Workers' Compensation

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The Workers' Compensation Practice Group is devoted to the exclusive representation of employers, insurance carriers and third party administrators. While many of the attorneys in this group have a background in civil litigation, they all focus their practice solely on the defense of workers' compensation matters. Our attorneys are well versed in the intricacies of this nuanced practice, and due to their constant presence in the courts where they practice, they are well respected by the judges before whom they regularly appear and the attorneys against whom they compete.

Our attorneys are involved in all aspects of workers' compensation, from the infancy of a claim through practice in the appellate courts. We are vigorous litigators who also recognize that litigation is not always the primary focus of an employer's successful workers' compensation program. Significant monetary savings can be achieved through the effective management of workers' compensation plans and innovative return-to-work programs, and our attorneys are on the cutting edge of case law developments to assist in the design, implementation and continuation of such programs. We also provide risk management services and can help reduce costs by becoming involved during the pre-litigation phase. In addition, the work of the attorneys in the firm's highly regarded Appellate Advocacy and Post-Trial Practice Group includes front-line responsibility for conducting necessary legal research, writing required briefs, and preparing and presenting oral arguments in post-trial motions and appeals.

As workers' compensation has become increasingly sophisticated, we have expanded our scope of practice to support clients in areas that have become tangential to the workers' compensation practice.

Workers' Compensation Fraud
Fraud contributes significantly to the cost of doing business and negatively impacts employers, insurance carriers and third party administrators. We can facilitate the filing of a fraud claim through local government agencies and review all cases for civil remedies to help our clients recoup some of the monies expended due to fraudulent cases.

Unemployment Compensation
It has become increasingly apparent that there is a cross-over between workers’ compensation and unemployment cases. While the two areas of law are mutually exclusive by way of collateral estoppel, it is clear the same issues are simultaneously being litigated in both forums. By using the unemployment and workers’ compensation forums to bolster defenses in both claims, we achieve successful results for our clients. Our unemployment practice is full service, with our attorneys handling claims at all levels of the courts.

Federal Black Lung
Our attorneys defend claims brought before the United States Department of Labor (USDOL) by coal miners and widows seeking benefits under the Black Lung Benefits Act. We are intimately familiar with the lengthy litigation process involved with Federal Black Lung claims originating at the USDOL and proceeding to a hearing before an Administrative Law Judge. Our attorneys have also handled numerous appeals to the Benefits Review Board and the United States Court of Appeals. We are also well versed in defending pulmonary disease cases under the Pennsylvania Workers’ Compensation Act that often go hand-in-hand with claims brought under the Black Lung Benefits Act.

Hearing Loss Claims
Injuries resulting from exposure to hazardous occupational noise comprise one of the largest group of specific loss/permanency claims in the tri-state area. In addition to becoming more commonplace, these claims have also become more technologically complex. Each attorney assigned to hearing loss claims are familiar with the science behind acoustical trauma, including the inner workings of audiometric testing, leading to effective cross examination of key witnesses. Further, our attorneys seek to expose pre-existing, non-work related hearing loss and differentiate it from compensable loss. We are one of the leading defense firms in protecting successor-in-interest employers that are unexpectedly plagued with hearing loss claims stemming from employees’ hazardous noise exposure with previous employers. In Pennsylvania, we were pioneers in the effort to change the standard of monetary award in hearing loss cases from an all-encompassing specific loss award to that of a percentage award based on actual work-related hearing loss. Our attorneys are also well versed in the practical implications of a working hearing conservation program and the benefits such a program can have on an employer’s bottom line. 

Medicare Compliance
Our Medicare team has the comprehensive knowledge necessary to effectively handle set-asides in all parts of the country. We are well-versed in federal and state liability systems, as well as the workers’ compensation systems. In addition to protecting Medicare’s interests through set-asides, we also alert our clients to the involvement of the State Children’s Health Insurance Program (SCHIP) Reporting Law. We offer cogent advice regarding case settlements, including the use of structured settlements and other strategies to bring cases to conclusion. We are willing and able to work with lawyers throughout the country to provide the support they need regarding Medicare issues.

Coverage
Occasionally, carriers are drawn into workers' compensation litigation notwithstanding a dispute between the employer and the carrier as to viable workers' compensation coverage. Our attorneys have experience in navigating the potential pitfalls that can arise during litigation due to the conflicting interests of the employer and the carrier, and have successfully obtained dismissals of carriers as parties from these unwarranted claims.

Interplay Between the ADA, FMLA and Workers' Compensation
Our attorneys have expansive knowledge of the ADA, FMLA and workers’ compensation statutes that all impact termination of employment. We fully understand the complex relationship between these statutes and provide our clients the necessary guidance during the pre-litigation phase. We also advise our clients on the potential impact of a wrongful termination and provide detailed recommendations to facilitate a lawful employment termination. Our legal approach focuses on mitigating future exposure by providing practical advice to avoid pitfalls when navigating the decision to terminate an employee. We work with our clients to evaluate and address all legal issues involving the ADA, FMLA and workers’ compensation as it pertains to avoiding a wrongful termination claim. 

Medical Marijuana
There has been a wave of medical marijuana legalization throughout the country in recent years. It is now legal in more than 38 states, including ones where we defend clients in workers’ compensation matters. Our attorneys are knowledgeable about the medical marijuana laws in these specific states and can provide sound advice on the many issues that arise in the workers’ compensation context. Some of these issues include insurance coverage, payment, reasonableness and necessity of medical cannabis treatment for work injuries, work injuries that qualify as conditions treatable with medical cannabis, and workplace safety concerns. We are also committed to tracking important trends in medical marijuana law nationally to keep our clients well informed of significant developments and the impact they may have on the practice of workers’ compensation.

PENNSYLVANIA

Fee Reviews
Fee reviews have become an increasingly important component of workers' compensation cases in Pennsylvania. Our attorneys are very familiar with the legal issues associated with the fee review process and its interplay with active workers’ compensation litigation. By becoming involved at the onset of a fee review filing, we are better positioned to defend the interests of employers/carriers. Medical providers use fee reviews to challenge the timeliness or amount of medical payments made by employers/carriers. Providers are given two opportunities to file a timely application for fee review – (1) within 90 days of their original billing date, or (2) within 30 days after they are provided with notice of a dispute, whichever is later. The fee review process presupposes that liability has been established, and thus, provider's allegations are accepted at face value during the initial stages. As an unfortunate consequence, employers/carriers may face unjust initial Determinations. Disputing a fee review Determination requires a de novo appeal, which must be filed within 30 days of the date of the Determination. Our attorneys have extensive experience navigating the issues that then arise during fee review hearings and provide excellent guidance based on our thorough understanding of CPT codes and types of treatment. Our goal is to handle each case in an efficient and cost-effective manner.

Heart and Lung Benefits
In addition to handling traditional workers’ compensation claims, our attorneys also advise local municipalities and counties in Pennsylvania on heart and lung claims. The Heart and Lung Act provides full wage loss benefits to certain eligible municipal, county and state workers who are injured in the performance of their job duties. With a depth of experience in this area, we are well versed in the associated law and adept at defending clients facing these types of claims. Our attorneys understand the complex interplay between the Heart and Lung Act and the Workers’ Compensation Act, and will provide the necessary guidance in pre-litigation settings, address all issues to challenge entitlement to Heart and Lung benefits, and explain its impact on a workers’ compensation claim. Our approach focuses on mitigating future exposure and providing practical advice to avoid pitfalls in handling Heart and Lung Act claims. We work with our clients to evaluate and achieve reasonable resolution of both the heart and lung and worker’s compensation claims, as well as address any subrogation issues.

FLORIDA

Stop Work Orders
Stop Work Orders or Requests for Business Records are issued by the Division of Workers’ Compensation Investigators for the state of Florida. A business cannot legally operate while a Stop Work Order is in place. Failure to comply with a Stop Work Order can result in increased penalty assessments and, in some cases, criminal sanctions pursuant to Florida Statute 440.105. Our attorneys can assist business owners in navigating this difficult and complicated process, including record requests, reducing penalty assessments and filing petitions before Department of Administrative Hearings.

Insurance Premium Audits and Disputes
Disputes occasionally arise between employers and carriers after an audit takes place. Workers’ compensation rates in Florida are based upon job title and payroll, and discrepancies discovered following an audit can lead to loss of coverage, fines and assessments. We can assist employers throughout this dispute process, which can lead to improved outcomes and reduced assessments.

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Michele R. Punturi, Chair
Wiedt_Kacey
Kacey C. Wiedt, Co-chair

First District Court finds that judge of compensation claims abused his discretion in rejecting terms of employment contract as the contract expressly provided claimant would receive his salary only during the five-month championship playing season.

Jacksonville
Workers' Compensation
The claimant signed a seven-year Minor League Uniform Contract. Per the contract, his salary at the time of his accident was $1,500 per month to be paid over the five-month championship playing season. What’s Hot in Workers’ Comp, Vol. 28, No.
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Fake COVID-19 test sinks plaintiff’s case

Workers' Compensation

We successfully prosecuted a suspension petition in a case of first impression in Pennsylvania. The claimant sustained a compensable mental injury while employed with the employer. Thereafter, he refused to attend an Impairment Evaluation after receiving 104 weeks of indemnity benefits due to his injury. The court initially issued an order compelling the claimant’s attendance. Nevertheless, the claimant maintained his refusal to attend the evaluation, citing the fact that he was COVID-19 positive and required to quarantine.

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Fatal claim petition against national trucking company denied.

Workers' Compensation

The decedent died of a heart attack after a three-day, over-the-road run for the trucking company. The decedent’s dependents argued that the heart attack was caused by the rigors of the job. Although the decedent died as he was about to execute paperwork denoting his employment status as an independent contractor—he never signed the document. The case, therefore, proceeded to litigation in the Workers’ Compensation forum. Expert evidence was presented on the issue of whether the decedent’s job duties had any contribution to the death.

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Favorable decision in Federal Black Lung case.

Workers' Compensation

We won a favorable decision from an Administrative Law Judge on a Federal Black Lung claim. The judge credited the claimant with 11 years of qualifying coal mining employment, but found that the claimant had failed to prove a totally disabling respiratory impairment and, therefore, denied the claim. We presented evidence from our medical expert that the claimant did not contract coal workers’ pneumoconiosis as the result of his work in the coal mines, and that he was not disabled by a respiratory impairment.

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Medical provider claim petition dismissed, with prejudice.

Workers' Compensation

The parties were litigating a motion for medical treatment in which a physician was recommending an additional spinal surgery. The physician moved forward without authorization and performed spinal surgery on the petitioner. In order to complete the surgery, the physician brought in several ancillary services, including a vendor to perform diagnostic monitoring during the surgery. Following the surgery, the medical provider submitted its bills to the carrier, which were rejected based upon the lack of authorization.

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Successful defense of claim petition in case involving forklift accident.

Workers' Compensation

The claimant was hit by a forklift while operating a forklift, and alleged the accident caused a back injury. Through employer witness testimony and medical testimony, we showed that the claimant did not sustain a back injury, and that her medical issues were pre-existing and unrelated to the accident. The judge found that the evidentiary evidence presented by the employer established that, even though the claimant was involved in a forklift incident, the claimant did not sustain a work injury, and her ongoing medical issues are unrelated to the forklift accident. 

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