This question requires a multiple part answer because its complicated. So lets start:
The Pennsylvania Workers’ Compensation System is now designed to move injured workers through the system as quickly as possible. Prior to legislative changes in the 1990’s, injured workers could stay covered by PA Workers’ Comp for decades. Settlements (then called Commutations) had to be in the “best interests” of the injured worker and closing or settling medical payments were not possible or legal. There were no truly bogus vocational evaluations like there are now. An injured worker who closed their case by the now-antique Final Receipt could easily reopen it.
There was no finality in the Pennsylvania Workers’ Compensation system and it was recognized that work injuries could have long standing implications for injured workers. That changed in the 1990’s as Pennsylvania, like other states, moved to restrict workers’ compensation benefits. Why did this happen? Understand that Pennsylvania Workers’ Comp is state regulated but privately funded unlike Unemployment and Social Security.
This means that insurance companies have a big say in how the laws are written and administered. In the history of Pennsylvania Workers’ Compensation there have been legislative changes every few decades. Sometimes, Pennsylvania’s law is liberalized like the changes in the early 1970’s. The changes in the 1990’s went the other way and PA WC became slanted in favor of insurance companies. If history is any guide, the law will again be liberalized around 2025 unless all workers ‘compensation is dropped in favor of National Disability Insurance as happened in Britain in the 1950s and as advocated by former President Bill Clinton in the 1980s (it didn’t happen here. Not yet).
States, including Pennsylvania, don’t change their workers’ comp laws by accident. They work together. All the top WC Administrators from each state get together each year along with politicians, insurance companies and defense attorneys and attend a conference sponsored by the International Association of Industrial Boards and Commissions (IAIBC). These meetings take place in exotic locations and there are plenty of insurance company sponsored junkets and parties. The bureaucrats discuss data provided by a privately funded think tank from Cambridge, MA called the Workers’ Compensation Research Institute. This outfit studies each state system and reports their date from an insurance company perspective. Small wonder that the anti-worker changes to State laws in the 1990’s resembled each other. (It would be very interesting to examine the travel budgets and expense vouchers of Pennsylvania’s Workers’ Compensation Officials for the past 30 years or so….)
The new goal of Pennsylvania Workers Compensation is to get injured workers out of the system as soon as possible through temporarily workers’ comp, quick settlements, labor market surveys and impairment rating exams. Today, Compromise and Release workers’ compensation settlement agreements allow an injured worker to settle all rights including medicals.
Pennsylvania workers’ comp insurance companies are frustrated that they haven’t been able to fully automate the system because of a pesky legal doctrine known as Due Process. Due Process is a right protected by the United States Constitution. A famous US Supreme Court decision called Goldburg v. Kelly ruled that when states give benefits to people; those benefits can’t be taken away without a hearing and the chance to present evidence.
This is a pain in the neck for insurance companies in Pennsylvania Workers’ Comp. There is a tension here between the insurance model and the due process model. The insurance model sees injured workers as little problems to be managed as efficiently as possible. The due process model recognizes that people have rights and emphasizes lawyers and litigation.
The legislative changes to Pennsylvania Workers’ Comp in recent decades have swung in favor of the insurance model; the resulting law in Pennsylvania is a hodge podge mess. Insurance Companies have not completely gotten their way in Pennsylvania but the Pennsylvania Insurance Federation is always at it and the reduced role of Organized Labor in Pennsylvania means that there is little to stop them.(Very little got past Julius Uehlein, the late head of the Pennsylvania AFL-CIO in the 1970’s and 1980’s.)
There are currently pending legislative proposals to, for example, extend the captive period requiring injured workers to treat with company doctors. If you can control the doctor, you can control the system. As a wise person once said: “No true independent evaluation goes unpunished”
PA Workers’ Compensation Companies would like to get rid of lawyers in the system starting with their own. The most rapidly rising cost in the Pennsylvania Workers’ Compensation system in the past decade has been the fees charged to insurance companies by defense lawyers. Insurance companies have responded by starting their own law firms and having their lawyers work “in house”.
Workers’ Compensation Insurance companies would love to get claimants lawyers out of the system although they haven’t yet figured out a way to do it. Their current approach s to have the adjuster tell the injured worker to settle their case as soon as possible instead of hiring an attorney “who will take all the money”.
This is rather amateurish and no doubt the insurance companies will become more sophisticated in coming years. Most realize that studies show the net recovery to the injured worker with workers’ compensation attorney far exceeds the costs of the attorney.
The current Workers’ Compensation law is designed to get injured workers so disgusted with the process that they give up and go away. To a large degree, Workers’ Compensation litigation in Pennsylvania is a charade. Many of the actors do not believe in what they are doing, they are well paid cogs in a machine. And they are all making money. The Employer’s doctor, the “independent” medical examiner, who testifies that the injured worker with the three level back fusion suffered a back sprain at work and the surgery was really caused by a childhood tricycle accident really doesn’t believe it. The so-called vocational expert who testifies that a 55 year old worker with a tenth grade education and a 15 lb lifting restriction is fully employable doesn’t really believe it.
The defense attorney who files a Petition for Termination claiming that the severely injured worker is fully recovered doesn’t really believe it.( Well, the young defense attorneys do, but they get jaded quickly).
You, the injured worker are getting hassled because 1) the WC system wants you to go away 2) The PA Workers’ Comp litigation process is a based on a series of phony charades and 3) Doctors, lawyers and various experts are making money playing charades that they don’t believe in. The only people not adequately served by the PA Workers’ Compensation system are employees injured at work and employers. If you would like to talk to a lawyer, free of charge, who really cares about the injured worker and is not interested in playing in the charade, feel free to contact any of the attorneys at Calhoon and Kaminsky P.C., at 1-877-291-9675.
