In an unexpected turn of events, the Pennsylvania Supreme Court delivered a ruling last month in a workers’ compensation case that will likely have a deep impact on workplace injury cases in the future. The ruling eliminated the policy of using the American Medical Association’s (AMA) benefits cap for employees severely injured and out of work for an extended period of time. Let’s dive in.
The Background
Historically, a key component of the Pennsylvania Workers’ Compensation Act states that after two years of receiving disability payments, injured employees may be required to participate in an impairment rating evaluation conducted by a physician. The evaluation relies on the guidelines outlined by the AMA that rate the injury as a disability percentage. Employees assigned a disability percentage below the AMA’s 50% impairment threshold can have their workers’ compensation benefits capped at 500 weeks post-injury. This provision went into effect back in 1996.
The Ruling
In 2000, an education employee slipped at the school where she was employed, severely injuring her knee and eventually necessitating surgery to repair it. Unfortunately, the surgery was not successful and she is still suffering pain and complications. When the school district mandated an injury evaluation in 2010, her injury was assigned only a 10% impairment rating. In a 2011 appeal, her attorney asserted that “citing a private medical group in workers’ comp injury ratings amounted to an illegal “delegation” of power by the General Assembly.” Surprisingly, the court agreed. in a 6-1 decision, Justice David Wecht asserted that the General Assembly did not have nearly enough control over the AMA’s guidelines and therefore, cannot allow the AMA to carry out or unduly influence Pennsylvania laws.
The Potential Impact on Workers’ Compensation Cases
By stripping the AMA guidelines from the Pennsylvania Workers’ Compensation Act, past, present, and future injured employees may be able to appeal claim denials well past the 500 week benefits cutoff date. Essentially, anyone whose benefits ran out or who settled before the 500 week mark since the 1996 implementation of the disability cap can now refile their claims. Employee advocate groups are calling this ruling a remarkable victory; small business advocates have grave concerns about how it will negatively affect the livelihood of small business owners. Only time will tell how the reverberations of the ruling will impact employers and the workers’ compensation system as a whole in the long-term. If your workers’ compensation benefits expired or you settled before 500 weeks of disability, The Law Offices Hall and Copetas may be able to help. Contact us today for a free consultation.
