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Dealing with Panel Doctors

Eric Abes on July 17, 2014

Many employers set up so-called panels of medical providers to treat injured workers for work related injuries. Under the new Pennsylvania Worker’s Compensation act if an employer sets up a list of at least six healthcare providers the injured worker has to treat with a provider on that list for the first 90 days of treatment. If the worker treats with someone not on the list, it would be at his/her expense. The 90 days begins to run with the first day of treatment and ends on the 90th calendar day from that point.

Many employers attempt to direct the injured worker to a specific medical provider. This can be an occupational medicine doctor that the employer sends everyone to or it could be the occupational medicine Department of local hospital. Needless to say, these referrals are very important to the physician or facility to which the injured worker is being steered. The injured worker has every right to question exactly where the loyalty of such providers actually lies. Every injured worker has the right to pick any doctor on the list with whom to treat, regardless of the preferences of the employer. Of course, if the injured worker has a back problem he cannot treat with the eye doctor on the list. So long as the physician treats the kind of problem the injured worker has, the worker can choose to see that physician. Workers should firmly but politely exercise their right to see the doctor on their list of their choosing. When in doubt about what one is able to do, injured workers should always consult a knowledgeable workers compensation attorney.

Sometimes during the 90 day surgery is recommended by one of the panel doctors. The best approach to dealing with this situation would be to wait until after the 90 days has expired, so that the injured worker can see a surgeon of his or her own choosing. The Worker’s Compensation act clearly provides that a workers compensation claimant can see any physician here she chooses after the 90 days. Our firm often recommends to our clients that he or she make an appointment with their own physician for the 91st day so as to begin the process as soon as possible.

Our Worker’s Compensation attorneys often see appointments made for injured workers near the end of the 90 day. We see panel doctors frequently releasing injured workers to full duty and/or certifying full recovery as the workers approach the 90 day deadline. The safer course for injured workers who already have an appointment scheduled after the 90th day is to avoid an examination with the panel doctor close to the 90 day deadline.

 If you, the reader, is looking for a workers compensation attorney in Pennsylvania, please feel free to call us. You will receive a no charge and no obligation consultation.

Thoughts After 45 Years

Eric Abes on May 30, 2014

When I first started to practice Workers’ Compensation Law in 1970 the most any individual could receive for lost wages as a result of a work injury was $60 per week. Now it is $932 per week. What a difference 44 years makes. However, Workers’ Compensation insurance carriers because of the increase in benefits contest many more claims and to a much greater degree.

Testimony of doctors are taken in order to prove or disprove that the injury is work-related and that the injury still exists and that it prevents the injured worker from working.

The Workers’ Compensation Judge then determines the credibility of the injured worker, witnesses and doctors.

Concerning credibility a common theme that I see running through my cases are comments by my injured workers clients that “I am not like all those others. I did get injured and seriously so.” The facts do bear out that my clients’ injuries whether it is a herniated disc, broken bone, concussion, a blown out knee or myriads of other injuries are not something that my client would be making up.

I see that often the public has the same perception that injured workers are not really injured. They should only see and talk to my clients who have no income because they cannot work, have difficulty paying their medical bills and cannot support their families. But that everyone in this country (though I wish it on no one) would suffer a work injury, they wouldn’t be so quick to think that others are malingering. In fact the amount that do so are extremely small. However, as the old saying goes, “put a drop of ink in a glass of water and whole thing turns black.” Likewise, one or two people who try to game the system make it all that much more difficult for everyone else. That just means that the truly injured worker has a harder road to hoe but justice usually prevails but not without a lot of hard work.

 

Are you entitled to Specific Loss Benefits?

Eric Abes on May 30, 2014

If you are an injured worker and you’ve been disabled as a result of your accident, you are probably receiving temporary total disability (TTD) benefits.  Those benefits are intended to compensate you for the wages that you’ve lost because of your injury.  TTD benefits are, by far, the most common type of benefits that are paid to injured workers in Pennsylvania.

However, there is another type of benefit available to some injured workers.  “Specific loss benefits” are payable to injured workers who have had a body part amputated or completely lost the use of a body part.  The body part at issue could be as small as part of a finger or as large as an arm or leg.  Unlike TTD benefits, specific loss benefits are NOT intended to compensate an injured worker for wages that he/she has lost.  Instead, specific loss benefits are designed to compensate the injured worker for the loss of his/her body part.  As a result, an injured worker could be entitled to a substantial sum of benefits even if that injured worker missed only a minimal time from work – or even no work at all. 

Specific loss benefits are also payable to injured workers who, as a result of their injuries, have permanent, unsightly scars on their heads, necks, or faces.  In many cases, injured workers can receive benefits for scarring years after they were injured, recovered, and returned to work.  Many injured workers even receive specific loss benefits for scars resulting from surgeries, such as cervical fusions, that were necessitated by work injuries.  

First Thing You Do: Call a Lawyer

Eric Abes on May 12, 2014

If I could have one wish, it would be that, whenever someone was hurt at work they would call an attorney immediately. Because, even the simplest case can become complex without warning, and, the longer one goes without a lawyer, the more complex a case can become. People often think that they do not need a lawyer because their case is simple: I broke my leg at work, of course my employer will take care of my bills and time off. Yes a case can be that simple, but that does not mean your employer or their insurance carrier will do the right thing.

With any job, people often ask, what is the best part? No one asks what is the worst part? The worst part of being an attorney is having to break the news to clients that logic and common sense have no place in the law. This was the first lesson I learned when I began practicing, and it comes up in every case, with every client.

Whether it is explaining to a client how an Independent Medical Exam can actually harm the claim. Or that if you can return to work in some capacity, even at drastically reduced wages, you will be limited to 500 weeks of lost wages benefits. Or that, yes you are entitled to indemnity benefits for your lost wages, all the other benefits you earned, like health insurance for your family are gone.

Some attorneys say, “When in doubt call a lawyer.” I wish they would call an attorney doubt or no doubt.

Pennsylvania Supreme Court: “A job must be open and available to count in a Labor Market Survey.”

Thomas Baumann on February 26, 2014

The Pennsylvania Supreme Court has recently issued a ruling that will help injured workers who are faced with labor market surveys by a vocational expert hired by the workers compensation carrier. In Phoenixville Hosp. v. Workers’ Comp. Appeal Bd., 81 A.3d 830 (Pa. 2013), the court concluded that a job must be actually open and available in order for it to be used to stop or reduce a claimant’s benefits.

Under the Worker’s Compensation act, the carrier has the right to hire a vocational expert and compel the injured worker to meet with that expert. The expert gathers information about the worker’s employment history, educational background, interest and skills. The expert then analyzes the skills the worker has that could be transferred to another job. Then, a review is made of the local job market to identify positions which the injured worker has the physical ability to perform, along with the vocational ability to qualify for the job. Insurance companies often file petitions to stop or lower and injured worker’s compensation based on the opinion of the vocational expert that work exists that the worker is capable of performing.

Claimant’s attorneys have often recommended to their clients to apply for the jobs which are found by the insurance company vocational expert. Not every vocational expert has been willing to notify the injured worker about the jobs as they become available. However, when our firm has been able to get the expert to agree to notify our clients about the job, we have urged them to apply. We felt this was often the best test of whether the job actually existed for our clients and also demonstrated good faith by our clients. The Supreme Court, in Phoenixville Hospital, has now essentially adopted our position. The court has concluded that an injured worker’s application for the job is relevant evidence that has to be considered by the workers compensation judge in a modification petition based on a labor market survey. If the worker applies for the position and is not hired, this can be evidence sufficient for a workers compensation judge to find that the work does not exist such that benefit should be lowered or stopped. This case also clarifies that a job has to not just exist in an abstract sense in that someone is working such a position. The position actually has to be open such that an injured worker could actually get hired for the job. As a result, this case has a favorable outcome for injured workers in the state of Pennsylvania.

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