Source: http://www.pawcj.com/2004/02/
Timestamp: 2019-04-24 18:18:05+00:00

Document:
For Social Security offsets, the new life tables were published on February 18.
For Medicare set-aside account approvals, the Centers for Medicare & Medicaid Services (CMS) has a coordination of benefits contractor. Accordingly, there is a new address to send requests for approvals of medicare set-aside proposals.
The Supreme Court granted the Employer's Petition for Appeal in the consolidated cases of Reifsnyder v. WCAB (Dana Corporation), Remp v. WCAB (Dana Corporation) and Hoffa v. WCAB (Dana Corporation). The Commonwealth Court in these cases reversed the WCJ's application of Section 309(d) of the Act on the basis that while the Employees were employed for all 52 weeks prior to the dates of injury, they had not worked a complete period of thirteen calendar weeks. The Commonwealth Court allowed the Employees to use section 309(d.2) of the Act.
The Supreme Court now has these cases with Colpetzer and Zerby, both of which used Section 309(d) but included the AWW of a prior work injury in the calculation. The Court denied the Petition for Allowance of Appeal in Shire, which used section 309(d) and included S&A benefits in the calculation.
The Claimants in the Dana Corporation cases were laid off for periods, and presumably they collected unemployment compensation benefits that could be included in an AWW calculation to achieve an average weekly wage that reasonably reflects the reality of the Claimant's pre-injury earning experience as a predictor of future earning potential.
In Coleman, Aplt v. WCAB (Indiana Hospital, et al.) the Claimant sought review of a WCJ's Order that she undergo a triphasic bone scan and MRI. The WCJ found the unrebutted medical evidence was that the tests were required; there was no medical evidence suggesting the tests would not have diagnostic value or place the Claimant at risk.
The Board dismissed the Claimant's appeal because she underwent the test, but the Commonwealth Court agreed to hear the issue and affirmed the WCJ as did the Supreme Court.
The Supreme Court held the term "physical examination" includes all reasonable medical procedures and tests necessary to permit a provider to determine the extent of a Claimant's disability. Furthermore, the test must meet the standard for suspension for refusal of care, e.g. it must involve only a minimal risk and offer a high probability of success. The fact that a test or procedure is invasive is not relevant; the Court said injections are commonplace in medical diagnosis and treatment. However, a reasonableness standard will be applied to the intrusiveness of the test or procedure. A minimally invasive test may be unreasonably intrusive, such as genetic testing, and introduction of a contrast agent into the body will not be unreasonably intrusive in most cases.
The Court concluded diagnostic testing to evaluate the extent of the Claimant's injuries falls under the definition of a physical examination when it is necessary, involves no more than minimal risk and is not unreasonably intrusive.
In R. Armitage v. WCAB (Gurtler Chemicals) the Claimant suffered from plantar fasciitis that arose from continuous standing. The condition was diagnosed in 1995. The Claimant kept working, however, only suffering a work restriction when the Employer sought to increase his hours in 1999 and the Claimant stated he could not do it. The Claimant's modified duty status continued until December 2000, when modified duty was no longer available. When the Claimant filed a claim in March 2001, his doctor testified that while standing aggravates the Claimant's symptoms, the Claimant's condition was no better or worse than it was in 1995. The WCJ was constrained to dismiss on the statute of limitations. The Board affirmed.
The Commonwealth Court agreed it is necessary to establish a daily aggravation to establish the last date of work is the injury date. The Claimant's doctor testified there was not a daily aggravation. However, the Commonwealth Court remanded for the WCJ to consider whether the Claimant's condition was aggravated on any date within the three year statute of limitations. The WCJ had not made a specific finding on this fact, and the Court identified testimony of the Claimant and his doctor that might support such a finding.
The equities of this case favor the Claimant. The policy concern of allowing the Employer to conduct a fresh investigation of the circumstances of the injury is satisfied without regard to the passage of time. Proper notice was given, and the Claimant's physical condition is unchanged. The Claimant should not be punished for continuing to work.
The Court did foreshadow a possible remedy for the Claimant. After recognizing the Claimant sought to set the date of injury when he first had a loss of (potential) earning power in 1999, the Court called this a "valid point," but then moved on to their analysis that the record might support an aggravation within the last three years.
New York Times Article: "Healing a Bad Back Is Often an Effort in Painful Futility"
In the January 2004 Pennsylvania Bar Association Quarterly, Paul Dellasega and Crystal Williamson of Thomas, Thomas & Hafer outline the employee's burden of proof in a wrongful discharge action alleging termination based on the employee's prosecution of a workers' compensation claim.
Also, Daniel R. Shuckers, Prothonotary of the Commonwealth Court, argues in favor of abolition of the "legal residuum" rule. The rule provides that in administrative adjudications when hearsay evidence comes in to the record, a finding of fact may not be based solely upon hearsay. Mr. Shuckers suggested the 1976 Commonwealth Court holding in Walker v. U.C. Board of Review is a relic of an era when administrative law judges were political appointees, untrained and/or uncaring about due process. Since this is no longer the case, Mr. Shuckers suggests the Commonwealth Court should fall in line with the Administrative Agency Law and the Rules of Evidence.
In the Administrative Agency Law and the General Rules of Administrative Practice and Procedure, even objected to hearsay can be admitted if relevant, material and and of the kind that would affect reasonable and fair minded persons in the conduct of their daily affairs. The Rules of Evidence (which are not binding on agency determinations) allow unobjected to hearsay to be relied upon.
John Gedid, Director of the Widener University School of Law -- Law and Government Institute, argues in favor of the "legal residuum" rule. Relying on fundamentals of due process from both the Federal and State Constitutions, Mr. Gedid states the courts have a duty to assure meaningful judicial review of agency action by assuring due process at the agency level. The right of cross-examination is the due process right preserved by the "legal residuum" rule.
In an introduction, the authors do recognize that the Supreme Court lately has been leaning toward more regulation of ALJ's. This is evidenced by the Supreme Court holdings in Daniels, which requires WCJ's to state the reasons for credibility determinations made on all but live testimony, and Wintermeyer, which holds the courts can reverse a credibility determination made with capricious disregard of other competent evidence. The suggestion was made that pressure on ALJs to decide large numbers of cases informally, efficiently, rapidly and inexpensively can cause an otherwise highly trained and diligent ALJ to pursue these objectives at the expense of fairness to a Claimant.
The article did not consider that fairness to the Claimant is not always achieved by requiring cross examination. In 1976, Baksalary had not been decided. Then, it was a matter of fairness to Claimants that the Employer should not be able to take an automatic supersedeas based upon an opinion of full recovery and then get a final order without a deposition. Now, it is often the Claimant that is prejudiced by the requirement that the Claimant take a medical deposition in every long-term (more than 52 weeks) case as defined in Weaver v. State of the Art.
However, the current state of the law still provides the necessary framework to achieve fairness in these cases. The legislature amended Section 422(c) of the Act to provide a medical report may be admitted in any case where there is no objection, and the Commonwealth Court withdrew the Iroquois Tool decision that held this amendment was unconstitutional. Under Rule of Professional Conduct 3.1 counsel has an obligation to not assert an issue unless there is a basis for doing so that is not frivolous. The comment to the rule would suggest that interposing a hearsay objection solely because counsel knows it is not cost effective for the Claimant to take his doctor's deposition would be in violation of the rule.
Fairness can be achieved with the "legal residuum" rule. The only result of abolishing the "legal residuum" rule would be renewed efforts to require that workers' compensation cases be litigated exclusively on medical reports.
A Northeast Pennsylvania Business Journal Article refers to the WCRI findings (January 21,2004 post) and includes commentary from a Harrisburg policy institute stating the cost of workers compensation insurance in Pennsylvania is about 8 percent above the national average cost per $100 of payroll, which ranks Pennsylvania 19th highest in the United States. The average benefit is more than 25 percent higher than the national average, ranking 11th. The article also includes comments from two claimants' counsel.

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