By: Sandra Weigel Kokal

Generally, case law has held that an injury occurring on the employer’s premises when coming or going from work, even for a meal, is compensable. Case law has held that getting to one’s workstation is a necessary part of a job.

Therefore, if you slip and fall in your employer’s parking lot you could be eligible for workers’ compensation benefits. Cases of this nature have held that arriving between 15-30 minutes before your required start time is ok and compensable. The Courts have stated that “an employee is considered to be within the course of his employment if on the premises where he is employed a reasonable length of time before the hour fixed to commence his duties.”

Other examples of compensable injuries include:

–employee injured when fell in office lobby after returning from lunch

–employee injured while picking up her paycheck on her day off as it was an employer approved practice

–employee injured while helping to push a co-worker’s car out of the snow in the employer’s parking lot

–employee injured while sleeping in the car in employer’s parking lot 30 minutes prior the start of employee’s shift when struck by a co-worker’s car

–employee injured after retrieving his clean uniforms prior to the start of his shift, returning to place uniforms in his car, and then sipping on ice while returning to employer’s business to start his shift

Each case is different, but an experienced attorney can compare your situation to the law and help you get the benefits you deserve. Injured workers should talk to an experienced Workers’ Compensation attorney whenever they suffer an injury on their employer’s premises. Even if the injury does not happen during their shift.

By: Edward Jaffee Abes

Recently there has been much publicity concerning concussions suffered by athletes. But what is a concussion?

A concussion in reality is a traumatic brain injury (TBI). The most common and least serious type of traumatic brain injury is a concussion. These are obviously caused by sports injuries or general recreation activities. They of course could also be caused by falls, auto accidents and even fighting. One sustains a concussion upon suffering an impact that jolts the brain. Essentially, because the brain sits in a protective spinal fluid within the skull, a trauma causes the brain to move around and bump up against the skull. Damage to blood vessels or injury to nerves can occur. This causes the brain to not function normally.

Common symptoms of a concussion are multiple. They may include some but not all of the following: balance problems, confusion, concentration issues, dizziness, headache, irritability, depression, nausea, vomiting, anxiety and sensitivity to light or noise. One should not judge for themselves the seriousness of the concussion but rather should seek medical attention to be evaluated. Even once recovered if the concussion was sustained in a regular activity such as a sport, a repeat concussion can have cumulative effects on the brain with severe consequences. Therefore, a doctor’s clearance is the best course of action before returning to normal activity.

Concussions cannot be entirely avoided but precautions can lessen the chance of sustaining a head injury. Wearing a helmet while participating in sport activities including bike riding will greatly reduce the incidents or severity of a traumatic brain injury. Play hard but play smart and protect yourself. By doing so, you will not affect your life or the lives of your family.

By: Douglas A. Williams

If you have been injured in a work injury, and are actively treating with a doctor, you may receive a “Utilization Review Request” in the mail. This document is often particularly confusing to those who aren’t in the legal profession. Many injured workers wonder whether the Utilization Review Request is an attempt to stop their weekly checks. Others fear the request may mean that they will be stuck paying medical bills.

When an insurance carrier files a Utilization Review Request, the carrier asks the Bureau of Workers’ Compensation to appoint an independent doctor to review the “reasonableness and necessity” of the injured worker’s treatment. So, for example, if the injured worker is seeing a chiropractor two times per week, the independent doctor would decide whether the worker needs to treat that frequently and whether the type of treatments provided by the chiropractor are reasonable and necessary. If the independent doctor finds the treatment reasonable and necessary, the insurance carrier must continue to pay for it. If the doctor determines that the treatment is unreasonable and unnecessary, the carrier is no longer responsible for paying for treatment with that doctor.

Injured workers should know that, regardless of how the Utilization Review Request is decided, his weekly checks will not be affected. Additionally, if the insurance carrier is excused from paying for treatment, the doctor is forbidden by law from billing the injured worker. Furthermore, the Utilization Review Request relates to the treatment provided only by the doctor who is the subject of the review. Finally, the doctor, the injured worker, or the insurance carrier has the right to appeal the Utilization Review doctor’s decision to a Workers’ Compensation Judge.

By: Sandra Weigel Kokal

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.

By: Susan Paczak

The VA will now granted disability compensation benefits to veterans who served at Camp Lejune for any length of time between August 1, 1953 and December 31, 1987 if they have developed certain diseases. The diseases the VA now recognizes are:

• Kidney cancer
• Liver cancer
• Non-Hodgkin lymphoma
• Leukemia
• Scleroderma
• Multiple myeloma
• Parkinson’s disease
• Aplastic anemia/Myleodysplastic syndromes

This means that if a Veteran who served at Camp Lejune between 1953 and 1987 develops one of these diseases and applies for benefits the VA will automatically recognize the disease as service-connected and grant disability compensation benefits. The VA will pay benefits not only for those on active duty, but also for veterans who were assigned to Camp Lejune while in the Reserves or National Guard.

Although the VA has not put out the necessary regulations to cover these diseases, a veteran who served at Camp Lejune during the time of the water contamination should apply for benefits immediately. The VA will hold the claim and grant benefits as soon as the regulations are finished. As the date benefits become payable depends on the date the veteran applied for benefits, the veteran should apply immediately. If a Camp Lejune veteran died from one of the listed diseases, his widow/er should file a claim for benefits immediately.

The VA may add other diseases to the list after more research is done. If the veteran has a disease s/he thinks was caused by the water at Camp Lejune, the veteran should file a claim immediately. Even if the claim is denied, if the disease is added to the list later on, the VA will most likely grant benefits back to the date of the original application. Also, the veteran can still prove that a disease not on the list is related to the chemicals in the water, if there is medical evidence from a doctor to support the claim.

By: Thomas C. Baumann

If you are injured on the job the workers compensation insurance carrier has the right under the Pennsylvania Worker’s Compensation act to require you to submit to a so-called independent medical examination(IME). While the examination is referred to as” independent”, it is rarely truly independent. There are numerous physicians in Western Pennsylvania to make several hundred thousand dollars a year examining injured workers at the request of employers and insurance companies and testifying on behalf of those entities. The lucrative nature of such business often renders the examination rather one-sided.

Injured workers can do several things to protect themselves with attending an IME. The injured worker should always time exactly how long he or she spends with the IME doctor. Based on feedback that Abes Baumann receives from its clients, the examinations rarely exceed 5 to 10 minutes. Yet, the IME doctors often testified they spend a half-hour to an hour with the worker. By timing the examination, the injured worker can testify how brief the examination was and help undermine the credibility of the IME doctor.

The injured worker should write down the time he or she arrived at the facility for the examination. He or she should then record the exact time he/she returned to the vehicle. Recording this timeframe will correlate with the actual time spent with the physician and lend credibility to testimony as to the brevity of the examination.

Injured workers should make notes regarding what happened at the examination immediately following the appointment. By writing down what happened, injured workers can buttress testimony regarding how short a period of time was spent with the doctor.

If the injured worker has a healthcare provider in the family or one who is a close friend, that person can be brought to the examination. The Worker’s Compensation act provides that an injured worker has the right to have a healthcare provider of his or her choosing attend the examination. Healthcare providers can include nurses, chiropractors or physicians. When a healthcare provider attends an IME, there is usually a much more thorough and fair evaluation.

Injured workers should always see treating physicians as soon after the IME as possible. This allows for fresh evidence to rebut the  opinions of the IME doctor. When you receive notice of an IME, and injured worker should always speak to his/her lawyer. If the injured worker has not yet retained counsel, he/she should definitely talk to a lawyer once they receive notice of an IME. That almost always means the insurance carrier starting to move against the worker.