We are excited to report that Glenn C. Neiman, one of the partners at Brilliant & Neiman LLC, was approached by Lawline.com, a division of LAWLINE, with an invitation to join their esteemed faculty. LAWLINE is the longest running legal TV show in New York City. Lawline.com is a leading internet provider of continuing legal education and law-related programming for attorneys. The faculty of Lawline.com includes such notable lawyers as Benjamin Brafman, Gerry Shargel, Harvey Weitz, Herald Fahringer and Hal Lieberman.

“It is a great honor to even be invited to join a staff with lawyers as admired as these folks,” said Mr. Neiman, “It’s like a baseball player getting put in a group with Babe Ruth, Ted Williams and Stan Musial.”

As we have mentioned in previous posts, the Philadelphia Workers’ Compensation Hearing Office has been in the process of moving. We are pleased to now report that the new hearing office has opened on schedule. Hearings on workers’ compensation cases will no longer be held at the State Office Building, 1700 Spring Garden Street, Philadelphia, PA. Hearings now will be held in the new office, located at 110 North 8th Street, Philadelphia, PA 19107.

Generally speaking, an injured worker in PA can ask a Workers’ Compensation Judge (WCJ) to review an accepted description of a work injury “at any time” (within the statute of limitations, of course) to amend those conditions for which the workers’ compensation insurance carrier should be responsible. In other words, usually, an injured worker, under the Pennsylvania Workers’ Compensation Act, can try to add more injuries to an accepted workers’ compensation case.

However, a recent decision by the Commonwealth Court of Pennsylvania put a significant hurdle in the path of an injured worker. On November 25, 2008, the Court decided Weney v. Workers’ Compensation Appeal Board (Mac Sprinkler Systems, Inc.).

In this case, the workers’ comp insurance company accepted a “left shoulder strain.” The injured worker filed a Petition to Review, to add a tear of the anterior labrum with large glenohumeral joint effusion, tendonitis or a partial tear of the supraspinatus/infraspinatus, minimal impingement, and biceps tenosynovitis, all in the left shoulder. The workers’ compensation insurance carrier agreed, and the parties executed a stipulation, providing that the work injury now included this more descriptive injury.

Under the Pennsylvania Workers’ Compensation Act, physical injuries, like carpal tunnel syndrome, low back strain or a fractured arm, are treated differently than emotional/psychological injuries, like post-traumatic stress disorder (PTSD), depression or anxiety. To obtain workers’ comp benefits in PA for emotional/psychological injuries, the injury must result from an “abnormal working condition,” rather than a person’s subjective response to a normal working condition. What constitutes an “abnormal working condition” under Pennsylvania workers’ comp law varies depending on the job at issue and is the subject of many court decisions.

Recently, the courts in PA have been very demanding in what constitutes an “abnormal working condition.” For some professions, such as firemen, policemen and other emergency first responders, the courts have set the threshold extremely high, finding very little in those jobs could possibly be “abnormal.” Essentially, some jobs should expect the unexpected, the courts seem to say.

Typically, harassment or bad behavior by a boss will not reach the level of an “abnormal working condition.” In fact, one of my favorite quotes on this subject comes from a 1996 decision of the Supreme Court of Pennsylvania, “In assessing whether work conditions are abnormal, we must recognize that the work environment is a microcosm of society. It is not a shelter from rude behavior, obscene language, incivility, or stress.”

Though the case of Armstrong v. Workers’ Compensation Appeal Board was decided by the Commonwealth Court of Pennsylvania over a year ago, on August 27, 2007, this decision continues to both amaze and irritate those of us who limit our practice to representing the injured worker in PA workers’ comp cases.

Under Section 406.1 of the Pennsylvania Workers’ Compensation Act, the workers’ comp insurance carrier has 21 days to accept or deny a claim. Typically, and logically, acceptance of a claim is done by issuing a Notice of Compensation Payable (NCP) [or an Agreement for Compensation], and denial of a claim is done by issuing a Notice of Denial (NCD). Since this seems to make perfect sense, naturally, this is not necessarily how things work.

On a Notice of Denial, there are six boxes, or “bases of denial.” Essentially, the workers’ comp insurance company checks one or more of those boxes, indicating the reason or reasons for the denial. Box number four on an NCD states, “Although an injury took place, the employee is not disabled as a result of this injury within the meaning of the Pennsylvania Workers’ Compensation Act.” This is rather unnecessary, since there is also a “medical only” NCP, to be issued when the workers’ comp insurance carrier feels there is no disability from the work injury.

Under the Pennsylvania Workers’ Compensation Act, an injured worker must give notice of his or her injury within 120 days of the injury. If this notice is not given within 120 days, a claim petition for workers’ comp benefits is barred.

When an injury is not known to be related to work, this time period may be extended. This is known as a “discovery rule.” In that case, notice must be given within 120 days of when the injured worker knows he or she has suffered a work injury.

A recent decision by the Commonwealth Court of PA, The Bullen Companies v. Workers’ Compensation Appeal Board (Hausmann), explored this issue. In this case, the injured worker was employed at a chemical plant for 17 years. The worker started getting treatment for kidney ailments in 2002, but did not notify his employer of a work injury until 2004, which the employer said was more than 120 days after the “injury” was suffered.

As we explained in a recent blog entry, under the Pennsylvania Workers Compensation Act, Section 440(a) to be exact, reasonable attorney fees are to be paid by the PA workers’ compensation insurance carrier, unless the workers’ comp insurance carrier proves it had a reasonable basis to contest the claim. By design, this was to be the rule; the exception would be when attorney fees were charged to the injured worker.

Unfortunately, this is not how things work in practice. In Costa v. Workers’ Compensation Appeal Board (Carlisle Corp.), decided by the Commonwealth Court of Pennsylvania on October 14, 2008, the workers’ comp insurance carrier was found to have a reasonable basis to contest a claim when their own doctor agreed a work injury had taken place.

How could the Court accomplish such a feat, you ask? Well, the workers’ compensation insurance carrier’s doctor felt the injured worker had suffered a neck strain, while the injured worker’s doctor felt he had herniated a disc in the cervical spine (this would help explain why the injured worker had neck surgery after the work injury). Thus, the Court felt that because the parties’ medical experts disagreed what diagnoses were related to the work injury, the workers’ comp insurance carrier had a reasonable basis to contest the injury.

Under the Pennsylvania Workers’ Compensation Act, a workers’ comp insurance carrier has 21 days to accept or deny a claim. During that period, the workers’ comp insurance carrier is to investigate the claim. This both fair and clear.

The award of attorney fees under the PA Workers’ Compensation Act is supposed to be the rule. Only when the workers’ comp insurance carrier demonstrates that the they had a reasonable basis to deny the claim is an award of fees to be denied. This is how the law sets forth the process. Again, this seems both fair and clear.

Unfortunately, the reality is that unreasonable contest attorney fees are rarely ordered against the workers’ compensation insurance carrier. Even though the PA Workers’ Compensation Act, and the cases from PA Courts, show the workers’ comp insurance carrier must have a basis to deny a claim at the time the decision is made to deny the claim, Workers’ Compensation Judges (WCJs) rarely apply the law this way.

Claimants receiving, or attempting to receive, workers’ compensation benefits in PA are required to report receipt of various income. There are three what we call “verification forms,” which workers’ compensation insurance companies can send to these claimants. If these forms, which were approved by the Pennsylvania Bureau of Workers’ Compensation, are not completed by the claimants, and returned to the workers’ comp insurance carrier within 30 days, workers’ compensation benefits can be stopped.

On the other hand, I recently received a copy of a “Claim Status Report,” which was sent by the workers’ comp insurance carrier to my client. Some of the questions were similar to those on the forms approved by the Pennsylvania Bureau of Workers’ Compensation, but there were other questions which a claimant would have no obligation to answer.

This is just another instance of why every Claimant should have access to an experienced PA workers’ comp attorney. Any time something is received by a workers’ compensation claimant, there should be a discussion with the attorney. There are so many rights and responsibilities the injured worker should know, that it just makes sense to have someone to watch their back.

While ankle injuries are common in PA workers’ comp cases, we do not hear about total ankle replacements as much as we hear of total knee replacements or total hip replacements. Unfortunately, sometimes a work injury causes such damage to the ankle, or triggers the development of arthritis in the ankle, such that a total ankle replacement is necessary.

A recent article on the American Academy of Orthopaedic Surgeons’ website talked of improvements in total ankle replacements. At this point, in the United States, only four types of implants are available for total ankle replacements. Each of these devices consists of only two components. This means there will not be much mobility in the ankle. Of course, the alternative, of fusing the ankle in one position, offers no movement at all.

Outside the United States, total ankle replacements are being done with a device containing three components, allowing greater mobility. FDA approval is being recommended for such devices to be approved for use in the U.S. The article suggests approval for these devices could come as soon as later this year.

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