3 - 2016 - Abes Baumann

Who Decides if You’re Telling the Truth?

Eric Abes on March 9, 2016

The Pennsylvania Supreme Court will hear oral arguments in an upcoming case to decide whether the Commonwealth Court overstepped its appellate function in making credibility judgments which is the sole function of the workers’ compensation judge.

In workers’ compensation cases, the law has held the workers’ compensation judge (WCJ) is the sole fact finder. The WCJ has sole power to assess the credibility of witnesses and resolve any conflicts in the evidence presented in a workers’ compensation case. The WCJ as the ultimate fact finder has the authority and power to evaluate and weigh the evidence. The WCJ may accept or reject any evidence in whole or in part.

In the upcoming case to be heard by the Pennsylvania Supreme Court, the Court will decide if the Commonwealth Court erred in rejecting the WCJ’s findings. The WCJ in this case had found the testimony of an IRE physician insufficient to grant the Employer’s Modification Petition. The Commonwealth Court did not accept this finding.

Prior Pennsylvania Supreme Court case have upheld this power of the WCJ and have stated that Commonwealth Court has abused its discretion in usurping the function of the WCJ. Again, the WCJ is the ultimate fact finder and it is not the function of the appellate courts to ignore or reweigh the WCJ’s findings. The PA Supreme Court will again decide this issue.

Who Chooses my Doctor for a Work Injury?

Eric Abes on March 9, 2016

If you have been injured at work it’s possible that your employer, or its workers’ compensation insurance carrier, have instructed you to treat with one particular doctor. Many injured workers believe that they must treat with the doctor to whom they are sent. However, this is not the case.

The Pennsylvania Workers’ Compensation Act permits an employer to maintain a list of panel of physician. Each list must contain at least six (6) different medical providers. It is true that, if your employer maintains such a list, the workers’ compensation insurance carrier only has to pay for treatment provided by those doctors – at least during the first 90 days after the first date of treatment for the injury. But, what employers and insurance carriers rarely tell injured workers is that the worker has the right to choose the doctor (or doctors) who will provide treatment. So, if your employer tries to tell you that you must see one particular doctor, ask your employer to see the list of panel physicians – and then choose whichever doctor with whom you want to treat.

It’s also important to remember that you have the right to switch from one doctor to another if you desire. Thus, if you’ve chosen to treat with one doctor on the list of panel physicians and you are not pleased with that doctor, you have the right to begin treating with a different doctor. In fact, you can treat with all of the doctors on the list of panel physicians if you wish. As long as you are treating with one of the doctors on that list, the insurance carrier must pay for the treatment.

Finally, you should also be aware that, if you’re employer doesn’t maintain a list of panel doctors, you are free to treat with any doctor of your choosing. Moreover, if you wish to see a specialist – such as an orthopedic surgeon, neurologist, etc. – you are not required to get a referral from your family doctor as is often the case with health insurance plans. Rather, you may simply call the doctor, make the appointment, and the insurance carrier will have to pay for the treatment as long as the treatment was necessitated by the work-related injury and is reasonable and necessary.

Who Decides if You’re Telling the Truth?

Who Chooses my Doctor for a Work Injury?

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