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Workers’ Comp. 2020 Wrap Up

  • Dave Brown, Esquire
  • 12/28/2020

2020 has been a year to forget with the COVID crisis crippling our country. We extend our deepest sympathies to everybody who has lost family members and friends to this dreadful virus. Let’s count our blessings and hope that the vaccines will put an end to the pandemic in 2021.

The world of Pennsylvania workers’ compensation fortunately has been able to operate smoothly throughout the pandemic, which has ensured that injured workers have been able to receive the benefits to which they are entitled – money for lost wages and payment of medical bills.

Each week in this blog, we summarize and sometimes offer suggestions to injured workers about some area of workers’ compensation law. We want to close out the year with a summary of an important ruling rendered this year by the Commonwealth Court of Pennsylvania – the Court which decides appeals that have been filed in response to decisions issued by Workers’ Compensation Judges throughout the state.

In that case, a woman, Ms. Ciarolla, worked as a pharmaceutical rep. Her job required her to travel around to medical offices. While driving in her car, she was involved in an accident as a result of which she injured her low back. Her pain and limitations from that injury prevented her from performing her job and she began to receive weekly workers’ comp. benefits. She received medical treatment for nine months following her accident, but then for the next 18 months, she did see a medical doctor for her back injury. Upon the advice of her pain management doctor that she had been treating with, over the 18-month period, Ms. Ciarolla did home exercises for her back and used oral medication (pills) and topical medication (cream) to help control her pain. However, she was not evaluated by the pain management doctor or any other doctor during this time. She did not undergo physical therapy or receive injections to her back. She resumed treatment after the year-and-a-half hiatus and then underwent an “independent medical examination” with Dr. Cosgrove, who was chosen by the insurance company to evaluate her.

Based on his examination of Ms. Ciarolla and review of her medical records, Dr. Cosgrove was of the opinion that she had fully recovered from her work-related back injury. On that basis, the insurance company’s lawyer filed a petition to terminate her benefits. The matter was heard by a Workers’ Compensation Judge, and Dr. Cosgrove gave a deposition. In support of his opinion that Ms. Ciarolla had fully recovered, he relied heavily on the 18-month gap in treatment. Ms. Ciarolla’s lawyer argued that she was receiving some form of treatment as she was doing home exercises and taking medication, so it’s not like she was doing nothing for her back injury.

The Workers’ Compensation Judge accepted Dr. Cosgrove’s opinion that Ms. Ciarolla fully recovered from her back injury and terminated her benefits. An appeal was filed by her lawyer to the Workers’ Compensation Appeal Board, which agreed with the Judge’s decision. An appeal was then filed to the Commonwealth Court, which likewise concluded that Dr. Cosgrove’s opinion sufficiently supported the Judge’s decision that Ms. Ciarolla fully recovered. The Commonwealth Court agreed with Dr. Cosgrove that the home exercises and use of medication by Ms. Ciarolla did not constitute medical treatment because she was not treating with any doctors during this time.

There is a big take-away from the Commonwealth Court’s decision in this case. If you injure yourself at work, it is crucial that you regularly undergo medical treatment if you expect to receive ongoing workers’ comp. benefits. The Judge was convinced that because Ms. Ciarolla did not get any medical treatment for an extended period of time, her back must have been fine. While she undoubtedly thought the medications kept her pain manageable and the home exercises kept her back limber and allowed her to function better, this was not enough to convince the Judge, the Appeal Board, or the Commonwealth Court that she had not fully recovered from her back injury.

Please keep this in mind if you sustain a work injury. In fact, make sure you receive treatment soon after you injure yourself. Some people injure themselves at work, try to shake it off, and end up not seeking medical attention for two or three weeks. A delay like that will make the insurance company – and possibly the Judge – skeptical about the extent of your injury. They may conclude that if you had really sustained an injury of any significance, you would have sought treatment right away – with an occupational doctor through your employer, an emergency room, or your primary care doctor.

Likewise, as Ms. Cioralla’s case illustrates, if you injure yourself at work and continue to experience pain and limitations which prevent you from doing your job, you cannot just stop treating with doctors, even if you feel like you have hit a wall with treatment. Make sure that you schedule appointments with the doctor or doctors who have been treating you for your injury. They may order additional diagnostic studies, such as an MRI or nerve conduction study, or recommend another type of treatment for your injury. As Ms. Ciarolla found out the hard way, the danger with not getting any treatment at all is that a Judge could infer that if you’re not treating for your injury, you must have recovered — and therefore cut off your benefits.

At Pearson Koutcher Law, we practice workers’ compensation law exclusively — and we only represent injured workers. We understand the importance of our clients treating regularly for their work injuries as consistent medical treatment can make the difference between winning or losing their case. If you recently injured yourself and are not sure what doctors to treat with or have been receiving workers’ comp. benefits but are concerned that the insurance company will try to cut off your benefits, please call us for a free, comprehensive consultation. We would welcome the opportunity to represent you and will always do our best to make sure your rights are fully protected.