Reinstating in PA Workers’ Comp After Benefits are Terminated

One of the most difficult burdens an injured worker in Pennsylvania faces is when he or she is trying to reinstate PA workers’ compensation benefits after a Workers’ Compensation Judge (WCJ) has terminated such benefits. Since the granting of a Termination Petition means that the WCJ has found the claimant fully recovered from the work injury, there is a logical problem to later show the same injured has “recurred.”

A recent decision by the Commonwealth Court of Pennsylvania, National Fiberstock Corp. v. Workers’ Compensation Appeal Board (Grahl), shed some light on the actual burden a claimant faces in this situation. In short, the claimant must prove that, after the date the WCJ found there was a full recovery, there was a change (a worsening) of that physical condition. A previous workers’ comp decision by the Court noted that this change must be proven “by precise and credible evidence of a more definite and specific nature than that upon which initial compensation was based.”

Obviously, this is a very difficult burden for the injured worker to reach. But, as the Grahl decision shows, the burden is hardly impossible. In the Grahl case, the injured worker won her case by proving her carpal tunnel syndrome had recurred, using the doctor’s physical examination (which showed atrophy, or shrinking of the muscle) and electrodiagnostic testing (EMG test). It is this type of objective proof of the change in her condition which won the case.

One of the arguments made by the workers’ comp insurance company was that Ms. Grahl’s doctor was not capable of testifying, because he did not see her until after the Termination Petition was granted by the WCJ (so he could not have known her condition at that time). The Court rejected this argument, since the doctor accepted and assumed that claimant was fully recovered when so found by the WCJ.

It is also important to note that this difficult burden flies both ways, as the Court also observed. When a workers’ comp insurance carrier loses a Termination Petition, the workers’ comp insurance company must prove a change in condition to win a later Termination petition. For more on this burden on the workers’ comp insurance carrier, see Lewis v. Workers’ Compensation Appeal Board (Giles & Ransome, Inc.)