Ordinarily, when an injured worker in Pennsylvania has his or her workers’ compensation benefits modified or suspended, such as by a return to work, having the benefits reinstated to total disability is not difficult provided that the loss of such work is not due to the fault of the injured worker, and the work-related disability continues.

The situation is much different, however, when the injured worker’s PA workers’ comp benefits are modified or suspended due to “bad faith conduct.” As explained by the Commonwealth Court of Pennsylvania in a recent case, Ward v. Workers’ Compensation Appeal Board (WCAB), decided on March 2, 2009, if the injured worker’s benefits were modified due to bad faith, then the injured worker has the burden to prove his or her medical condition worsened such that he or she is no longer capable of performing the job which had previously been found to be available.

The claimant in Ward was injured in 1992. In 1999, the PA workers’ comp insurance company was successful in litigating a Petition to Modify benefits. Specifically, the Workers’ Compensation Judge (WCJ) found that jobs were available to claimant, within his physical restrictions, but that he did not apply for the jobs. The WCJ ordered the total disability benefits modified to “partial disability benefits.”

As an attorney representing injured workers in Pennsylvania, I find “no work” jobs to be one of the nastier and more insulting actions an employer can take. Like they sound, “no work” jobs are positions offered to injured workers by their pre-injury employers, where the injured worker is to sit at a desk and literally do nothing. One of the favorite tricks of nasty employers is to offer such a job, wait for the employee to fall asleep, then fire the employee for sleeping on the job.

Though Courts in PA have held that “no work” jobs are “real” jobs, and have suspended workers’ comp benefits to injured workers who refuse such jobs without reason, a recent case shows the PA Courts do recognize limits to such actions. In Channellock, Inc. v. Workers’ Compensation Appeal Board (Reynolds), the Commonwealth Court of Pennsylvania held that a “no work” job was not within the injured worker’s physical capabilities.

The injured worker was taking medications which made him drowsy. A Workers’ Compensation Judge found both the injured worker, and his doctor, credible on this point. The injured worker tried the “no work” job and fell asleep. The worker was threatened with termination if this happened again. The Court found that proved that the job required that Claimant stay awake and that the credible evidence showed Claimant cannot stay awake due to his medication. As such, the job was not available to the injured worker and workers’ comp benefits were to continue.

The last major changes to the Pennsylvania Workers’ Compensation Act came in 1996. Among other things, workers’ comp insurance carriers were given a credit for some other benefits an injured worker might receive, such as unemployment compensation, severance benefits, Social Security Retirement benefits and pension benefits [Section 204(a) of the PA Workers’ Compensation Act]. These offsets were designed to avoid an injured worker receiving a “double” recovery.

As attorneys representing injured workers, we were disappointed when two cases were decided by the Commonwealth Court of PA, holding that these offsets were to be taken on the gross (before tax) amount of these benefits, rather than on the net amount. In fairness, if the injured worker is paying part of his benefits back for tax, he or she did not actually “receive” the entire benefit being offset. Indeed, then the injured worker in PA, in effect, is getting less in workers’ comp benefits than the amount the Pennsylvania legislature intended.

This issue was even more disturbing, and perplexing, when the Pennsylvania Bureau of Workers’ Compensation issued regulations, stating that the offsets under Section 204(a) should be on the net amount. These regulations were issued just before the first of the above-mentioned two cases, though neither case mentioned the regulations.

As mentioned in a previous blog post, Pennsylvania Courts have become increasingly strict with regard to cutting off PA workers’ compensation benefits to retired injured workers, even when the retirement is due to the work injury.

Those of us who represent injured workers’ in PA workers’ comp were surprised and excited when the Supreme Court of Pennsylvania issued a terse, one paragraph, Order in the case of Gray v. Workers’ Compensation Appeal Board (WCAB), reversing Commonwealth Court of PA, the WCAB and the Workers’ Compensation Judge (WCJ), and demanding that the claimant’s workers’ comp benefits be reinstated, “in light of the competent, uncontroverted evidence presented by Petitioner that her retirement from the work force was involuntary, and her increased, debilitating shoulder pain prevented her from continuing to work.” We can only hope that the very strict punishment for retired injured workers in PA is lessening. As always, we will keep you updated on developments in this area.

As a Claimant’s lawyer, practicing exclusively in PA workers’ comp, I was thrilled when the Supreme Court of Pennsylvania decided Lewis v. Workers’ Compensation Appeal Board (WCAB) in 2007. The Court in Lewis limited a PA workers’ comp insurance company’s ability to continually file petitions to terminate a claimant’s workers’ comp benefits. Specifically, the Court held that a workers’ compensation insurance carrier in PA had to prove there was an actual change in condition from the previous adjudication of disability (again, for this case to be important, the injured worker had to have previously defended a Termination Petition).

There was some concern, however, with how the Commonwealth Court of Pennsylvania would interpret the Lewis decision. As we posted in a previous blog entry, the Commonwealth Court initially did properly follow Lewis. Last month, the Commonwealth Court of Pennsylvania set claimant’s workers’ comp attorneys’ minds at ease, when they issued a decision in Delaware County v. Workers’ Compensation Appeal Board. Here, like in Lewis, the workers’ comp insurance company lost a Termination Petition, then filed another Termination Petition. Finding the workers’ compensation insurance carrier’s doctor credible when he testified the injured worker had fully recovered from the work-related injury, the Workers’ Compensation Judge (WCJ) granted the Termination Petition.

On appeal, the Commonwealth Court of PA, vacated the termination and remanded to the WCJ (sent the case back to the WCJ for additional findings). The Court found that the WCJ had granted the Termination Petition in error, because it was not enough to simply find the workers’ compensation insurance carrier’s doctor was credible when he testified that the injured worker had fully recovered from her work injury. Instead, the Court said the WCJ must first decide whether the workers’ comp insurance company proved that the claimant’s condition had changed from the time of the first Termination Petition to the time of the second. Only after that finding is made can the WCJ decide whether the workers’ compensation insurer proved the injured worker had fully recovered.

In an interesting study, posted on www.medscape.com, patients with lumbar disc herniations have been found to recover better than those patients who refuse surgery to concentrate on medications, exercise and physical therapy. An injured worker suffering a herniated disc in his or her back (or neck, for that matter) is a frequent condition we see in PA workers’ comp cases. Often, the injured worker is undecided regarding whether to have surgery performed. This study should be interesting, and enlightening, reading for those injured workers.

The study, known as the Spine Patient Outcomes Research Trial (SPORT), appeared in the December 1, 2008 issue of Spine. This trial reviewed 1244 patient cases, from 13 American spine clinics, over a period of four years. Each patient had at least a six-week history of a herniated disc in the lumbar spine, causing both back and leg pain. The patients either underwent a surgical procedure (standard open diskectomy), or a course of medications, home exercises and physical therapy.

After the four-year period, the patients who had the lumbar surgery were statistically happier, and better recovered, than those who did not. The surgical patients had better relief of pain (by about 15 points on a 100-point scale), greater physical functioning (also by about 15 points) and lesser disability (by about 13 points). Overall, 79.2% of the surgical patients, and 51.7% of the nonsurgical patients, reported major improvements in their condition. The benefits of surgery were seen as soon as six weeks after the surgical procedure, and were found to last through the four years of the study.

A recent article on www.emaxhealth.com noted that the U.S. Food & Drug Administration (FDA) has approved an extended-release version of the chronic pain medication, Ryzolt (sold under the name of “Tramadol”). Though Tramadol has previously been available, this simplified dosage is new. Unfortunately, chronic pain is something we see all too often in PA workers’ compensation cases.

This drug is used for managing moderate to moderately severe chronic pain. The extended-release form of the drug should allow patients to better control their pain over the course of the day. With both immediate-acting, and extended-release, parts, Tramadol hopes to provide better relief to chronic pain sufferers.

The article notes that chronic pain impacts approximately 75 million people in the United States, “more than diabetes, heart disease and cancer combined.”

It still amazes me when I see an injured worker represented by a general practice attorney. As you folks can see from the frequent postings on our blog, the law in Pennsylvania workers’ comp frequently changes. Lawyers who do not handle PA workers’ compensation cases on a regular basis can be at a severe disadvantage.

When you break your leg, you do not seek the medical opinion of a heart doctor. Instead, you want to be treated by a doctor who sees conditions like yours everyday. A doctor who remains informed about changes in areas of medicine as it concerns your condition. Do not treat your legal needs any less. Make sure when selecting a PA workers’ compensation attorney, the lawyer you pick has extensive Pennsylvania workers’ comp experience and practices frequently in this area.

A recent post on Workers’ Comp Insider, a blog devoted to workers’ compensation cost control, explores the problems being faced by FedEx and its workers. FedEx has managed to avoid having its workers join a union, by classifying them instead as “independent contractors” rather than “employees.” The blog entry points out that this arrangement may be on the way out, given the potential impact of a Democrat-controlled congress. Note was also made that State Courts have frequently found the FedEx drivers, who wear FedEx uniforms and drive FedEx trucks, to be “employees,” regardless of how they are described by FedEx.

This points out an important fact, one that may not be known by every injured worker – just because an employer terms its workers “independent contractors” does not make it so. In fact, for Pennsylvania workers’ compensation purposes, a Workers’ Compensation Judge (WCJ) will examine many elements of the relationship between the injured worker and the employer. How that relationship is described, and whether they are called “employee” or not, is only a minor factor.

The most important factor in determining whether an injured worker is truly an “employee” in PA is the degree of direction and control held by the employer. For example, is the employee told what to do and how to do it, or does the employee make these decisions on his or her own. Even if this control is not actually exercised by the employer, Pennsylvania Courts have found its mere existence proof enough.

Recently, two pharmaceutical companies, Genzyme Corporation and Osiris Therapeutics,

announced that they have joined to develop two adult stem cell treatments. These medications, known as Prochymal and Chondrogen, may be a valuable resource to treat a wide variety of conditions. Benefits from these treatments may include control of inflammation, development of tissue regeneration and prevention of scar formation.

Clinical trials for Prochymal are currently underway for Crohn’s disease, diabetes, chronic obstructive pulmonary disease (COPD) and acute myocardial infarction. Chondrogen, to interest of those injured workers suffering from persistent knee pain, is in clinical trials to treat osteoarthritis of the knee.

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