Author Archives: Karl Voigt IV, Esq.

Injured workers: Pennsylvania Republicans want a loan…from you!

by Karl Voigt

Injured workers: Pennsylvania Republicans want a loan…from you!

On June 29, the Pennsylvania Senate approved a $31.6 billion budget. The legislature is even today, Sunday, meeting to work out the details. Somewhat shortsightedly, they have yet to figure out exactly how to fund their new budget.

One idea tossed out by Republican lawmakers is to take out a loan from the State Workers’ Insurance Fund (SWIF) to help balance the budget. In what they have styled a “temporary loan” from the Fund, they would draw up to $1.5 billion from the insurer’s reserves. There are, however, no specific plans to actually repay the loan.

Some of you may be familiar with SWIF: they are a state run insurance fund that primarily insures employers in Pennsylvania that have a poor safety record or can’t secure policies elsewhere. They do not have the reputation of being the best-run insurer in the Commonwealth.

What the Republicans see is SWIF’s $1.5 billion in assets. These primarily bond funds are to be used by SWIF over the course of time to pay injured workers’ claims. However, the Republicans are seemingly ignoring the fact that SWIF has $1.7 billion in projected liabilities for injured workers’ claims. Meaning that SWIF’s money isn’t enough to pay its future obligations. So, if SWIF loans Pennsylvania its money, where will it get a loan when their money runs out?

Further, while SWIF collected nearly $214 million in premiums in 2015, its operating expenses actually exceeded that amount. Which means SWIF doesn’t operate at a profit; it is actually operating at a deficit.

So essentially, the legislature – operating at a deficit – is contemplating a loan from its own agency that operates at a deficit. Readers are encouraged to contact their local Representatives to let them know their thoughts.

 

 

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CDC Guidelines for Prescribing Opioids for Chronic Pain

by Karl Voigt

You may have seen in the news, or perhaps even here, that the Center for Disease Control has published new Guidelines for Prescribing Opioids for Chronic Pain. This is seemingly in response to not just the addictive nature of opioids, but also the quadrupling of deaths from prescription opioid overdose over the past 15 years. Since so many of our clients have been offered or prescribed opioid medications to manage their pain, it is worth a review.

OxyContin

The Guidelines are targeted to primary care physicians and not so much to pain management doctors. Most of these Guidelines focus on the criteria for initiating opioids and, frankly, they suggest avoiding it.

Interestingly, however, primary care physicians write nearly 10 times more opioid prescriptions per year than pain management doctors combined. Based on my own experience, I wonder if this is because pain management physicians often write the initial opioid prescriptions, then later pass along care to the patient’s primary care doctor.

The new Guidelines can be found here: http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.

The CDC also published a checklist for primary care doctors to use in initiating opioid prescriptions for their patients. It can be found at https://stacks.cdc.gov/view/cdc/38025.

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by | March 31, 2016 · 8:49 am

Pennsylvania Announces 2016 Average Weekly Wage

by Karl Voigt
Pennsylvania’s Secretary of Labor and Industry has announced the 2016 Statewide Average Weekly Wage.This figure serves as the basis for determining the maximum and minimum weekly Workers’ Compensation benefit rates in Pennsylvania. The figure has increased to $978 from the 2015 average of $951. This increase affects the weekly rates paid to workers who were injured on or after January 1, 2016.

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PA Appellate Court Curbs Workers’ Compensation Impairment Rating Evaluations

by Karl Voigt

In a late-breaking development, the Pennsylvania Commonwealth Court has severely limited the use of Impairment Rating Evaluations by insurance companies. This ruling may affect ongoing Workers’ Compensation claims, as well as those that have been affected in past years.

Workers’ Compensation insurance companies have, since 1996, have the ability to subject an injured worker to an Impairment Rating Evaluation (IRE). Like an insurance medical examination (IME), the IRE requires a physical examination by a doctor. The examining doctor must then use the American Medical Association’s Guides to the Evaluation of Permanent Impairment, which is now in its sixth edition. If the claimant is less than 50% disabled according to the Guides, wage loss benefits are limited to no more than 500 weeks.

In Protz v. Workers’ Compensation Appeal Board (Derry Area School District), No. 1024 C.D. 2014 (Pa.Cmwlth. 2015), the Commonwealth Court heard a challenge from an injured worker whose benefits were limited as a result of an IRE based on the sixth edition of the Guides. The Court in essence struck down that IRE.

Here’s the problem: the sixth edition of the Guides that is now in use is stricter than the fourth edition. The Pennsylvania General Assembly has never scrutinized the fifth or sixth editions. Therefore, the Court found that making doctors use the most recent AMA guidelines to evaluate disability unlawfully delegated power away from the government and to a private organization, who can amend its Guides without legislative review.

Of course, this will affect IRE petitions presently being litigated; IREs based on the fifth or sixth edition may not be valid. However, since the publication of the fifth editions of the Guides in 2000, there are a large number of people whose benefits have been modified. What will happen to these cases is uncertain. However, the employer in this matter has appealed this issue to the Pennsylvania Supreme Court, so stay tuned here for updates.

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What are the first things to do if you get hurt at work?

by Karl Voigt

Karl just answered this Pennsylvania workers’ compensation question on Avvo.com:

 

“I was at work and fell at customer site. I tripped and fell on rebar and 2 inch wide bolts sticking out the ground. I bruised my left forearm, cut open my right hand and rehurt my old shoulder injury. Hurt both knees from hitting ground. Hurt lower back.”

– Philadelphia, PA

 

Sorry to hear about your injury. As others have already pointed out, you have likely a Workers’ Compensation case, as well as one for personal injury.

You need to take some immediate action, and don’t necessarily need a lawyer to get started.

First and foremost, you must immediately notify your employer about the injury, carefully describing each affected area of your body. There are some pretty strict deadlines for advising your employer of the work injury. Once you do, your employer has 24 hours to report it to its Workers’ Compensation insurance company. In turn, the insurer has 21 days to investigate your case and accept or deny liability. As you can tell, the sooner you give notice, the better.

Your next immediate step will be to seek medical care. The sooner the better, not just for your recovery, but also for your case. Any delays in getting medical treatment for a work injury could possibly be used against you.

The best result in your case would be a quick and full recovery. Usually, a lawyer gets involved if that doesn’t happen, or if the insurance company has denied the case. Naturally, it would not hurt to sit down and talk with the lawyer to lay out a plan to address all possible contingencies.

Good luck!

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Pennsylvania H.B. 916 Would Extend WC Coverage to Emergency Management Volunteers

by Karl Voigt

The Pennsylvania legislature is once again attempting to amend the Commonwealth’s Workers’ Compensation Act, this time in the form of House Bill 916, which aims to extend insured status to emergency management volunteers.

As a matter of public policy, the Act has long extended insurance coverage to volunteer firefighters, volunteer ambulance corps, volunteer hazmat teams, and other similar volunteers working in the public interest. Namely, §601(a) of the Act bestows Workers’ Compensation insurance coverage on people who are injured while working as unpaid volunteers.

It would, of course, be inherently unfair to disallow coverage to our volunteers who are injured in the line of duty. Why should their families suffer as a result of an injured that occurs from their volunteer work? Volunteers compose 70% of the nations firefighters. To deny coverage could discourage individuals from volunteering.

This new proposal extends that coverage to emergency management volunteers, who typically respond to large disasters such as hurricanes, earthquakes, floods, or civil disturbances. This proposal even specifically extends coverage to volunteers while traveling to and from these emergencies.

H.B. 916, if enacted, will ensure coverage to our emergency management volunteers who are injured in the line of duty.

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Can I choose where to get a functional capacity evaluation?

by Karl Voigt Karl just answered this Pennsylvania workers’ compensation question on Avvo.com:

“Off work collecting WC 9 months with knee. Doc wants me to do an FCE. Can I choose who I want to go to?

Had left menisectomy on July 29, 2014. Had PT, cortisone, Euflaxxa, and more therapy. I am in pain and limp all the time Also told I am candidate for total knee replacement.Not sure if I want to do The total replacement because doctor said even I did he would not release me full duty. I am a delivery driver who is in and out of truck 100 or so times a day delivering pkgs weighing up to 150 lbs. He said to do FCE so he let company know my restrictions. So just want to know if I can choose the FCE facility.”

You can choose who performs the functional capacity evaluation.

You are well beyond the “captive period”, a relatively short period of time where you *may* have to treat with doctors chosen by your employer. You are free to choose your own medical care providers. You wrote that you have already gone undergone physical therapy. If you have developed a good rapport with your physical therapists, and they offer functional capacity evaluations (FCEs), it may not be a bad idea to test with the people most familiar with your condition. You are, of course, free to go elsewhere as well. Naturally, when you do undergo the test, there are some things you should know ahead of time. Namely, You should know that there are tests built into the test to gauge your effort and exertion. Many patients don’t know this, but you will likely be given a score to measure the validity of your effort. The doctor will use this score in actually prescribing your physical limitations. Therefore, It is important to put forth a strong and consistent effort during the examination, which is often conducted over several hours. This is not to say that you should hurt yourself. However, the therapist will be conducting periodic tests to gauge your effort. Good luck!

To see the full question, go to: http://www.avvo.com/legal-answers/off-work-collecting-wc-9-months-with-knee—doc-wa-2140008.html?answered=true

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