The Supreme Court of Pennsylvania Upholds Decision to Protect Injured Workers from Unlawful Medical Exams

June 29, 2017

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On June 20, 2017, the Supreme Court of Pennsylvania handed down the most significant workers’ compensation decision in years, if not decades. The recent ruling should ensure that thousands of injured workers across the Commonwealth will continue to receive necessary benefits aligned with the true extent and duration of their injuries.

 

Pond Lehocky Stern Giordano and others involved in the ongoing fight to protect workers’ rights have been waiting for the Supreme Court of Pennsylvania’s ruling with much anticipation, ever since the case was first decided in the Commonwealth Court in September of 2015. The case involves Mary Ann Protz, who had her disability status changed from total to partial and her workers’ compensation benefits limited as a result, even though her work injury continued to persist.

 

This new court ruling will help many severely injured people like Ms. Protz by preventing the premature removal, limitation, or automatic capping of their workers’ compensation benefits. Previously, according to statute, when an injured worker had been receiving workers’ compensation benefits for two years, the insurance company could compel them to undergo an Impairment Rating Evaluation (IRE). An IRE doctor would then use the American Medical Association’s (AMA) guidelines to determine if the worker was more or less than 50 percent disabled. If the doctor concluded that the injured worker was less than 50 percent disabled, the injured worker’s benefits would be capped at 500 weeks.

 

Doctors had been using the 6th edition of the AMA’s guidelines for evaluations. In September 2015, the Commonwealth Court determined that use of the 6th edition was unconstitutional because the guidelines were developed by a private company (the AMA), not by a state agency, and because there had been no meaningful review of the statute in question in nearly two decades. It is a violation of the Pennsylvania Constitution to give a private company the authority to determine how injured workers are evaluated under the law with no government oversight. Since that determination, Pond Lehocky Stern Giordano has been aggressively defending their clients from being forced to attend unlawful IREs.

 

Now the Supreme Court of Pennsylvania has upheld the Commonwealth Court’s determination that IREs are unconstitutional and can no longer be used to disadvantage injured workers by automatically shifting their disability status. The Supreme Court found that relying on the AMA’s published guidelines to determine ongoing disability hands over “broad and unbridled” authority to a private entity that lacks any accountability or responsibility to the public interest and betterment of Pennsylvanians injured on the job.

 

Thanks to this decision, there is no longer a basis in the law for insurance companies to seek automatic changes to an injured worker’s disability status. They must go through the regular processes, present evidence, and prove their case. This ruling indicates a shift in favor of injured workers and helps even the playing field in an area of law where the rights of injured workers have increasingly come under attack in favor of insurance company profits.

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