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Pennsylvania Supreme Court Eliminates Premature Terminations for Workers’ Comp Benefits

Last summer, the Supreme Court of Pennsylvania set a precedent when it struck down a key part of the state’s workers’ compensation law that had been in effect for more than 20 years. By ruling in favor of Mary Ann Protz, a 54-year-old Westmoreland County woman who had injured her knee in a slip and fall while working for the Derry Area School District more than a decade ago, the court’s decision eliminated the practice of following the American Medical Association’s guidelines to cap benefits to severely injured workers. That decision means that injured workers who require longer recovery times before they can return to work will no longer need to worry about their benefits being terminated prematurely.

Employees who receive workers’ comp benefits were required to periodically see an approved doctor for an impairment rating evaluation (IRE), which determines the percentage of impairment which controls the length of time benefits will be paid.  But many Pennsylvanians on workers’ comp have complained that the IRE resulted in their benefits ending long before they were capable of returning to work. And that was the case with Mary Ann Protz, following knee surgery and resulting complications, when she made her required doctor’s visit to be evaluated. The doctor rated her injury as a10-percent impairment, and as directed under the AMA guidelines, any worker injury that falls below a 50 percent impairment threshold can have benefit payments capped at 500 weeks, or nearly 10 years.  Protz, however, was still disabled from her job, and she appealed the IRE rating.

The Supreme Court of Pennsylvania found in favor of Protz, a decision which also benefits other employees who are suffering or will suffer from severe workplace injuries in Pennsylvania.  The IRE process was determined to be unconstitutional.  In the Protz decision,  as Justice Wecht wrote, “The General Assembly gave the AMA de facto, unfettered control over a formula” that determined state-administered benefits.

The ruling benefits severely injured workers because they can now receive workers’ comp benefits for the amount of time necessary to recover from an injury instead of the time dictated by AMA guidelines. Under those guidelines, few doctors reported an impairment-percentage rating of greater than 50 percent, which is required to continue long-term benefits. As the Pittsburgh Post-Gazette reported, one notable effect of the ruling is that “the court left open the possibility that any injured worker over the past 20 years who has let the 500-week clock run out — or has settled a workers’ compensation case before hitting that cap — could be eligible to re-file.” The decision was hailed by workers’ rights advocates and, as might be expected, criticized by insurers.

If you’ve been injured on the job, Rudberg Law Offices, LLC can help with your workers’ compensation claim or appeal. Call us at 412-488-6000 or contact us online to see if you can file for new benefits or extend your current benefits under the new rule.