Pennsylvania Worker's Compensation Reform
Injured workers and workers
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1. Worker's compensation hearings are limited to 30 minutes. This means that in order to get all the testimony entered into evidence it may take several hearings. This drags everything out for long periods of time. The worker's compensation judge has a good chance of getting the facts confused and not making a decision based on the correct facts. Who does this benefit? The attorneys because both are collecting payment no matter how long it takes to resolve the case. There is no incentive for the attorneys or the state to bring the case to an end.
2. Doctors are paid for their testimony and are allowed to give their testimony via deposition. All depositions are taken at the doctors place of business and the doctor picks the time. This means that if a doctor is busy he/she can schedule the deposition as much as a year later. Who does this benefit? The worker's compensation insurance companies because they can end up with a testimony they want and the doctors and lawyers again because they will get money no matter how long it takes to end a case. In some cases the same doctor is allowed to give two totally different testimonies that contradict each other. The doctors have discovered that it is very lucrative to testify in workers compensation cases. The average cost for a doctor to testify is $1,000.00 to $4,000.00 and the judge gets to choose which one he wants to believe, which is not always the treating doctor of the injured. Most of the time the judge accepts the testimony that supports the workers compensation insurance company. Doctors are not held accountable for how they testify. Here is an example: Doctor X is chosen by the claimant for treatment of an injury. The doctor is later asked to testify on the behalf of the claimant and gives a testimony supporting the claimant because he is being paid to do so by the claimant. At a later date, during a different petition filed by the worker's compensation insurance company, the same doctor X testifies on behalf of the worker's compensation insurance company, because they are now getting paid by the insurance company for their testimony this time. The testimony is now totally different than the testimony given earlier. The doctors can do this because no one holds them accountable for the way they testify. The PA worker's compensation judges and the PA medical board do not see this practice as an unethical act. If doctors are not held accountable for changing their testimony, of course they are going to change it when asked because they get paid for their testimony. The average payment for an IME is approximately $500.00 to $1,000.00 and for a doctor to perform an Independent Medical Exam (IME) and the average cost for the doctor to testify as to the results of the IME is $1,000.00 to $4,000.00 per hour. Complaining to the Ridge administration's medical board is not going to get you any results. The medical board in Pennsylvania consists of medical personnel, attorneys, and pharmaceutical workers. The medical board very rarely disciplines a doctor for any wrong doings. This is a clear case of conflict of interest on the Pennsylvania medical board because there is no representation of the patient. This is an area of the law that the worker's compensation insurance companies have found they can exploit. Who does this benefit? This would benefit the workers compensation insurance company, because after this type of action no one knows who is right and who is wrong and therefore justice is a guessing game and not the actual truth.
3. The worker's compensation insurance company can file as many petitions that they want. All petitions filed are accepted even if they have no legal foundation. This happens because when the partition is sent in it is scanned into the worker's compensation computer system and no one checks it to see if it has any foundation. An injured worker can be hauled into court just as a harassment tactic used by the worker's compensation insurance company. When the injured gets a favorable decision and the insurance company is found to have had no reason for filing a petition the injured should be reimbursed for their legal fees. This is rarely done even though it is part of the law that helps to protect the injured from frivolous petitions. In Pennsylvania, all petitions filed are accepted as having a good legal foundation. Why the worker's compensation judges ignore this part of the law is beyond my understanding. The petitions are filed to get the injured off full disability so the compensation rate can be lowered and eventually eliminated all together. Who does this benefit? The worker's compensation insurance company because they get to put the injured in financial difficulty and can get the case settled for less then what the injured is entitled and it puts a time limit on the benefits that must be paid out. Medical benefits are being waived by the injured to get a settlement so that bills can be paid.
4. When either the defendant or the claimant loses a case an appeal is filed. It's takes anywhere from 4 months to 18 months, and even longer, to get a decision from the Pennsylvania worker's compensation appeal board. The reason it takes so long is there are a limited number of judges on the appeal board for the entire state. These appeal judges come from the pool of attorneys that was practicing workers compensation law in PA. (Remember the attorney can take to the job of appeal judge his/her prejudice towards either side). The board travels around the state and returns to one particular city about every 4 months. This drags everything out and costs both parties legal fees just so the state can save money and function with one appeal board. Who does this benefit? The lawyers and the worker's compensation insurance companies benefit from this practice. The attorneys because they just keep collecting money no matter how long it takes and the worker's compensation insurance companies because the longer it takes to make a decision the better chance the judge will confuse the facts and make a decision not based on the truth. The appeal is given in a written form. The appeal judge reads the evidence submitted by both sides and makes a decision from the written material. This is a poor method for an appeal because if the judge interprets the written documents wrong for either side then the decision will be flawed because neither side has the opportunity to set the record straight.
5. When the employer commits fraud or the workers compensation insurance company there is nowhere to file a complaint. The worker's compensation act specifically states that fraud committed by any party involved in a case will be prosecuted and held accountable but yet this does not appear to be applied equally to both sides in Pennsylvania.
Filing a complaint with the worker's compensation bureau about a judge failing to take action when fraud is committed by the workers compensation insurance company/employer is a waste of time. The bureau wants nothing to do with a fraud complaint unless the claimant commits it.
All insurance fraud hotlines in Pennsylvania are set up to take information and act on a fraud tip only if it is against a claimant or policyholder not the insurance carrier.
When fraud is reported to the Insurance Commissioner of Pennsylvania it is handled in the most unusual manner. Contacting the insurance company accused of the fraud and asking them if they know anything about the fraud committed in the complaint is the way the insurance commission investigates the complaint. Of course, the answer will be, what fraud, and then a form letter is sent to the individual who filed the complaint stating "The investigation turned up no evidence of insurance fraud" and the case is closed. The Auditor General of PA established this during his investigation of the Insurance Commission of PA.
The office of the Pennsylvania Attorney General, Office of Consumer Complaint, Insurance Fraud Department will take a complaint of insurance fraud committed by an insurance company/employer but will not take any legal action. The complaint is taken, time passes, a form letter is sent out to the person filing the complaint stating: "No legal action will be taken at this time."
6. There are no cost of living raises for an injured worker. A stay on worker's compensation can be long. Years will pass and the injured get no increase in benefits even though one's expenses continue to increase. There has no been a cost of living raise to an injured worker for 30 years going on 31 years.
7. Pennsylvania takes one third of your gross income when you use worker's compensation. This represents the taxes that you would have to pay. The Social Security tax and Medicare tax are eliminated and nothing is added to the injured worker's accounts while on worker's compensation. This means you get no credit towards retirement while on worker's compensation. The state gives the one-third discount to the workers compensation insurance company. This hurts the injured down the road when retirement time comes around.
8. When on worker's compensation, one cannot file a federal, state, or local income tax return. This is unfair because the tax rate for all others is adjusted when one files a return. The worker's compensation act prohibits one from filing a tax return therefore taking away any tax forgiveness the injured may be entitled too. The injured ends up giving up more money for tax payments than the working counterpart.
9. In Pennsylvania the law allows the insurance company to contact one's treating physician, via what is called ex-parte communication, with fraudulent information for the expressed purpose of getting the treating physician to change his opinion about one's medical condition. When the workers compensation insurance company sends this kind of information to the treating physician the injured never knows about it and does not have a chance to dispute the information. If the treating physician is prejudiced enough the/she may decide to testify on behalf of the worker's compensation insurance company leaving the injured without any medical testimony. Once this occurs the injured is removed from total disability and the insurance company is able to force the individual back to work before the injury is healed. This is the way the workers compensation insurance company reduces the amount of monetary benefits received by the injured. The state of Pennsylvania turns its back and allows this to happen. The law is supposed to protect the injured from this type of action but Pennsylvania's worker's compensation bureau allows this practice. Who does this benefit? It benefits the worker's compensation insurance companies.
10. If the insurance company decides that the injured should go back to work it maybe necessary to retain legal counsel. When an attorney is retained, the legal fees are deducted from your benefits before it is received. It's sent directly to the attorney from the insurance company and it is very difficult to stop the payments if you are dissatisfied with your attorney's performance. Make sure you get a good attorney from the start. You, the injured, must file a petition with the worker's compensation judge hearing the case at the time and ask him to remove the attorney from your case. This is the only way to stop the payments that are going to the attorney.
11. The right to expect confidentiality of medical records is lost when one uses worker's compensation. When a workers compensation claim is filed for an injury, the claimant/injured is considered to have started litigation for compensation for the injury. In our legal system when you litigate for an injury your right to keep your medical records private is lost. The thinking behind this is that the workers compensation insurance company defendant, in the litigation, has to have the right to see the records in order to defend against the litigation. However, the workers compensation insurance companies are using ex-parte communication with the treating physician not to get medical information but rather to supply information to the treating physician in an attempt to get a change in the diagnosis thus interfering in the treatment of the injured. I thought workers compensation was an insurance benefit that could be used when injured to get medical and financial help until able to return back to work. This means even if one directly tells the physician not to release any medical information, the doctor can still release medical information without disciplinary action from the Pennsylvania Medical Board. The Pennsylvania medical board does not recognize this practice to be unethical or illegal. The information is supposed to go through the attorney of the injured before it is released to the insurance company. PA has chosen to bypass this procedure. This hurts the injured worker because other medical information besides the injury information is being passed on to the insurance companies.
12. If one's injury require a change in careers, to bad in Pennsylvania, because there is no clause in the worker's compensation act to afford the injured any job training. You will be on you own. The state has a vocational rehabilitation program but it is so under funded that not many get to use it. The most severe disabled get it first and if the fund runs out of money before it gets to you, then you get no help. You then go on a waiting list only if you qualify. The standard for qualifying for vocational rehabilitation is so high that most injured, even though they can't return to their pre injury job, would never meet those standards. To bad this issue was not important enough for the governor to initiate a change. This would help a lot of injured workers to get back to work and restore their lives back to normal, if that is possible.
13. While working one may have had medical insurance through one's employer, however, if the injured is unable to return back to the same job and is fired by the employer, all medical benefits are lost without compensation. One's injury will still be treated and paid for by the worker's compensation insurance company, but the other medical coverage supplied by the employer will be lost. If you were being treated for a life threatening disease, the loss of your medical benefits would turn out to be deadly. An offer has to be made to the injured to continue with the coverage at a cost to the injured, but this usually is to expensive for one to afford when on the fixed income of worker's compensation. To bad this issue was not important enough for the governor to initiate a change.
14. If the worker's compensation insurance company is successful in modifying the benefits of an injured worker the money to pay the bills may have to come first before filling a prescription for medication needed for treatment of the injury. The insurance company is not required to pay for the medication up front. In other words, if the injured worker does not have the money to pay for the medication, then send the receipt to the insurance company and wait for reimbursement, the injured worker will not get the medication necessary for the treatment of the injury. The workers compensation insurance company can delay the reimbursement, knowing it will cause financial hardship, and cause the injured worker to suffer or do without other necessities. This can be extremely difficult hardship for the injured worker if the treating doctor is prescribing several expensive medications until the one that works is found.
15. Twice a year the worker's compensation insurance company has the right to force you to go for an "independent medical examination" or "IME". This supposed to be "independent" even though the worker's compensation insurance company selects the doctor and pays for the examination. The doctors that the worker's compensation insurance companies hire are professional witnesses for hire. The doctor will conduct an examination of the injured worker, but the diagnosis will reflect what the worker's compensation insurance company needs to either totally stop the worker's compensation benefits or greatly reduce the amount of the worker's compensation benefits. Remember the worker's compensation insurance company has spent lots of money to get a report that works in their favor not the injured worker's. Governor Ridge and a majority of Pennsylvania Legislators feel that this concept is good and brings about a fair assessment of an injured worker's physical condition into the proceedings. This clearly benefits the worker's compensation insurance company and no one else. This is the most pathetic and unfair concept I have ever heard. In order for the "IME" to be truly independent, impartial and a true assessment of the injured worker's physical condition a neutral party should select the physician. The physician should be independent of all parties involved in the litigation, including the state of Pennsylvania.
16. Here is the most puzzling aspect of workers compensation in PA. The insurance companies have lobbied to get a time limit assessed to injured workers benefits. The current limit is 500 weeks. After the 500 weeks the injured worker will no longer be eligible to collect workers compensation. Even though the disability has not gone away the insurance company will disappear and the injured worker will then be on his/her own. My question to the PA legislature would be, why? Again, worker's compensation was established in exchange for an injured worker giving up the right to sue the employer for a work related injury. If an injured worker were suing an employer for an injury that would be permanent and would last until death, the injured worker would seek enough financial relief to last a lifetime. How can the state put a limit on worker's compensation as long as the worker is disabled? The legislatures have given up something they were not legally able to give up. Most injured workers turn to Social Security Disability at this point. This practice has allowed the insurance industry to shift the burden of caring for the injured worker over to Social Security Disability. Instead of the burden and expense being on the insurance company it is now on Social Security Disability. Why should Social Security Disability pay for the injury instead of the insurance company, which was paid to take care of the injured? This may be one of the reasons the Social Security system is going running out of money. This is happening because the legislature has decided to let the insurance companies get away with this practice.
17. Another interesting twist to workers compensation in PA is that if you had an existing disability, it cannot be considered when the insurance company hires a vocational rehabilitation company to find employment for the injured worker. This is kind of ridiculous because if the injured worker were blind before getting injured on the job the job search would have to take into consideration the blindness. However, in some cases if an injured worker has an existing disability like a knee injury, and this it will not be taken into consideration when an rehab company is hired for a job search. This practice is crazy, it allows to much room for the insurance company/rehab company to send an injured worker to a job interview for a job that they know the injured worker cannot perform with the two disabilities but the injured worker can perform the job if only the most recent injury is considered. By doing this they get the injured worker to turn down the work and this allows the worker to be put on temporary disability status for turning down the job. This will limit the amount of time the injured worker is eligible to collect worker's compensation under the current law.
18. The Pennsylvania Worker's Compensation Bureau is using the American Medical Association's "Guide to the Evaluation of Permanent Impairment" as a guide for determining an injured worker's disability rate for worker's compensation. The AMA warns against this practice. The guide is for determining impairment not disability. There is a difference between the two. The AMA writes this about the Guide to the Evaluation of Permanent Impairment, "Criticisms have focused on 2 areas: internal deficiencies, including the lack of a comprehensive, valid, reliable, unbiased, and evidence-based system for rating impairments; and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation. We focus on the internal deficiencies and recommend that the Guides remains a tool for evaluation of permanent impairment, not disability".
19. Here is the true reason Worker's Compensation is so high in Pennsylvania. There is an organization of insurance companies located near Philadelphia, Pennsylvania, called the "Pennsylvania Compensation Rating Bureau." This organization is made up of the major insurance companies doing business in Pennsylvania. Just recently a couple of large businesses sent representatives and a representative from the Labor and Industry Department was added to the ranks during the rate setting phase of the worker's compensation insurance industry. This organization arbitrarily sets the rates for worker's compensation insurance in Pennsylvania. This organization (Pennsylvania Compensation Rating Bureau) is not a part of the Pennsylvania government. The word bureau is very misleading. The insurance industry has been allowed to set the worker's compensation rates for Pennsylvania without any regulation or input from the government. These insurance companies are making billions of dollars off of worker's compensation by setting their own rates. They are able to determine how much profit they will earn. The insurance companies are the reason the rates are so high. They claim that it is the injured worker causing the high rates when in fact they are causing the problem and high rates themselves. The state of Pennsylvania allows them to get away with this for some unknown reason (campaign financing and lobbyists). Cutting the few benefits of injured workers will do little to offset this practice. The Pennsylvania government is allowing the insurance companies to make billions of dollars in profit from worker's compensation while they deny any pay out of benefits.
By signing this petition I agree that reform is needed on the above subjects to make the Workers Compensation Act used in Pennsylvania what is was originally intended to be. Workers compensation was created and enacted in exchange for the right of an injured worker to sue his/her employer. The reform would give back the benefits the legislature has taken from the injured worker.