your State legislators and tell them how you feel, before this Bill becomes reality!

As we have done in the past, our attorneys will be at the Pennsylvania Bureau of Workers’ Compensation Conference in Hershey, PA, on June 12th and 13th.  This is the one annual program run by the Bureau itself.  There is a large attendance by adjusters, risk management and safety officials, attorneys (from both sides of the fence) and Workers’ Compensation Judges from all across PA.

While we regret being out of town, and unable to serve our clients on these two days, we believe attending this seminar is beneficial to ultimately represent injured workers in Pennsylvania.  By listening to updates in case law and legislation, we stay current on trends and developments (as followers of our blog know, of course, we already stay pretty close anyway!).

Perhaps just as significant as the seminar, is hearing the topics being discussed by attorneys for the insurance carriers, and, even more so, the Workers’ Compensation Judges (WCJs).  It is invaluable to have some insight into how any particular situation, or any set of facts, will be viewed by our opponent, or by the WCJ.

On this blog we often discuss the beginning and ending of a workers’ compensation case in Pennsylvania.  This is a natural, and obvious, area of litigation.  However, there is also potential for dispute, and thus, litigation, when an injured worker goes back to work.  This is especially true where the injured worker remains under limitations, and there may or may not be partial disability benefits due.  Recently, the Commonwealth Court of Pennsylvania issued a decision is this area.

In Holy Redeemer Health System v. Workers’ Compensation Appeal Board (Lux), a nurse (Claimant) suffered a back injury in the nature of lumbar sprain, facet arthropathy, and radiculitis while bending to care for a patient.  She was disabled from her pre-injury position (as a telemetry nurse) by this injury.  Since her employer had modified-duty work available within that department, the Claimant continued to work (with restrictions) and suffered no loss in wages.  The workers’ compensation insurance carrier accepted the claim on a medical-only basis.

While the injured worker continued to perform the modified-duty work, at no loss in wages, her employer created a permanent, available position in a different department and offered it to Claimant.  The employer did not force or require Claimant to leave her original modified-duty position.  This new position actually led to Claimant earning less money than in her modified-duty job in the other department.

As attorneys representing the injured worker in Pennsylvania, there is a call we get far too often.  It starts with the injured worker telling us that they lost their case before the Workers’ Compensation Judge (WCJ) and need assistance in litigating an appeal before the Workers’ Compensation Appeal Board (WCAB).  Unfortunately, in the vast majority of these cases, we are simply unable to offer help to the injured worker.

The role of the WCJ in Pennsylvania workers’ compensation is something we have discussed on this blog in the past.  Essentially, the WCJ is the ultimate Finder of Fact.  When a credibility determination has to be made, it is the province of the WCJ to do so.  As long as there is support in the evidentiary record, and the WCJ explains his or her reasoning, these credibility determinations cannot be reversed or changed on appeal.  Even if the appellate body, whether the WCAB, the Commonwealth Court of Pennsylvania, or even the Pennsylvania Supreme Court, admits it would have concluded otherwise, it still cannot change the Findings of Fact or credibility determinations rendered by the WCJ.

So, you may be wondering, if an appellate court cannot change the Findings of Fact or determinations of credibility of a WCJ, what is required then on appeal?  Basically, a successful appeal requires that it be shown the WCJ made an error of law.  An appellant would have to show that there is no substantial basis to support the ultimate Conclusion of Law made by the WCJ.  In other words, accepting the facts as found by the WCJ, the appellant should still have won.  For better or worse (depending if you win before the WCJ), it is pretty rare to find a true “error of law” made by the WCJ.  This is why we can rarely help an injured worker with an appeal, when the injured worker does not contact us until he or she loses in front of the WCJ.

Since the Pennsylvania Workers’ Compensation Act covers “employees,” but not “independent contractors,” the relationship between these two terms is something we have previously discussed on our blog.  A recent case from the Commonwealth Court of Pennsylvania on this topic featured an added twist of a late answer.

In Hawbaker v. Workers’ Compensation Appeal Board (Kriner’s Quality Roofing Services and Uninsured Employer Guaranty Fund), the injured worker was employed as a roofer, when he fell.  The injury was denied by the workers’ compensation insurance carrier, who alleged the injured worker (the “Claimant”) was actually an independent contractor, and not entitled to benefits under the Pennsylvania Workers’ Compensation Act.

Claimant filed a Claim Petition, and the insurance carrier did not file a timely Answer.  Under the law, all factual allegations made by the Claimant are deemed admitted if there is no timely Answer denying the allegations (Known as a “Yellow Freight” situation, for the case which first addressed it).  Claimant included in the allegations that he was an employee of the employer.  After hearing the evidence, the Workers’ Compensation Judge (WCJ) found the Claimant to have been an independent contractor, and denied the Claim Petition.  This was affirmed on appeal to the Workers’ Compensation Appeal Board (WCAB).

When one thinks of an “injury,” typically one is imagining a sudden physical incident.  Maybe a roofer falls from a ladder.  A nurse pulls her back positioning a patient.  A machine operator catches a hand in a device.  While these are certainly injuries we see in PA workers’ compensation, not all work injuries are like these.  Some are physical, some are mental.  Also, some fall more into the category of “disease” than “injury.”  Yet, as a recent case from Commonwealth Court of Pennsylvania reminds us, all are compensable under the Pennsylvania Workers’ Compensation Act.

In Kimberly Clark Corporation  v. Workers’ Compensation Appeal Board (Bromley), the injured worker was an electrician in his employer’s plant.  He was diagnosed with metastatic bladder cancer in the Summer of 2005, and sadly passed away on June 23, 2006.  His widow (the “Claimant”) filed a Fatal Claim Petition.

In litigation before a Workers’ Compensation Judge (WCJ), Claimant presented the testimony of two coworkers of her late husband.  Both testified that the late husband had been exposed to various chemicals and substances which are known to cause cancer while doing the duties of his job.  The witnesses listed the names of many of the materials.  Claimant also presented the testimony of an oncologist, who explained that the bladder cancer developed due to the exposure to these carcinogens.

We have discussed the role of Utilization Review (UR) both on our website and on our blog.  This helps demonstrate how important this concept is in the Pennsylvania workers’ compensation system.  As the Bureau’s Workers’ Compensation Automation and Integration System (WCAIS) takes an increasingly bigger role in the practice of workers’ comp in PA, there are changes which must be made.  One of those deals with the UR process.

UR is, of course, the process to determine whether a given course of medical treatment is reasonable and necessary.  If treatment is found to not be reasonable and necessary by the Utilization Review Organization (URO), the workers’ comp insurance carrier is not liable for the payment of that treatment (nor, by the law, is the patient).  A determination by a URO can be appealed to a Workers’ Compensation Judge (WCJ).

Typically, a UR is initiated by the workers’ compensation insurance carrier, to try and avoid paying for a specified medical treatment.  Frequent targets in these URs are physical therapy, chiropractic treatment and medications.  However, there are often situations where we file a UR, prospectively (for some future treatment), so our client can more easily get a specific treatment, whether it be a diagnostic study (such as an MRI or EMG), surgical procedure, or unusual medication.

Representing injured workers in Pennsylvania, we see many severe injuries.  One condition which certainly belongs in this category is Reflex Sympathetic Dystrophy (RSD), otherwise known as Complex Regional Pain Syndrome (CRPS).  This debilitating condition has been discussed on our blog in the past.

Since a hallmark of RSD/CRPS is incapacitating pain, much of the challenge in treating patients with the condition is providing some level of relief.  A tool which may be coming to the arsenal of pain management physicians in the future is Neridronic Acid.  Clinical trials of this medication are promising enough to have led the U.S. Food and Drug Administration (FDA) to label Neridronic Acid with the Breakthrough Therapy designation, as noted by the U.S. National Institute of Health (NIH). These clinical trials appear to have shown a significant reduction in pain and symptoms of CRPS with the Neridronic Acid treatment, as reported by Pain News Network.

We will be keeping an eye on this, and other, avenues that the medical community pursues to care for injured workers with this serious condition.

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