Workers' Compensation Law Declared Unconstitutional
On June 20, 2017, the Pennsylvania Supreme Court issued a decision that will reshape the way disability is assessed in the Commonwealth and potentially help countless people receive the workers' compensation benefits they deserve. Here's a quick overview of the case and the effects it could have on the workers' compensation landscape.
In 1996, the Pennsylvania legislature passed Act 57, a law that work injury lawyers across the Commonwealth opposed. Act 57 amended the existing workers' compensation provisions such that after 2 years of someone being on workers' compensation benefits, the insurance company or the employer can request an impairment-rating evaluation (IRE). The IRE was a medical examination conducted by a certified doctor according to the "Guides to the Evaluation of Permanent Impairment" published by the American Medical Association (AMA).
If the individual was "rated" to be less than 50% impaired based on these guides, their benefits would be capped. Meaning that after a certain period of time their checks would just stop. What lawyers for injury victims worried about--and what was later to proved true--is that the law hurt those that were the most severely injured.
Imagine you were hurt at work due to no fault of your own and now you can never do the job that you did. You underwent surgery, sometimes multiple procedures, and the doctors said you are as good as you are going to get--that you will just have to manage to live with your permanent pain, restrictions, suffering and disability. Or worse, your doctor said there is more treatment that could possibly help you improve. But the insurance company sent you to one of their doctors who said you have reached Maximum Medical Improvement.
Now the insurance carrier would request an IRE. You could fight it and hope you would win on the basis you haven't reached Maximum Medical Improvement, according to your doctor. But if you lost, or couldn't fight it at all, you had no choice but to go an IRE by a physician designated by the Bureau of Workers' Compensation--most of the time a "hired gun" working for the insurance company.
Regardless of how bad you were hurt, if IRE rated you at less than 50% impairment, you knew that time was running out and your benefits would stop. Sadly, to be at 50% or worse, as one judge put it, "you'd have to be a paraplegic." Another judge said in his 20 years on the bench he only saw 5 people rated 50% or worse. And forget if you had a mental impairment on top of it as the 'Guides' didn't take that into account. Many seriously disabled people were affected over the past 20 years. Many lost their benefits. Fortunately, since the inception of the law, injury lawyers like Mitch Dugan and his team of Dugan and Associates have fought tirelessly against this law that devastated the lives of so many seriously injured and disabled.
Finally, the IRE process made its way to the Pennsylvania Supreme Court, and the Court issued its decision, righting this 20-year injustice. Here's how the case played out.
A hall monitor named Mary Ann Protz suffered a work-related knee injury in 2007. She was judged to have total disability, so her employer, Derry Area School District, began paying benefits. In 2011, the School District requested an IRE, which was conducted according to the Sixth Edition of the AMA's guides. Protz's disability was rated at only 10%, and the school district filed to have her benefits reduced to partial disability.
Under the existing law, employers are entitled to IRE's performed under the most recent guides from the AMA. After her disability rating was lowered, Protz appealed, arguing that the requirement to use the guides was unconstitutional. Article II, section 1 of the Pennsylvania Constitution says:
"the legislative power of this Commonwealth shall be vested in a General Assembly, which shall consist of a Senate and a House of Representatives."
Protz claimed that by putting the responsibility on the AMA to delegate disability rating guidelines, the Commonwealth was illegally avoiding its responsibility. The Workers' Compensation Appeals Board rejected Protz's argument and affirmed the initial decision to reduce her benefits.
But Protz then appealed to the Commonwealth Court. They overturned the Appeals Board's decision, saying that the Commonwealth could not delegate its authority without first setting its own primary standards.
When Act 57 was written, the Fourth Edition was the most current. However, the AMA has since released a Fifth, and finally a Sixth Edition. The Commonwealth Court decided that no guide could be used that postdates the Fourth Edition, because that was the edition the legislature originally reviewed and approved, setting a primary standard necessary for delegating authority. The Court also decided that Protz's case should be sent back to the workers' compensation judge to be re-evaluated using the Fourth Edition of the guides.
Both Protz and Derry Area School District appealed to the Pennsylvania Supreme Court. The Supreme Court eventually issued a 6-1 decision that struck down the entire section of the law requiring the use of the most recent edition of the guides as unconstitutional. The decision also halted the Commonwealth Court's order to re-evaluate Protz under the Fourth Edition guides.
The Pennsylvania Supreme Court's decision declaring the 1996 law unconstitutional is a huge victory for work injury victims everywhere. To lawyers representing people suffering work injuries like attorney Mitch Dugan and his team, this provides some hope that people that have been hurt at work will have some protection of their benefits.
Make no mistake, insurance companies have lots of money and lobbyists constantly in the legislatures ear trying to reduce individuals' benefits at every turn, but this is an important win for those suffering daily. And it is a big win for any unfortunate workers who get hurt in the future, as they will not have to suffer as so many have over the past 20 years.
As they say the wheels of justice turn slowly, so it will take time for the legal system to sort through the many issues it now faces with having a 21-year-old law overturned. But we at Dugan and Associates are hopeful and will continue to protect the rights of those who are injured. What is known immediately is that no longer can an insurance company request an IRE. What has to be sorted out is what happens to those who have already had their benefits reduced or ended by an IRE.
The Court's decision is a step in the right direction. There will be more battles and possibly more litigation over this law because of these unanswered questions. And we know there will be other battles for injury victims and those hurt at work and their families to fight. If you have been injured at work, or you just have questions about personal injury or workers' compensation, you should consult with a skilled and knowledgeable workers' compensation attorney. The team at Dugan & Associates has decades of combined experience, and we are ready to help you. If you have questions or you need representation, contact us for a free consultation today.
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