Workers’ Comp In-Cites
Welcome to the latest edition of Schaff & Young's Workers' Comp In-Cites. Designed to provide our clients with practical insight, Workers' Comp In-Cites outlines recent developments in Pennsylvania workers' compensation law and explains how those decisions impact our clients and their cases. Barbara Young, Michael Schaff and the other attorneys at Schaff & Young, P.C. are always available to discuss these cases – or any other questions or concerns you might have. Just give us a call at (215) 988-0090 or send an email to info@schaffyoung.com. We look forward to hearing from you.


No Strict 30 Day Deadline for Downcoding

A workers' compensation carrier, which fails to notify a medical provider of its intent to downcode a medical bill until more than 30 days had elapsed since the submission of the bills, does not lose the right to "downcode" the charges, according to the Commonwealth Court in Dr. Jeffrey Yablon v. Bureau of Workers' Compensation Fee Review Hearing Office (PMA). Rather, the procedures set forth in 34 Pa. Code § 127.207 only provide penalties when the procedures regarding downcoding are not followed, but do not bar an insurer's ability to downcode after 30 days of the submission of the bill.


May 2011 Edition
Volume V
Number 5
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Termination of Benefits Permitted Even If Claimant May Experience Future Symptoms

That’s the holding in Schmidt v. Workers' Compensation Appeal Board (IATSE Local 3), in which the Commonwealth Court ruled that benefits may be terminated even when the medical expert credited by the Workers' Compensation Judge has testified that the claimant might experience symptoms in the future. In so ruling, the Court affirmed the distinction between an "employer's medical expert accepting the fact that the claimant suffered from pain" and "the medical expert accepting the fact that the claimant suffered from pain."


Benefits Cannot Automatically Be Suspended Or Terminated For Employees Who Lack Pre-Injury Job Certifications

In University of Pennsylvania v. Workers' Compensation Appeal Board (Hicks), the Commonwealth Court ruled that, when a claimant is unable to perform his or her pre-injury employment, an employer is not entitled to a termination or suspension of benefits based upon the employee's current lack of a certification that would otherwise be necessary to perform the pre-injury job.


UR Petitions – No Requirement to Show a Change in Condition

In a Utilization Review petition, an employer always retains the burden of proof. In order to prevail, however, the carrier is not required to show a change in condition since a prior UR determination, nor must its medical expert refer to prior UR determinations. So ruled the Commonwealth Court in Gary v. Workers' Compensation Appeal Board (Philadelphia School District).


Receipt of a Pension Does Not per se Equal the Voluntary Withdrawal from the Workforce

In City of Pittsburgh v. Workers' Compensation Appeal Board (Leonard), the Commonwealth Court ruled that acceptance of a pension alone will not necessarily give rise to the presumption that a claimant has voluntarily left the labor market. Rather, an employer must provide sufficient evidence to establish that, under the totality of the circumstances, the claimant has voluntarily left the workforce. Moreover, a claimant can rebut the presumption that he or she has voluntarily left the workforce by voluntarily establishing that he or she is seeking employment or that the work-related injury forced the claimant to retire.


Receipt of a Pension Does Not per se Equal the Voluntary Withdrawal from the Workforce

The Pennsylvania Supreme Court has granted appeals in the following matters on the following issues – as specifically specified by the Court:

City of Pittsburgh v. Workers' Compensation Appeal Board (Robinson)

Did the Commonwealth Court err by holding that, in a petition to suspend compensation benefits based upon an alleged voluntary withdrawal from the workforce, the employer bears the burden of showing by the totality of the circumstances that the claimant has chosen not to return to the workforce?

Phoenixville Hospital v. Workers' Compensation Appeal Board

1. Did the Commonwealth Court err and misinterpret the meaning of §306(b)(2) of the Workers’ Compensation Act, 77 P.S. §512(2) in determining that a job is available to a claimant for purposes of said Act even when a claimant applies to each individual job contained in a labor market survey and does not receive an offer of employment?

2. Did the Commonwealth Court err in failing to remand the matter to the Workers' Compensation Judge for a determination of whether or not the jobs identified by the employer's vocational expert were open and available in light of the fact that the holding of Commonwealth Court in the within matter altered the status of the law at the time of the decision rendered by the Workers' Compensation Judge?

Bowman v. Sunoco, Inc.

Did the Superior Court, in a decision of first impression and of statewide substantial significance, disregard the public policy of the Commonwealth of Pennsylvania and the plain meaning of the Penna [sic] Workers [sic] Compensation Act when it decided that a third party release in the form of a "Worker's Comp Disclaimer" signed in consideration for employment and receipt of compensation benefits, which further required the waiver and eternal release any [sic] and all rights to make a claim, commence a lawsuit, or recover damages or losses is not void against public policy when the language of the Disclaimer openly conflicts with the language of section 204(a) of the Pennsylvania Workers [sic] Compensation Act which expressly renders such agreements as void against public policy?