Injured Worker Wins Benefits

A laborer seriously injured at a construction site won workers’ compensation benefits despite the fact that his employer was uninsured.

A laborer seriously injured at a construction Site M’on workers’ compensation benefits despite the fact that his employer was uninsured.

The laborer was tearing off a roof and told the employer that the beams were dry-rotted and could not support him. The employer disagreed and told the laborer to slide plywood over the beams and stand on the plywood; he did, and he fell from the roof onto a concrete slab. He suffered a skull fracture, an orbital fracture, and mild brain injuries. Placed in a drug-induced coma, he was hospitalized for over a week and later treated by neurosurgeons and brain trauma specialists.

The Pennsylvania Uninsured Employers Guaranty Fund (the Fund) stands in the shoes of uninsured employers, managing claims and litigating against Workers when necessary, The Fund challenged the laborer’s right to benefits, focusing largely on the expectation that he should return to work. The laborer’s brain trauma expert testified at the hearing that the laborer had pressure headaches, vision blurring, fatigue, short-term memory problems, and mild cognitive deficits. He characterized the injury as a mild traumatic brain injury that left the laborer with significant cognitive problems and vision problems. He noted that the laborer had discontinued treatment but had not recovered.

The Fund engaged a physician to conduct an independent medical exam that was performed after the laborer’s other medical treatment had essentially ended. Because its physician concluded that the laborer could return to work, and because the laborers health-care providers did not reexamine him after the independent exam, the Fund claimed that its physician’s testimony was superior, in part because it was more recent in time.

On appeal, the Commonwealth Court disagreed, first noting that in the case involving the teacher, he was already collecting his monthly pension payments at the time he entered the guilty plea and was not aware that his conviction would trigger a pension forfeiture. When he received notice of the forfeiture, he tried to withdraw his guilty plea, but the presiding judge found that pension forfeiture was not a valid reason to withdraw a fully counseled guilty plea.

Judges and all public officials and employees are subject to these strict laws that create the potential for pension forfeiture. Given the objections raised by the judge and teacher described above, it appears that some individuals with public pensions may not be fully aware that they face grave risks of forfeiture the hearing officer found the laborer’s expert more credible. Next, the court found that the most recent examination in workers’ compensation cases is not necessarily or always the more reliable.

Workers seeking compensation for injuries must prove the nature and duration of their disabilities. Once they have met that burden to the satisfaction of the hearing officer, the fact that a more recent exam results in a different opinion is not binding on a hearing officer.

Workers should keep up with their medical care in order to present the best case at a hearing. But the most recent medical exam does mot carry any superior weight at a hearing simply by reason of its date and time.

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