Pennsylvania Workers’ Compensation Lawyer Blog

Who better than the injured worker to know the pain that person is feeling? At this point in medical science, we do not have a “pain meter.” Doctors can examine a person, and obtain diagnostic testing, such as x-ray, MRI and CT scan, but, ultimately, doctors can only tell us whether they can find an objective basis for a person’s pain. No doctor could credibly state whether a person has pain.

This becomes an issue in PA workers’ compensation cases. A Workers’ Compensation Judge (WCJ) must decide whether to believe an injured worker, when he or she testifies regarding the symptoms they suffer. At least, that is how a reasonable person could assume the system works.

In reality, in PA, according to a recent decision by the Commonwealth Court of Pennsylvania, the testimony of the injured worker, without matching testimony from a physician, cannot defeat a petition filed by the workers’ compensation insurance carrier to modify or suspend the injured claimant’s workers’ compensation benefits. In World Kitchen, Inc. v. WCAB (Workers’ Compensation Appeal Board), the Independent Medical Examiner (IME, otherwise known as Defense Medical Examiner (DME)), released the injured worker to full time work.

Injured workers in Pennsylvania are entitled to payment of wage loss benefits, as well as payment for medical treatment related to the work injury. The term “medical treatment” in PA is defined broadly. It includes obvious items, such as an MRI or x-ray, medications, doctor visits and surgery, but it also can include items you might not immediately consider, such as prosthetic devices and home modifications.

Regarding home modifications, Pennsylvania Courts have previously held that a workers’ comp insurance carrier only has to modify an injured worker’s home one time. While the workers’ compensation insurance company is required to replace medical equipment that wears out, such as wheelchairs, braces and orthotics, the law was unclear whether revisions to a home modification had to be paid for by the workers’ comp insurance carrier.

Recently, the Commonwealth Court of Pennsylvania decided the case of Equitable Resources v. WCAB (Workers’ Compensation Appeal Board). In that case, the injured worker was paralyzed in the work injury. The workers’ compensation insurance carrier paid for modifications to the home. Unfortunately, some time later, it was discovered the modifications were done poorly, and considerable expense was required to fix the mistakes made by the original contractor (who, by the way, was selected by the employer). The workers’ comp insurance carrier refused to pay for the subsequent repairs, believing they had paid for the initial home modification, and that was the extent of their responsibility.

As we discussed in a previous blog entry, the Supreme Court of Pennsylvania accepted review of the Cinram Manufacturing v. Workers’ Compensation Appeal Board (Hill) case. This case dealt with how one can change or amend a Notice of Compensation Payable (NCP) under the PA Workers’ Compensation Act. Yesterday, the Supreme Court issued a decision, affirming the decision of the Commonwealth Court of PA.

The Supreme Court decided that there are two types of changes one can make to a NCP: The change is either a “corrective amendment” (meaning the diagnosis or injury was one present when the work injury took place) or it is a “subsequently-arising” or “consequential” condition (something which happened after the date of injury, such as depression from chronic pain, Complex Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy (RSD), fibromyalgia, overuse syndrome, just for examples).

A Workers’ Compensation Judge (WCJ) can order a change to the NCP in the “corrective amendment” situation, regardless of what type of litigation is pending. However, if the situation is one involving a subsequent or consequential condition, then the claimant must file a Petition to Review. This distinction drawn by the PA Supreme Court represents a change from what was believed to be existing law (Specifically, the cases of Jeanes Hospital v. Workers’ Compensation Appeal Board (Hess) and Commercial Credit Claims v. Workers’ Compensation Appeal Board (Lancaster), both previously decided by the Supreme Court of PA).

Ordinarily, to suspend (or even modify) workers’ compensation benefits to an injured worker in PA, the workers’ compensation insurance carrier must show a change of medical condition and prove work is available within the injured worker’s physical capabilities [Benefits can be suspended for other reasons, but this is the most common].

There are exceptions to this rule, and one of those exceptions was the issue involved in Braz v. Workers’ Compensation Appeal Board (WCAB), decided recently by the Commonwealth Court of Pennsylvania.

Claimant decided to move to Portugal after his injury. Upon learning of this fact, the workers’ compensation insurance carrier filed a Petition to Suspend Compensation Benefits, since Claimant had “voluntarily removed himself from the labor market.” Because the workers’ comp insurance company presented no medical evidence, showing a change in medical condition, the Workers’ Compensation Judge (WCJ) denied the Petition. On appeal, the WCAB reversed the WCJ, and granted the Petition.

To obtain workers’ compensation benefits in PA, the worker must be injured while in the scope and course of his or her employment. Fortunately, PA law does not require that a worker be chained to his or her desk, or work area, the entire day. Pennsylvania law recognizes that “small temporary departures” from work do not remove an employee from being in the scope and course of his or her employment. The degree of latitude given also varies depending on whether one is a “stationary” as opposed to a “traveling” employee.

Recently, the Commonwealth Court of Pennsylvania decided Department of Labor & Industry v. Workers’ Compensation Appeal Board (Savani), finding a stationary employee not in the scope and course of her employment when she fell and suffered a fractured arm while off the employer’s property on a paid break. The Court found that being off the employer’s property for personal reasons, even though on a paid break, was not “a small temporary departure from work” or an “inconsequential or innocent departure from work.”

These types of cases vary greatly, depending on the facts in each situation. This is why it is important to have your case reviewed by an experienced PA workers’ comp attorney.

**Update – Decision of the Commonwealth Court of PA REVERSED by Supreme Court of Pennsylvania on July 20, 2011 – See blog entry of August 2, 2011**

When a worker gets hurt at work in PA, the Pennsylvania Workers’ Compensation Act requires that the employer be notified of the injury with 120 days. If the injury is one of repetitive, or cumulative, nature, such as carpal tunnel syndrome or hearing loss, the 120-day period does not begin until the date the condition, and its relation to work, is known (called “the discovery rule”). This notice does not need to contain the exact diagnosis of the work injury, but merely “a reasonably precise description of the injury.”

In Gentex Corp. v. Workers’ Compensation Appeal Board (Morack), decided by the Commonwealth Court of Pennsylvania on June 4, 2009, the Court addressed what “sufficient” notice of an injury must contain.