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When an employee in Pennsylvania gets injured, the PA Workers’ Compensation Act allots the workers’ compensation insurance carrier 21 days to investigate and accept or deny the claim.  If 21 days is not sufficient, the insurance carrier can opt to issue a Notice of Temporary Compensation Payable (NTCP or TNCP), and continue the investigation for up to 90 days more.  If the TNCP is not properly revoked within those 90 days, according to the Act, the TNCP becomes a regular Notice of Compensation Payable (NCP), and the injury can no longer be denied.  Simple, right?

Not so fast.  When a TNCP has been issued (for both wage loss and medical benefits), an insurance carrier can simply file a Medical-Only NCP, accepting liability solely for the medical aspect of the case (thus, denying liability for wage loss), without ever revoking that TNCP or issuing a Notice of Denial (NCD) for wage loss.  While this seems contrary to the words, if not the spirit, of the Act, the Commonwealth Court of Pennsylvania says this is perfectly fine.

This happened recently in an unreported case, Moretti v. County of Bucks (Workers’ Compensation Appeal Board), though prior reported decisions of the Commonwealth Court, supporting such a situation, were cited by the Court.

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On May 6, 2023, the Eastern PA-Delaware Region of The Leukemia & Lymphoma Society held “Big Climb Philly” at Lincoln Financial Field. The event has raised over $500,000.00 for this important cause. We at Brilliant & Neiman LLC are proud to have one of our attorneys, Glenn Neiman, participate in the event with the team from Angeion Group (a major class action administration firm in Philadelphia). We know that being a good corporate citizen means getting involved with worthy causes. As such, we are proud to support the noble efforts of LLS to help find cures and treatment options for this devastating disease. To learn more about The Leukemia & Lymphoma Society, or make a donation, you can visit LLS.org.

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An injured worker in PA is entitled to certain benefits under the Pennsylvania Workers’ Compensation Act.  We discuss these benefits in great detail here, on our website.  Basically, these benefits include wage loss (called “indemnity”), medical, “specific loss” and fatal claim benefits.  Given some pending legislation, we will be discussing the “specific loss” benefits today.

“Specific Loss” benefits encompass any type of benefit other than wage loss, medical or fatal claim.  It includes loss of use of a body part and scarring, as was addressed in a previous blog post.   Under the Pennsylvania Workers’ Compensation Act, only scarring of the head, face or neck is compensable.  A Workers’ Compensation Judge (WCJ) can award from zero to 275 weeks for the scarring, depending on the level of disfigurement.  And, this payment is to be made only after the injured worker is no longer receiving total or partial disability benefits.

But, House Bill 930 would change all of that, if it were to become law.  First, scarring would be compensable anywhere on the body, not just the head, face or neck.  Which, of course, is logical, since most areas of the body can be seen by others and potentially cause embarrassment if there was some level of disfigurement.  Second, the WCJ would be able to award up to 400 weeks, since significant disfigurement should entitle the victim to significant compensation.  Lastly, House Bill 930 would allow the scarring award to be paid while the injured worker remains on total or partial disability.  Which, again, makes sense, since the scarring does not wait to appear.

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On June 1, 2023 and June 2, 2023, the Pennsylvania Bureau of Workers’ Compensation will hold its 22nd annual “Workers’ Compensation Conference.” Here, attorneys, Workers’ Compensation Judges (WCJs), employer representatives, adjusters, risk management/safety employees and others who work in the world of workers’ comp from across the entire State of PA, gather to discuss and learn changes and trends of which they should be aware.

Our attorneys attend this conference nearly every year, and will do so again this year. While we, as attorneys who represent injured workers, are in the vast minority (most of the attorneys who attend this conference are seeking work from the workers’ compensation insurance company representatives in attendance), we feel it is critical to the representation we provide.

By being in the room while the insurance industry representatives are told about the state of the workers’ comp laws, we are getting a peek into their thought processes. This helps us understand and anticipate steps and strategies the workers’ compensation insurance carriers may take. We are also able to have informal conversations with WCJs and defense attorneys, building relationships that may improve communication in future dealings. Not to mention, we are also learning, attending the seminars on such topics as return to work, payment of medical bills, employee mental health (especially post-injury), medical advancements and negotiation strategies.

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What if an injured worker in Pennsylvanian is employed by a company who (in direct violation of PA law) fails to carry workers’ compensation insurance?  Back in the old days, the injured worker, through no fault of his or her own, would be stuck with whatever assets the employer had.  However, in recognizing the pure unfairness of such a situation, several years ago, the Pennsylvania legislature created the Uninsured Employers’ Guaranty Fund (UEGF), essentially functioning as an insurer for the uninsured employers.

While the UEGF is wonderful in theory, it is less so in practice.  Funding for the UEGF comes from other insurance carriers, and it is seemingly consistently underfunded.  The law holds that the UEGF is NOT an insurance carrier, so it cannot be penalized for violations of the Pennsylvania Workers’ Compensation Act (Act), including the failure to pay an award as ordered by a Workers’ Compensation Judge (WCJ).  This makes collecting an award from the UEGF a delicate and diplomatic process.

In the past several years, to protect the limited funds of the UEGF, the PA legislature has tightened the requirements to obtain an award against the UEGF, and made such litigation much more difficult.  Timeframes have been drastically shortened and requirements of proof have been significantly increased.

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Over the past several years, PA has legalized the use of medical marijuana.  Given the current difficulties in dealing with the opioid epidemic, this would seem to be a reasonable tool to help injured workers (and anyone else suffering from chronic pain) deal with their conditions without the use of narcotic medications.  The controversial status of marijuana, and both PA and Federal law, however, gave us great uncertainty as to whether use of medical marijuana would be covered under the Pennsylvania Workers’ Compensation Act.  Two recent decisions by the Commonwealth Court of Pennsylvania answer this question quite clearly in the affirmative.

Notably, the Medical Marijuana Act [MMA] specifically states that “Nothing in [the MMA] shall be construed to require an insurer or a health plan, whether paid for by Commonwealth funds or private funds, to provide coverage for medical marijuana.”  Additionally, marijuana remains illegal under Federal law.  These two factors have made payment for medical marijuana under the PA Workers’ Compensation Act (Act) nearly impossible.  Until now.

The two companion cases on this issue of first impression are Appel v. GWC Warranty Corporation (Workers’ Compensation Appeal Board) and Teresa L. Fegley, as Executrix of the Estate of Paul Sheetz v. Firestone Tire & Rubber (Workers’ Compensation Appeal Board).  Both of these injured workers suffered from severe pain, one from multiple back surgeries and the other from several conditions, including “herniated disc at L5-S1, cervical sprain, disc herniation at L4-L5, lumbar radiculopathy, cervical strain with cervical myofascial spasm, major depression, and aggravation of cervical degenerative spondylosis of degenerative disc disease.”

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If you are a football fan, you may have been following the story about Von Miller, star linebacker for the Buffalo Bills.  The story is also of interest, however, to injured workers, including those in PA.  (Parenthetically, we should note that Miller is, in fact, an injured worker, though the Pennsylvania Workers’ Compensation Act has special provisions for professional athletes – that said, the point of this article is that the care given to Miller is not the care received by the typical injured worker in PA).

On November 24, 2022, Miller injured his knee in a game against the Detroit Lions.  Being a star NFL player, Miller had access to the best medical tools possible, and was not required to have any kind of delay.  An MRI done the day after the injury showed the Anterior Cruciate Ligament (ACL) remained intact.  This meant the injury was not as severe as the team and player initially feared.

But, then an interesting thing happened.  Miller underwent exploratory surgery on the knee earlier this week.  A tear of the ACL was discovered, and repaired, during the procedure.  A tear that was not seen on the MRI.  Rather than missing a couple of weeks, suddenly Miller’s season was over.

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The Pennsylvania Bureau of Workers’ Compensation has announced that the Statewide Average Weekly Wage (SAWW), for the fiscal year ending June 30, 2022, is $1,273.00.  Under the PA Workers’ Compensation Act, this means the maximum compensation rate for work injuries sustained on or after January 2, 2023, will be $1,273.00.  This represents a 5.7% increase over the maximum compensation rate for 2022.

 

 

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Under the Pennsylvania Workers’ Compensation Act, once an injured worker establishes that he or she has suffered a work-related injury, benefits continue until something happens.  That “something” may be the injured worker returning to gainful employment, a doctor finding the injured worker fully recovered, or another change in situation.  But, a doctor could not possibly find the injured worker fully recovered before the date a workers’ compensation insurance carrier accepts a claim, right?  According to the Commonwealth Court of PA, that suspicion would be wrong.

In Danielle Wolfe v. Martellas Pharmacy (Workers’ Compensation Appeal Board), the injured worker was employed as a cashier, when on June 10, 2017, a metal gate came down on top of her head.  The workers’ comp insurance company issued a Notice of Temporary Compensation Payable (NTCP, also referred to as TNCP)) on June 28, 2017, accepting a “skull contusion.”  Rather than revoking the NTCP, the insurance carrier issued a Medical-Only Notice of Compensation Payable (MO-NCP) on September 8, 2017.  This stopped wage loss benefits (the Court also dealt with whether the insurer can dispense with the statutorily-required Notice Stopping Temporary Compensation (NSTC), finding that they can).

On August 10, 2017, the injured worker underwent a Defense Medical Examination (DME; humorously referred to by the Court as an Independent Medical Examination (IME) – nothing “independent” about these).  When the DME physician opined that the injured worker had fully recovered, the insurance company filed a Petition for Termination.

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One of the pitfalls in the Pennsylvania workers’ compensation system is the concept of “withdrawal from the labor market.” Without intending to do anything but receive additional income, an injured worker in PA can easily cause his or her workers’ compensation benefits to stop accidentally. This is one of the many reasons we urge every injured worker to have the representation of an attorney Certified as a Specialist in Workers’ Compensation law (as are both of the attorneys at Brilliant & Neiman LLC).

A recent decision from the Commonwealth Court of Pennsylvania, Hi-Tech Flooring, Inc. v. Workers’ Compensation Appeal Board (Santucci), reminds us of the perils of an alleged “withdrawal from the labor market.” Here, the injured worker suffered what was initially accepted as a “right knee contusion.” Later litigation expanded the injury to a more accurate injury description of “ongoing progressive degenerative changes of the right knee as a result of the August 18, 2014 work incident.”

A few years after the injury, seeking to have additional income, the injured worker filed for pension benefits from his union and filed for Social Security Disability (SSD) benefits. Each application was accepted. The decision approving the SSD application noted that Claimant had the following ailments or conditions, “lumbar and cervical disc disease, status post C5-6 cervical discectomy and fusion; bilateral knee degenerative osteoarthritis, status post bilateral arthroscopic procedures; right hip degenerative joint disease; and status post total hip replacement.” According to the Court, the determination granting the SSD benefits did also mention “resulting synovitis in Claimant’s right knee and ongoing right knee pain.”

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