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Can Injured Workers Refuse Medical Treatment

  • Dave Brown, Esquire
  • 06/08/2023

On June 1, 2023, PA workers’ compensation lawyer Dave Brown of Pearson Koutcher law participated in an oral argument before the Pennsylvania Workers’ Compensation Appeal Board in a case involving an important workers’ compensation issue. The Appeal Board, comprised of the full board — the Chairman and five Commissioners — heard oral argument on four cases during an annual workers’ compensation conference in Hershey, Pennsylvania attended by people in all walks of the profession, including judges, lawyers, and insurance adjusters. The Appeal Board chose four cases with unique and compelling issues.

Knee Injury At Work

The case that Dave argued involved a man in his late 20s, with a strenuous job that entailed extensive walking and climbing, who sustained a serious knee injury at work. An MRI showed that he tore his anterior cruciate ligament (“ACL”) and medial meniscus. An orthopedic surgeon for his employer’s workers’ comp. insurance company recommended that he undergo surgery to repair these tears. The surgeon felt that the surgery had a high likelihood of restoring the injured worker’s ability to return to his job, with minimal risks. The surgeon further stated that if the man underwent the surgery, he would have a seven-month recovery period ahead of him; he would be in a brace for six weeks and then have to complete a lengthy physical therapy program.

Injured Worker Refused Surgery

Dave’s client did not want to get the surgery because it’s such a serious procedure and as a single father of three young children, the long recovery period would impede his ability to take care of his children. He does not have a strong support system, and he is responsible for most of the caretaking of his children. He wanted to pursue more conservative treatment that a doctor specializing in regenerative medicine recommended: stem cell treatment and plasma rich platelet (“PRP”) injections. He was told by his doctor that this treatment likely would improve his knee condition to the extent that he would be able to return to his strenuous position. However, he could not receive the stem cell treatment and PRP injections because the PA workers’ comp. insurance company would not pay for it, and the doctor did not accept health insurance. The treatment is quite expensive, and Dave’s client would have had to pay for it out-of-pocket.

Appealing A Petition To Suspend

Because the injured worker would not agree to the knee surgery, his employer filed a petition to suspend his workers’ comp. benefits on the basis that he refused reasonable medical treatment. The petition went before a Workers’ Compensation Judge, who ruled that although the man dealing with the knee injury was presented with an alternative treatment to surgery, and he had important familial obligations, his refusal to undergo the surgery warranted the suspension of his benefits. Dave appealed the Judge’s decision, and before the Appeal Board in Hershey, he argued that the Judge’s decision should be reversed because his client had good reasons to decline the surgery.

Establishing The Injured Workers Medical Treatment Is Reasonable

There was much discussion about the law on this issue. Our courts have ruled that in order to establish recommended medical treatment is reasonable, an employer must show it is highly probable the treatment will correct the claimant’s injury; enhance the claimant’s prospects for returning to gainful employment; and that there is a minimal risk to the person undergoing the treatment. An 85-90% chance of a successful surgery with a return to work has been found to be reasonable. Conversely, treatment with a 50-70% chance of returning the claimant to work has been found not to be reasonable.

injure Worker Refusing Medical Treatment

Pennsylvania courts, including the PA Supreme Court, have also found that an injured worker’s reasons for refusing recommended medical treatment should be considered in making a determination whether the treatment is reasonable. Once the employer submits evidence that the medical treatment is reasonable, the injured worker may present evidence, pertinent to his individual case, why the treatment is not reasonable.

Pregnant Woman Injured At Work Refuses Medical Treatment

A case that Dave cited to the Appeal Board during oral argument involved a woman with a back injury whose doctor recommended epidural steroid injections and lumbar surgery as treatment options that could potentially improve her back condition and get her back to work. The woman declined this treatment because it was counter-indicated based upon her desire to breast-feed her infant son as she was advised injections or surgery could cause harm to her son while she was breast-feeding him. The Workers’ Compensation Judge found, based on her unique circumstances, that the woman did not refuse reasonable medical treatment and therefore her benefits were not subject to suspension. The Appeal Board, as well as the Commonwealth Court of Pennsylvania, agreed with the Judge’s decision.

Injured At Work? | Call Pearson Koutcher Law

Dave and his fellow PA workers’ compensation lawyers at Pearson Koutcher law fight hard for their clients in every single case. They hope that the Appeal Board will reverse the Judge’s decision and rule in their client’s favor. Every workers’ compensation case has its own set of complicated issues, and if you have been unfortunate enough to injure yourself at work, it is important that you have an experienced, knowledgeable, and passionate lawyer on your side to fight tooth-and-nail with the insurance company. At Pearson Koutcher Law, workers’ comp. is all we do – these are the only types of cases that we handle. Each lawyer in the firm has more than 25 years of experience representing injured workers in workers’ comp cases. If you have been injured at work, please call our office right away for a free, comprehensive consultation.