Pennsylvania Supreme Court strikes down IRE provisions in Workers Compensation Act

Attorneys across the Commonwealth of Pennsylvania have been waiting for the Pennsylvania Supreme Court to clarify the status of the Impairment Rating Evaluation section of the Act, since the Commonwealth Court struck down provisions and remanded the case back to a Workers Compensation Judge.   The PA Supreme Court issued it’s decision as I sat in a workers compensation hearing around 11:30 AM this morning.   In Protz v. WCAB (Derry Area School District), No. 6 WAP 2016, the Court struck down the IRE provisions of the Act as unconstitutional in it’s entirety.

To help you understand, let me first explain the IRE process.  First, and foremost, it is a process used to limit injured worker wage loss benefits.  The injured worker is examined by a doctor chosen by the Commonwealth for what is called an impairment rating evaluation.  The IRE exam is solely used to establish a whole body impairment.  If the IRE examination finds an injured worker to have 50% or less whole body impairment from the work-related diagnoses, then wage loss benefits are capped to 500 weeks (about 9 1/2 years).   A request for an IRE examination by the insurance carrier cannot occur until an injured worker has received at least 104 weeks (2 years) of total disability compensation. Don’t confuse this examination with an IME  (defense) examination.  They are entirely different.  IRE examinations are nothing more than a tool for an insurance carrier to limit wage loss benefits of the injured worker.  Additionally, the provision is also unfair because it is nearly impossible to get a 50% or more whole impairment rating evaluation, outside completely catastrophic injuries. Continue reading

In Pennsylvania, what happens to Medicare Set Aside Funds

You may have heard about Medicare Set Aside agreements when it comes to Workers Compensation lump sum settlements.  They are complex and confusing too many.  Let me try and help explain a little about this complex area of law.

First, when is a Medicare Set Aside agreement required as part of a structured workers compensation settlement?  Generally, with a worker’s compensation settlement, federal law prohibits Medicare from paying for injury-related medical expenses or medications that an employer is responsible to pay.  In essence, other insurance coverage exists for those medical expenses.  To achieve that purpose, Federal government regulations require that a portion of settlement funds be “set-aside” in an account to pay for future medical expenses related to the work injury. So what specifically triggers this process?  Here are the general criteria when a settlement should be submitted for CMS review.

CMS will only review new WCMSA proposals that meet the following criteria:

  • The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or

  • The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00

So, what is the important words in here — “is” and reasonable Continue reading

New Opioid policy for Injured Federal Employees

The US Department of Labor’s Division of Federal Employee Compensation has issued new guidelines for the use of opioids to treat injured federal employees.  There has been significant nationwide concern over the growing opioid addiction epidemic across America and we should expect more changes to come, at the state levels as well.

Here is the gist of the new opioid guidelines.

  • Implementation is set for August 2017
  • Opioids can be prescribed for an initial 60 days.  However, the prescription must be broken down to  two 30 prescriptions each.
  • After the initial 60 day prescription, then to extend opioids, the treating physician must complete a Letter of Medical Neccessity (LMN). A LMN must be completed for any subsequent prescriptions.
  • Compound medications containing opioids must alway be prescribed with a LMN.  This guidelines goes into effect as of June 26, 2017.

The use of narcotic painkillers has been steadily increasing, and with that rise in use has come addiction, abuse and resulting deaths.  Many estimates put opioid use three times  higher this decade than previous decades.  Unfortunately, patients with long-term injuries are readily prescribed narcotic pain medications and that use has created significant dependency issues for many users, especially those suffering from arthritis and back injury. In many instances, insurance companies simply find it much cheaper to pay for opioid prescriptions than other treatments, including surgical procedures, that could provide much more effective long-term relief.

I suspect we will start to see similar measures rolled out in state Workers’ Compensation programs.

If you are an injured Federal Government employee, or you have suffered any work injury in the private sector and live in Pennsylvania or Maryland, contact Mooney & Associates today for a FREE consultation.  Don’t risk it going alone.  You have too much to lose.  You can call us at 717-200-HURT.