A ruling by Pennsylvania’s Supreme Court may help injured workers. This decision brings into question the use of American Medical Association guidelines that could place a cap on workers’ compensation payments for injured workers.
A recent Pittsburgh Post-Gazette article provides a summary of the decision. The case concerns a worker receiving a 10 percent rating for the work-related injury back in 2010. The worker complained that this rating was inadequate regarding the injuries she received. Her knee injury led to complications and the need for surgery.
Issues the current found with current law
Under current law, insurers can require workers to see a physician after two years of receiving workers’ compensation benefits for an impairment rating evaluation. By using the American Medical Association guidelines during such evaluations, it could lead to a capping of benefits.
This worker’s attorney suggested that the use of a private medical group rating in a workers’ compensation matter amounted to an illegal delegation of power. The Pennsylvania Supreme Court agreed.
The majority opinion stated that current law “did not require that the AMA hold hearings, accept public comments, or explain the grounds for its methodology in a reasoned opinion, which then could be subject to judicial review.” Also, there were no requirements for periodic updating of the guidelines. There have only been two updates of the guidelines since 1996.
The purpose of workers’ compensation
A work-related injury often can prevent the worker from returning to the job. Medical costs for the treatment can be expensive. Also, the worker will require compensation for lost wages.
The laws governing workers’ compensation are confusing and complex. The intent of such laws is to help injured workers. However, this is easier said than done since it involves several processes.
Attorneys practicing in this area understand the application of these laws and how to apply them to individual circumstances.