Mooney Law Wins Review Petition to Expand Injury Description

I recently won a Review Petition expanding the injury description beyond the accepted injury. This type of petition is frequently litigated in Pennsylvania workers’ compensation and I have handled tons of these petitions for more than a decade. Often, the injury description at the time of injury is not the accurate description of injury. What follows then is denied medical treatment and unpaid medical bills.

In this case, the workers’ compensation insurance company accepted an injury to my client’s shoulder. My client treated and had surgery on her shoulder. However, although the surgery relieved her shoulder pain, it did not relieve symptoms that were radiating down her arm. Her shoulder surgeon referred her to a spine surgeon because he suspected her ongoing arm symptoms were coming from her cervical spine (neck). What ensued was denial of treatment and unpaid medical bills from the insurance company because ongoing treatment was for her neck, and not the shoulder.

I filed a Review Petition seeking to expand the description of injury to include the cervical spine. Through the litigation, we took our client’s testimony and the deposition testimony of the client’s spine doctor. Of course, the insurance company had an Independent Medical Exam (IME) that refuted any cervical injury.

The litigation was contentious as the insurance company tried to point to the fact that our client did not initially complain of neck pain. That assertion was false. However, even more so, our client had been complaining of symptoms running down her arm since the occurrence of the initial injury. We were also able to show that our client never had any neck pain or symptoms running down her arm prior to the work injury. After months of litigation, the Workers’ Compensation Judge granted the Review Petition and expanded the description of injury to include cervical related diagnosis. My client is now able to have cervical spine surgery and it will be paid for by the insurance company as well as receiving ongoing wage loss benefits while she recovers from the cervical spine surgery. Not only did we win the Review Petition, but the Judge awarded that our legal fees were to be paid by the insurance company.

The point here is that when a work-related injury occurs, insurance companies accept an injury but limit the definition of the injury and limit the body parts accepted. As medical treatment continues, conditions are ruled out through treatment, which can be indicative of the actual injury coming from another body part. That will trigger denied medical treatment. Like this case, some injuries appear to be to a body part like the shoulder, but the actual injury includes several body parts, such as the shoulder and neck. Again, this will trigger denied medical treatment. Finally, in some cases, the condition that was originally accepted was simply referred pain and the actual injury was to a referring body part, such as an accepted back injury that is actually a hip injury. Again, this will trigger denied medical treatment.

This leads to mounting unpaid medicals bills, credit problems for the injured worker, and frustration because of difficulty getting the medical treatment needed. Injured workers have legal recourse. Injured workers can fight back against insurance companies. Our client fought back and won. Over a decade of representing injured workers, I have won many bouts of litigation involving description of injury. If you have been injured at work, you do not need to fight an insurance company alone. Call Mooney Law today for an absolutely FREE consultation. Better yet, we only get paid if we win for you! Call us at 717-200-HELP or 717-632-4656. You can also visit our website and complete the Schedule a Consultation form to schedule a consultation. We are ready to help!

Mark Buterbaugh

Attorney representing injured workers and Social Security Disability clients in Pennsylvania and Maryland.