Cases dealing with benefits stopping in PA workers’ compensation, due an alleged “retirement” of the injured worker, are frequent on our blog. Usually, Pennsylvania Courts are reading the PA Workers’ Compensation Act ever more strictly. A recent case, however, gives hope to the injured worker in Pennsylvania.

In Keene v. Workers’ Compensation Appeal Board (Ogden Corp.), the Commonwealth Court of Pennsylvania reversed the Workers’ Compensation Appeal Board (WCAB), who in turn had reversed the Workers’ Compensation Judge (WCJ), when the WCJ denied a Petition for Suspension (for an alleged voluntary withdrawal from the labor market).

The WCJ found that the injured worker, who had hurt her knee at work in 1989, had not voluntarily withdrawn from the labor market, and denied the workers’ comp insurance carrier’s Petition for Suspension. The injured worker said she had looked for work for a long time and the failure to find any work had depressed her, so she stopped even looking. The WCAB reversed, finding that the injured worker failed to look for a job for a two-year period, showing that she had withdrawn from the labor market.

In Pennsylvania workers’ compensation matters, a workers’ comp insurance carrier can only get a “Termination” of benefits when the injured worker is “fully recovered” from his or her injury. This sounds like, and should be, a difficult standard for the insurance carrier to meet. Unfortunately, as happens too often in law, the appearance is deceiving.

Recently, the Commonwealth Court of Pennsylvania decided the matter of Schmidt v. Workers’ Compensation Appeal Board (IATSE Local 3). Mr. Schmidt suffered a herniated disc in his low back and a lumbar strain in an accident at work. For this injury, the injured worker had extensive surgery, which the Court related as:

L3-4 decompressive laminectomy, right-sided microdiscectomy, fusion utilizing autologous laminectomy bone and symphony augmented bone bank bone, pedicle screw fixation at L3 and L4 bilaterally utilizing the Expedium DePuy spine instrumentation system.”

We have already mentioned on a past blog entry that injured workers in Pennsylvania can collect PA workers’ compensation benefits and Social Security Disability benefits at the same time. However, a recent opinion from the United States Tax Court, reported on LawyersUSAOnline.com, reminds us that the receipt of the two benefit programs together can have unintended tax consequences.

Our firm only handles Pennsylvania workers’ compensation cases; we do not handle tax matters of any kind. Having said that, depending on the spouse’s earnings, if Social Security Disability benefits are being received, workers’ compensation benefits received by an injured worker in PA can be taxable, when ordinarily they would not be taxable. This issue was also addressed recently by the Social Security Administration in a POMS (essentially, a memo). Obviously, this situation changes depending on the circumstances in each case, and the advice of a tax professional should be obtained.

On many occasions over the years, we have addressed the Utilization Review (UR) process in Pennsylvania workers’ compensation cases. This is the process either party, usually the workers’ comp insurance carrier, uses to obtain a determination as to whether a treatment at issue is “reasonable and necessary” such that the insurance company must pay for the treatment.

What is sometimes lost in this abstract analysis is the impact a UR has on real live people. When a Request for Utilization Review is filed by a workers’ compensation insurer, the insurance carrier is immediately relieved of payment of bills for the treatment at issue, unless and until the treatment at issue is found to be “reasonable and necessary.”

Being in business for profit, or at least to make a living, not all providers are able, or willing, to continue to provide treatment once a UR is filed. One of the most dangerous areas this problem hits home is with medications.

While the Pennsylvania Workers’ Compensation Act generally precludes an injured worker in PA from suing his or her employer, the injured worker does have the ability to sue a third party, if that party is responsible for the injury. Since workers’ compensation in PA does not provide any payment for pain and suffering, the ability to file a civil action against a third party is a valuable option. Answers to this, and other questions regarding the PA workers’ comp system, can be found on the Brilliant & Neiman LLC website.

As can be seen from a recent article in the Legal Intelligencer, verdicts in cases involving work injuries can be significant. This again demonstrates the importance of having an experienced PA workers’ comp attorney, who knows what to be looking for in such a case.

As noted in a previous blog posting, Glenn C. Neiman, a partner at Brilliant & Neiman LLC, joined the prestigious faculty of Lawline.com in 2008. It was recently announced that his next seminar for Lawline.com will be on changing the description of injury in PA workers’ compensation, a topic which has been addressed here recently. The seminar, currently scheduled for late July, will be streamed live through Lawline.com, then made available to attorneys across the State of Pennsylvania, as well as throughout the United States.

Utilization Review is the proper course of action when either party in a PA workers’ compensation case questions whether medical treatment is reasonable and necessary. We have discussed this process in a previous blog entry.

Since the Pennsylvania Workers’ Compensation Act is remedial legislation, intended by its creators to provide the injured worker with the benefit of the doubt, what is considered “reasonable and necessary” does not have to cure a condition. As PA Courts have previously stated, “Treatment may still be reasonable and necessary ‘even when it is designed to manage the claimant’s symptoms rather than to cure or permanently improve the underlying condition.'”

A recent case, Gary v. Workers’ Compensation Appeal Board (Philadelphia School District), decided by the Commonwealth Court of Pennsylvania seems to certainly blur this line. In 2001, Ms. Gary injured her neck and back while working. Then, in 2003, a Utilization Review Determination found the treatment of a chiropractor to be reasonable and necessary.

The Allentown Workers’ Compensation Hearing Office has been located at 160 Hamilton Street, in Allentown, for several years now. We have just been advised by one of the Workers’ Compensation Judges (WCJ) at that office that the hearing location for Allentown will be moving shortly. The plan is for the move to take place in July, 2011. We are told the new location will be closer to the Allentown exit, off of the Pennsylvania Turnpike.

As we have discussed in previous blog entries, in PA, a workers’ compensation hearing is typically held in the County in which the injured worker resides. We will provide more information, including the new address, when we are advised by the PA Bureau of Workers’ Compensation.

Previously, we posted a blog entry on the Commonwealth Court of Pennsylvania decision in Phoenixville Hospital v. Workers’ Compensation Appeal Board (Shoap). This was the decision where the Commonwealth Court was unmoved when the injured worker applied for every job in a Labor Market Survey and found none available to him. The Court said the workers’ compensation insurance carrier can still obtain a Modification or Suspension of workers’ comp benefits in this situation.

Thankfully, the Supreme Court of Pennsylvania accepted appeal in this matter on April 27, 2011. We will certainly keep our readers informed when the Supreme Court of PA reaches a decision.

The issue of “retirement” and “voluntary withdrawal from the labor market” is one we see often in Pennsylvania workers’ compensation. We have had blog entries on how applying for Social Security Retirement benefits can impact the receipt of PA workers’ comp benefits, and how receipt of pension benefits can have such effect. In fact, I have given a seminar on this very topic in the past.

So, when the Commonwealth Court of Pennsylvania tackles this issue, we certainly take note. Recently, the Court rendered a decision in the matter of City of Pittsburgh v. Workers’ Compensation Appeal Board (Leonard). Here, the Workers’ Compensation Judge (WCJ) granted a suspension of benefits for a “voluntary withdrawal from the labor market,” but did so at a later date than the workers’ compensation insurance carrier wished, and reinstated benefits thereafter when the injured worker “re-entered the labor market.”

If you are a follower of our blog [and thanks for following us!], you can probably guess that this case turns on the facts. The injured worker here was a police officer who suffered a work injury to his forearm and knee. On April 1, 2006, Claimant received a disability pension, though an Independent Medical Examination (IME) [I chuckle every time I actually write “independent” in that context] found that he was able to work at a light to medium duty level.

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