Pa. House votes to reinstate exams for those severely injured at work

Pittsburgh Post-Gazette

The Republican-controlled Pennsylvania House passed legislation on Friday that requires the most severely injured people receiving workers’ compensation to undergo a follow-up medical exam that could result in a reduction of benefits.

The passage reinstates the follow-up evaluations after they were struck down by a surprise Pennsylvania Supreme Court decision last summer.

The court ruled 6-1 that the state’s reliance on American Medical Association guidelines in those follow-up evaluations was unconstitutional because the state illegally delegated power to a private group to determine state-administered benefits.

That ruling found in favor of a 54-year-old Westmoreland County woman, represented by a Pittsburgh lawyer, who badly hurt her knee when she slipped and fell at work 10 years ago.

The court’s ruling also roiled insurance markets, resulting in an unusual mid-year increase in loss costs — a major component in the calculation of workers’ compensation insurance premiums paid by businesses.

Benefit costs rose 6.06 percent effective Feb. 1, according to the Pennsylvania Compensation Rating Bureau, a private group that influences workers’ compensation insurance rates by collecting information from the more than 400 insurance companies offering such policies statewide.

It was the highest annual hike in at least 20 years and translated to double-digit increases in insurance premiums that employers pay.

Rep. Rob Kauffman, RFranklin, said that amounted an annual cost of $165 million for businessesstatewide.

Mr. Kauffman introduced the bill, HB 1840, last October to reinstate the evaluations. It passed on Fridayon a 115-80 vote. Mr. Kauffman indicated he expects Gov. TomWolf to support the bill if the Senate passes it.

“It will be good for injured workers, those who employ them, those who represent them, those who insure them and (will create) a positive business climate we want to foster here in Pennsylvania,” Mr. Kauffman saidon the floor before the vote.

The bill requires the rating bureau to re-evaluate workers’ compensationbenefits costs within 90 days of the law becoming effective.

“Immediately following this calculation, the amount of savings shall be used to provide an immediate reduction in rates, equal to the savings, applicable to employers’ workers’ compensation policies,” the text of the bill reads.

Opponents of the measure argue that the exams — called impairment rating evaluations — unfairly limit benefits for the mostinjured workers.

Under the measure, an employer’s insurance provider can request that injured workers undergo a medical assessment after two years out of the workplace. If the physician — using guidelines set by the American Medical Association — finds that a worker was less than 35 percent injured at that point, the insurer can cap partial benefits at 10 years.

If the physician rated a worker’s injury at more than 35 percent, the worker receives full, lifetime benefits.