In a Pennsylvania Work Comp case, the employer/insurer usually issues a Notice of Compensation Payable when they accept the fact that a work injury took place. On this key, controlling document, there is a place in the upper left hand corner to list “body parts affected” and “type of injury”. In the vast majority of cases, the insurers will list the most benign diagnoses- such as a “lumbar strain/sprain” or “contusion”. There are several reasons for this. First, the NCP must be issued (although many times it comes later) within 21 days from when the injured worker gave notice of his/her work injury. In this early stage, the medical treatment hasn’t been very well developed. Also, the injured worker usually treats with the Employer’s Panel Doctors- who tend to minimize the nature of the injuries, naturally. In addition, since the insurer issues the NCP unilaterally, they are not going to put themselves on the hook for serious injuries- although in some cases, where the nature of the injury is clear- such as a fractured bone after a fall- they will. Because most people have some degree of arthritis, the insurers hope that a doctor will label the work injury a “contusion” or “sprain/strain” while pinning the causal connection of the injury after a few months to this underlying condition.
So, if you have been injured at work, what should you do if the insurer minimizes the nature of your injury? Talk with an experienced Pennsylvania Workmans Comp Lawyer. If your medical bills and wage loss benefits are being paid appropriately, I tend to let the description stand. However, if medical bills or wage loss isn’t being paid, I will file a Petition to Review to challenge the description of the work-related diagnoses. Or, if the insurer files a Petition to Terminate, Modify, or Suspend– efforts to reduce their liability-then I will counter with my Petition to Review at that time.
Why is the description of the work injury important? There are a host of reasons. First, you don’t need unpaid medical bills and credit problem which can result when the insurer refuses to pay medical bills for a work-related back surgery- with them claiming the injury was a mere strain or sprain. Secondly, the value of your case for settlement purposes may be affected by the description of the work injury. For example, if your chronic low back pain has caused a psychological condition such as anxiety or depression, you may want to file a Petition to Review to add these diagnoses, to enhance the value of the case for settlement purposes and/or to have medical coverage for ongoing treatment if no other source of insurance exists.
How do I win a Petition to Review? Talk to your PA Work Comp Lawyer. But generally, the lawyer will take the injured worker’s testimony in addition to testimony from the treating doctor. The insurer will almost always set up an Independent Medical Exam to see if the IME doctor agrees with the allegations. If the doctors disagree with each other- which is quite common- the litigation can take up to a year depending on many factors. (ie, what Judge gets assigned the case, coordinating schedules for doctors’ depositions, delays, etc).
In summary, the description of a PA Work Injury is a critical part of a PA Work Comp case. Don’t let your employer or insurance company dictate what injury is deemed work-related. Get a legal analysis from a Pennsylvania Work Comp Lawyer to determine if and when you should proceed with a challenge to the description of injury.
For more info about Pennsylvania Workers’ Compensation, call Attorney Michael Cardamone directly at 215-206-9068 7 days a week or email Michael@cardamonelaw.com.