Having spent over a decade litigating Pennsylvania Workers’ Compensation cases, I have to say that the system is quite fair overall. Both injured workers and employers/insurers have due process- the ability to be heard, the ability to present evidence, and to receive a “reasoned” decision from a Workers’ Compensation Judge.
However, when an injured worker in Pennsylvania has her claim denied at the outset- that is, within 21 days from the date of notice, (at least, theoretically, as we practictioners know that many claims are not accepted or denied within the 21 day requirement), she must file a Claim Petition- even if the denial is unfounded or simply filed to avoid payment. The case then gets set for a series of hearings, a period of six months for medical depositions, and then several months for the written arguments and a decision from the presiding WCJ. This process often takes approximately 12 months. In the meantime, the injured worker is without her wage loss and medical benefits, and forced to live on unemployment compensation, or other available benefits such as short or long- term disability. Frequently, an injured worker whose claim has been denied, has to dip into their life -long savings, just to provide food and shelter for her family. Sometimes, the injured worker has no job to return to, as employers will eliminate the position, terminate the injured worker, or fail to provide work within the doctor’s restrictions.
The effects of this long process are devastating to injured workers in Pennsylvania. Credit is irreperably damaged, savings are exhausted, houses are lost, and stress levels go through the roof- exacerbating the disability, and often causing additional mental problems such as anxiety and depression.
We could speed up this process by instituting a preliminary hearing– similar to our criminal law system, whereby an injured worker in Pennsylvania would have to present a “prima facie” case- perhaps within 30 days of the initial filing, demonstrating vis- a -vis testimony and medical reports, that a work injury and a commensurate disability has occurred. If proven, two thirds of the wage loss and medical benefits would commence, plus statutory interest. If denied, then the case proceeds onto the merits with depositions and full testimony from the relevant witnesses. If the prima facie case is met, the employers would still have the right to defend the case on the merits through the usual process. If the prima facie case is met, but then reversed in the final, written decision, the employers/insurers could seek reimbursement from the Supersedeas Fund.
This is just one idea for speeding up the Claim Petition process in Pennsylvania Workers’ Compensation to avoid the cascading devastation caused by the 12 month waiting period when a claim is denied at the outset.
-Michael W. Cardamone
Fighting For Injured Workers In Pennsylvania