Workers' Compensation Defense

NEWS

On August 1, Michele Punturi (Philadelphia, PA) was joined Michelle Leighton (Partner and National Claim Advocacy & Consulting Leader at Connor Strong) and Robin S. Roeder (Senior Vice President Risk Management at Sedgwick) in presenting a webinar for CLM, “The Dream Team Approach to WC Case Management,” where they discussed why controlling exposure is central to the workers’ compensation claims and litigation process. For successful case management, the employer, broker, claims adjuster and attorney must work from the same strategic playbook. By adopting a team approach, we can identify roles and ensure clear communication among all team members to limit exposure, reduce costs, and close claims. But who defines the rules of the game, and who are the star team members? What are their roles, and how should they interact to benefit each other? This session offered an updated perspective on balancing the team dynamic. 

On August 9, The Legal Intelligencer published Michael McMaster's (Philadelphia, PA) article "AI in Workers' Compensation: Are We There Yet?" You can read Mike's article here.
 

RESULTS*

Tony Natale (King of Prussia, PA) successfully defended a Claim Petition involving complex injury allegations and a most disturbing initial judgement on the pleadings since the employer failed to timely answer the claim petition. When Tony became involved, he was able to limit the judgement on the pleadings to the date that a timely Answer could have been filed. Ongoing disability in the case turned on the claimant’s medical evidence and credibility. The claimant presented an expert witness who opined that the claimant’s virtual lifetime of serious low back and neck abnormalities were “aggravated” by the claimant sitting down at work after feeling dizzy. Tony presented rebuttal expert evidence from a well-respected orthopedic surgeon demonstrating no architectural change in the claimant’s lumbar spine or cervical spine due to the alleged injury event and no ongoing or acute problems. The court accepted the defense evidence as credible, and the claimant was found to be without ongoing disability and fully recovered from any condition subject to the former judgement on the pleadings. 

Bill Murphy (Roseland, NJ) was able to permanently close a matter involving a serious shoulder injury with a Section 20 resolution. By way of background, in New Jersey, Section 20 settlements (full and final) are approved in a small number of limited cases—denied claims, minimal treatment, dispute as to whether there’s any permanent disability, etc. In this case, the petitioner sustained significant injuries to her shoulder with an MRI showing tearing. The petitioner ultimately underwent two shoulder surgeries, and our own permanency expert found permanent disability of 7.5% partial total. Based upon wage statements Bill obtained, he asserted that any permanency award should be paid at a reduced rate—making the monetary award about $40,000 less than what would be paid at the full chart rate. When the judge attempted to have the parties settle for a higher percentage of disability—to make up for the lower rate—Bill indicated our intent to take the matter to trial. In order to avoid a trial, the judge indicated he would approve a Section 20 settlement. Thus, in an admitted claim involving serious injuries, two surgeries and our own doctor conceding permanency, we were able to close the matter out permanently with a Section 20 resolution. 

Michael Duffy (King of Prussia, PA) received a favorable decision where Judge Rosen granted our termination petition and denied the claimant’s Petition for Penalties and Petition to Review Utilization Review Determination. The employer had accepted a right middle finger sprain. In prior litigation, the claimant’s review petition seeking to expand this injury was denied. In the pending termination petition, the Judge found the claimant not credible with regard to his ongoing complaints. The claimant claimed to be bed bound, and the judge opined that this allegation as a result of a finger sprain was absurd. The penalty petition related to payment of medical bills, and the judge found that, since the medical bills were related to the hand and not the finger, the penalty was denied. The Judge also denied the claimant’s Petition to Review the Utilization Review Determination, finding that more than 185 physical therapy visits were not reasonable for a finger sprain and because the opinions of the reviewer were corroborated by the employer’s expert’s opinion of full recovery.

*Prior Results Do Not Guarantee a Similar Outcome 

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_{What’s Hot in Workers’ Comp, Vol. 28, No. 8, August 2024, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2024 Marshall Dennehey, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.}