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To answer an often asked question, in Pennsylvania, there is no limit to how long an injured worker can receive total disability workers’ compensation benefits. However, as a practical matter, it is difficult to receive total disability benefits in PA for more than two years. After an injured worker in Pennsylvania has received total disability benefits for 104 weeks, the workers’ compensation insurance company can request the injured worker attend an Impairment Rating Evaluation (IRE).

An IRE is somewhat different than an Independent Medical Examination (IME), as the doctor who performs an IRE is selected by the Pennsylvania Bureau of Workers’ Compensation (the workers’ compensation insurance carrier selects the doctor in an IME). The doctor who performs the IRE will examine the injured worker and review records. Subsequently, the doctor will decide what percentage the injured worker is impaired from the work injury. This percentage is determined by guidelines developed by the American Medical Association.

If the injured worker is found to be less than 50% impaired by the work injury, the workers’ compensation insurance carrier may be able to have the status of the disability changed from “total” to “partial.” While this change does not effect the amount of workers’ compensation benefits the injured worker receives, it does put a time limit on how long the benefits can be received. An injured worker in PA can only receive partial disability benefits for a maximum of 500 weeks.

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One of the more commonly misunderstood aspects in the Pennsylvania Workers’ Compensation Act is the status of medical treatment within the first 90 days of the injury. Too often, an injured worker will be told by his or her employer that they must treat with a specific company doctor. This is not completely true, according to the Pennsylvania Bureau of Workers’ Compensation.

If the employer follows the requirements of the Pennsylvania Workers’ Compensation Act, and properly posts a listing of healthcare providers (not necessarily doctors, more on that later), the employer is only required to pay for treatment with those listed healthcare providers for the first 90 days of treatment after a work injury.

To have the listing of healthcare providers (known as a “panel posting”) be “proper,” the list must meet certain requirements. For one thing, there must be at least six healthcare providers on the list, of which at least three must be doctors. The names, addresses, telephone numbers and specialties of each healthcare provider must be stated as well. The healthcare providers on the list must be “geographically accessible.” The list must be prominently displayed, and the employer must have the worker sign a document acknowledging that the worker saw the list at the time the worker is hired, after a change is made on the list, and after the injury.

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Though the reasons for the dramatic increase are not clear, it appears total knee replacements and total hip replacements are much more frequent now than in the past. According to an article on the American Medical Association website, total knee replacements increased 63% from just 1997 to 2004. Over that some period, total hip replacements were up 48%.

One of the potential reasons for the striking increase is the trend of the population to generally be both older and heavier, putting greater strain on these joints. Better technology in performing the total joint replacements has also been said to have increased the frequency with which the procedures are recommended by doctors.

From the perspective of patients, the total knee replacement or total hip replacement may appear to be a safer long-term way to treat their chronic pain than continued use of medications. This is especially true given the controversy, and apparent side effects, of the class of medications including Vioxx, Bextra and Celebrex, known as Cox-2 Inhibitors. An increase in the amount of advertising by the manufacturers of the artificial joints may also make patients more interested in having the total joint replacements done

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Glenn C. Neiman, one of the partners at Brilliant & Neiman LLC enjoys educating people, including other attorneys who do not limit their practice to workers’ compensation, about the complicated world of workers’ compensation in Pennsylvania. Recently, the National Business Institute invited Mr. Neiman to be a speaker at a workers’ compensation seminar in Allentown, PA, but the timing did not work out. Luckily, Mr. Neiman was able to be a speaker at a workers’ compensation seminar for the Bucks County Bar Association last year. Mr. Neiman has had the pleasure of speaking at seminars for both of these organizations in years past.

From time to time, Brilliant & Neiman holds free seminars on Pennsylvania workers’ comp issues for the general public throughout Southeastern PA. We think it is important for injured workers, especially those without attorneys, to know their rights. If you are interested in attending one of these free seminars, please contact us for information about our next seminar in your area.

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An injured worker in PA can settle both the wage loss and medical parts of his or her case by entering into a Compromise & Release Agreement. This is something which can only be done when both the injured worker and the workers’ comp insurance company agree to settle the case. Neither side can force the other to settle a case. Once the parties agree to the terms of a settlement, a Compromise & Release Agreement must be prepared, detailing the terms of the settlement. Then, before the settlement is final, a hearing must be held before a Workers’ Compensation Judge, who must be satisfied that the injured worker understands the terms and conditions of the settlement.

Recently, the Commonwealth Court of Pennsylvania decided that a Compromise & Release Agreement could not be approved because the injured worker had died before a hearing to approve the settlement could be accomplished. This case, Miller v. W.C.A.B. (Electrolux), was decided on January 4, 2008.

Understand that settling a workers’ compensation case in Pennsylvania is a very complicated process. It is very important that you have an experienced workers’ compensation lawyer working for you, to make sure that you receive the maximum recovery possible, and that your rights be properly protected.

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Did you know that you can read the entire Pennsylvania Workers’ Compensation Act online? While certainly not fun reading material, the PA Workers’ Compensation Act can provide valuable information. This is not a substitute for having an experienced workers’ comp attorney, but is another resource an injured worker can use to learn and protect his or her rights.

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We are often asked by injured workers about things related to Independent Medical Examinations (IME). The Pennsylvania Workers’ Compensation Act allows a workers’ comp insurance company to send an injured worker to a doctor of their choosing approximately twice a year. If an injured worker does not attend an IME, the workers’ compensation insurance company can file a petition to suspend workers’ compensation benefits.

Whether the IME is just a visit to be examined by the doctor the insurance company has selected varies by the case, though this does remain the situation in the vast majority of cases. The situation gets more complicated when the IME doctor asks that some additional testing be done on the injured worker. Whether the injured worker has to agree to this additional testing depends on the test at issue and the circumstances in that case.

According to a decision by the Commonwealth Court of Pennsylvania, an IME does include ” . . . all reasonable medical procedures and tests necessary to permit a provider to determine the extent of employee’s disability.” This was in the case of Coleman v. W.C.A.B. (Indian Hosp.), decided in 2004. The Court said the workers’ compensation insurance company must prove the test is necessary, has no more than minimal risk, and is not unreasonably intrusive. In that case, the Court found the injured worker did have to have an MRI done.

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Logic may make you think that if you are permanently disabled from your career as a result of a work injury, you are free to take your pension and continue receiving workers’ compensation benefits. Unfortunately, this is not the case in Pennsylvania, and whether to take a pension in a PA workers’ compensation case is a very important decision, which should only be done after discussing your particular situation with an experienced Pennsylvania workers’ compensation attorney.

When an injured worker starts taking his or her pension in PA, the workers’ compensation insurance company can argue that the injured worker is no longer entitled to workers’ compensation benefits, because the injured worker has “left the workforce.” The injured worker must then show a Workers’ Compensation Judge either that he or she is actually seeking employment or that he or she is not capable of performing any work at all (not just the injured worker’s old job, but any job in the entire labor market) as a result of the work injury. If the injured worker does not prove one of these two things, a Workers’ Compensation Judge can suspend (stop) the injured worker’s wage loss benefits (the weekly or bi-weekly checks). The injured worker’s right to medical treatment for the injury is not affected.

The case I recently saw that brought this situation to mind, Mason v. W.C.A.B. (Joy Mining Machinery), was decided by the Commonwealth Court of Pennsylvania on March 18, 2008.

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In a recent decision favorable to injured workers in PA, the Supreme Court of Pennsylvania said that, under certain circumstances, a workers’ compensation insurance company must pay not only to modify a van to be wheelchair accessible, but to pay for the cost of the van itself. This is an important change in the law, because there had been an older case, finding the workers’ compensation insurance company was only responsible to pay for making a van wheelchair accessible (and not for the cost of the van itself).

The injured worker in this case, who was paralyzed in a work injury, was not able to get out of the house, even to medical appointments, without this special van. Fortunately, the Court saw the unfairness of making the workers’ compensation insurance company pay only to modify the van for a wheelchair, when the injured worker might then not even be able to afford buying the van itself. The Court said, ” . . . the van is crucial to restore some small measure of the independence and quality of life that existed before the work injury.”

This rule is probably limited to cases like this, involving a catastrophic injury. The Court also said the situation of the injured worker in each case needs to be examined. For example, is a new van required? Did the injured worker own a van before the injury? Was any automobile owned by the injured worker before the injury? The answers to these questions, and others, would determine whether the workers’ compensation insurance company would have to pay for the cost of the van in any future case.

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Though workers’ compensation insurance companies routinely deny that carpal tunnel syndrome is caused by work activities, a recent article suggests that about half of all cases of carpal tunnel syndrome are, in fact, related to work activities. According to the article, Carpal Tunnel Syndrome Treatment, approximately two million people in the United States suffer from carpal tunnel syndrome. An estimated 260,000 surgeries are performed each year to address the condition.

“Carpal tunnel syndrome . . . tends to affect people more frequently who use their hands excessively, such as pianists, concert violinists, hairdressers, computer operators, manual laborers, artists, sculptors, dentists, and even neurosurgeons,” says James R. Bean, MD, American Association of Neurological Surgeons president-elect.

Contact Information
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5 Neshaminy Interplex Dr, #205
Trevose, PA 19053
Phone: (215) 638-7500 [Formerly (215) 244-8101]Fax: (267) 803-6298
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Allentown, PA 18101
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Pineville, PA 18946-0196

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