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. After a medical provider claim petition was filed, the respondent filed a motion to dismiss the matter for failure to obtain the requisite statutory authorization. The medical provider argued that it was only providing ancillary services and, therefore, did not require the authorization of the carrier under the New Jersey Workers’ Compensation Statute. The medical provider also argued that they were the “victim” since they were advised by the physician that the procedure was authorized. The judge rejected both arguments, holding that all medical providers including providers that provide ancillary services for surgical procedures, are required to obtain the same authorization for their treatment, or risk not receiving financial reimbursement.

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. 

The petition was filed by the claimant before an administrative judge. The claimant alleged he was entitled to reinstatement of indemnity benefits after he voluntarily stopped working due to hand pain. We argued the light-duty position available and offered to the claimant was a one-handed position, and presented employer fact witness testimony and video of the light-duty job in rebuttal.

We successfully excluded the cervical spine from an established workers’ compensation claim. The claimant injured his lumbar spine and alleged he passed out while at home from the lumbar spine pain, causing a neck injury. We presented hospital records revealing no injury to the cervical spine and that the claimant did not seek any medical treatment to the cervical spine until seven months after this alleged incident.

We obtained a favorable decision denying a claim petition that alleged a low back injury, including sprain/strains and intervertebral disc displacement status, after multiple surgeries. The claimant had a lumbar laminectomy in 2016 and a lumbar fusion in 2018. He alleged a work injury in April 2019 when emptying a small trash can into a dumpster. During the course of the litigation, however, the claimant and his doctor offered testimony that the claimant’s back problems, including the 2016 and 2018 surgeries, were related to his general employment duties with the employer and that the April 2019 incident was the “straw that broke the camel’s back.” We presented expert medical testimony from an orthopedic surgeon that the claimant’s back problems were degenerative in nature and were not caused or aggravated by his work activities or the alleged April 2019 incident. The judge denied the claim petition outright and found that the claimant had failed to sustain his burden of proving any work-related injury.

We successfully defended a claim petition on behalf of a well-known local hospital. The judge’s decision was based upon a full recovery opinion by a Board Certified orthopedic surgeon who was found credible, competent and persuasive given his credentials and understanding of the claimant’s extensive history, along with his review of post- and pre-injury records and diagnostic study films supporting no post-traumatic abnormalities. Based upon this strong medical expert testimony, the judge limited the claimant’s claim to a period of three months only, despite the claim for ongoing total disability, and did not expand the claimant’s nature of injury to include a herniated disc in the lumbar spine. In addition to expert deposition testimony, surveillance was also submitted and accepted, which demonstrated the claimant’s activities contrary to any ongoing disability and, more importantly and just as significant, were extensive medical records demonstrating that the claimant downplayed her prior injuries and her complaints, completely inconsistent with the actual medical records.  Further, the judge recognized the defense’s cross-examination of the claimant’s medical expert, particularly with respect to his credentials, analysis of the MRI and lack of identifying a herniated disc diagnosis in all of his medical records, yet testifying to same in an effort to support the claimant’s allegations of this description of injury.   

We succeeded in having the Industrial Accident Board grant reimbursement of an amount of total disability benefits tendered that were offset by contemporaneous short-term disability payments. The Board denied the claimant’s motion to compel production of paystubs that he claimed were required to determine the appropriate offset amount, if any. The Board reasoned that the information provided was sufficient to calculate the overpayment amount and that the Fair Labor Standards Act did not require the pay records be kept in any particular form.

The plaintiff alleged she was exposed to COVID-19 while caring for a patient and infected both of her adult sons. One son died from COVID-19. We argued that COVID-19 was not an occupational disease and that she could not establish she contracted COVID-19 at work. The Industrial Accident Board agreed, resulting in a significant win for the employer.

We established that the employer was never served with the notice of assignment of the claim petition to a judge. While the claimant’s attorney had properly served the claim petition itself on the employer, we correctly argued that it is the notice of assignment that triggers the employer’s obligation to file an answer within 20 days. We were able to prove that the employer’s address on the notice of assignment had the wrong zip code and that the employer was never served. Therefore, the judge found that the employer had a reasonable excuse for its late answer to the claim petition.

The petitioner filed a claim petition within the New Jersey Division of Workers’ Compensation seeking benefits and alleging employment with a trucking company. However, the petitioner had previously obtained an occupational accident policy in the role of an independent contractor. When filing the workers’ compensation petition, counsel for the petitioner erroneously named the occupational accident policy carrier as carrier for the trucking company. Although it would appear clear that jurisdiction and coverage do not exist in such cases, most times it is a lengthy process to have such matters addressed by the court and ultimately dismissed. In this case, we were successful in obtaining the dismissal and ceasing further unnecessary financial costs to the client.

We convinced the Commonwealth Court to affirm a workers’ compensation judge’s decision. The judge had denied the claimant’s petition to review a Utilization Review (UR) determination and rejected the claimant’s argument that the judge was barred from ruling on UR petitions by the rules of collateral estoppel and issue preclusion.

We persuaded the Pennsylvania Supreme Court to deny a claimant’s petition for allowance of appeal. In this workers’ compensation matter, the claimant challenged the constitutionality of Act 111 and its Impairment Rating Evaluation (IRE) provisions.

We prevailed on a lengthy case on behalf of a trash collection company. The case involved testimony from seven employer witnesses, in addition to medical expert testimony. We successfully defended all petitions pertaining to the claim, including review and penalty petitions. This high-exposure case—the claimant had an average weekly wage of $2,846 with a maximum compensation rate—was the result of the claimant being terminated for failure to timely report a work-related injury as per company policy.

We successfully prosecuted a termination petition and at the same time defended a review petition on behalf of a Berks County mushroom facility in a falling object case. The claimant sustained a strain injury to his neck when he was struck by a stack of falling mushroom baskets at work. Although the baskets only grazed one side of his head and neck, the claimant alleged that his opposite shoulder was injured in the accident to the extent of a fully torn rotator cuff tendon. The claimant also alleged that a calcified longitudinal ligament in his neck was also caused by this accident, resulting in surgery and disability. We convinced the court that the only injury sustained during the incident was a neck strain that fully recovered—all other alleged injuries were found not to be work related.

We defended a claim petition and penalty petition wherein the claimant alleged serious neck and back injuries as a result of a work-related motor vehicle accident. We convinced the judge that the claimant was not in the course and scope of employment at the time of injury and, therefore, his claim was barred. The judge noted that, based on claimant’s testimony on cross examination, he had a legal address in North Carolina but was allegedly leasing an apartment in Newtown Square, Pa. He alleged he was on a special mission on the date of injury, traveling to an office owned by the employer. It was established that on the date of the accident, he was traveling on an expressway in New Jersey prior to his shift and admitted that his job required him to service many of the employer’s offices. The judge accepted the defense argument that the claimant was traveling to work, not in the course and scope of employment and not on a special mission, and dismissed the claim and penalty petitions.

We won a total controvert on a workers’ compensation exposure claim and successfully defended a denial. The claimant alleged exposure to a toxic airplane paint thinner at a plant in Kentucky in December of 2019. He was a subcontractor of the airplane manufacturer, but a Florida employee. The claimant complained of breathing issues and skin rashes. He sought treatment at an emergency room in Kentucky on the date of alleged exposure ,and again approximately 10 months later for skin rashes. However, the claimant was able to continue working without any wage loss the entire time. The employer/carrier denied and defended on the basis that the claimant could not prove causation by clear and convincing evidence pursuant to F.S. 440.02. The claimant obtained an IME, which opined that his breathing issues could be attributable to the alleged exposure, but that the rashes most likely were not. The claimant’s IME physician opined that the claimant needed to undergo additional testing to determine causation. The employer/carrier’s IME opined that the major contributing cause of the claimant’s rashes and breathing issues was not the alleged exposure. The Judge of Compensation Claims accepted the employer/carrier’s IME and held that the claimant failed to prove that a workplace chemical exposure was the major contributing cause of his complaints. 

We successfully handled a landscaper’s claim of a work-related low back injury. The claimant gave an inconsistent account of how his injury occurred, and when he gave notice. The defense presented five fact witnesses from the employer, two of whom testified the claimant never gave notice, and three of whom testified he told them he was going to fabricate this Workers’ Compensation injury because he wouldn’t be entitled to unemployment compensation benefits at the end of the season. Coincidentally, the testimony revealed the claimant did not receive unemployment compensation benefits. The IME physician found that the claimant fully recovered from any injury he sustained. The claimant subsequently had two surgeries, with $750,000 in medical bills (unadjusted). The judge found that the claimant sustained a low back sprain and then terminated him as of the date of the IME.

The Appeal Board rejected the claimant’s argument that the testimony of the employer’s medical expert did not support the judge’s finding of a termination of benefits for a low back injury because the employer’s medical expert testified that if the claimant was asymptomatic in her back prior to her slip and fall in a kitchen at work, the injury may have aggravated a pre-existing, underlying condition in her lumbar spine. But, at the judge level, the claimant admitted under cross examination that she had a prior work injury to her low back that she did not report, which caused her to experience ongoing low back symptoms. The Board noted that the potential expansion of the claimant’s low back injury, based upon the testimony of the employer’s medical expert, was dependent on whether the claimant had no prior low back complaints, which said she did (and failed to disclose). The Board, thus, held that the judge correctly found the claimant’s low back injury was limited to that of a lumbar strain and sprain from which she was fully recovered. The decision was affirmed. 

We successfully prosecuted a termination petition on behalf of a Philadelphia-based ice cream shop. The claimant sustained a serious ankle fracture after a slip and fall in the shop’s freezer. We utilized the treating physician to certify the claimant’s full and complete recovery from the ankle fracture and established that there were no residual maladies or disability stemming from the incident.

Our attorneys were successful in obtaining an order for dismissal in the Mount Holly, New Jersey Workers’ Compensation court. In his claim petition, the petitioner alleged permanent disability as a result of contracting COVID-19 while working for the insured. He alleged that while working as an auto hauler he was exposed to COVID-19, which resulted in a permanent pulmonary disability. The defense argued to the judge that the petitioner’s discovery failed to provide sufficient proof and evidence supporting that the petitioner had COVID-19 or that, if he did, it was “related to his job.”

We successfully defended a regional energy efficiency service agency in a claim petition wherein the claimant attempted to use the COVID-19 pandemic to support payments of disability. The claimant alleged that a work-related auto accident disabled him from employment at the time he was subject to an economic lay-off due to the pandemic. The defense convinced the court that at the time of layoff the claimant was capable of performing his pre-injury job duties despite alleged restrictions due to the motor vehicle accident. The judge also found the claimant to have made a full and complete recovery from the work injury during the pandemic lay-off, and the claimant demonstrated no good reason for his failure to return to work once the pandemic restrictions dissipated. The claim petition was denied and dismissed.

The injury was accepted for a foot contusion for medical benefits only. The claimant claimed much more severe injuries and sought wage loss benefits after his termination from employment. We successfully argued that the injury was limited to a contusion from which the claimant had recovered, and that his termination was for cause. The Workers’ Compensation Judge denied the claim petition and granted our termination petition.

The claimant filed a claim petition alleging that she sustained a contusion to the back of her head, a concussion, bilateral shoulder pain and neck pain. The judge found the claimant credible and that an incident did occur in the course and scope of her employment. However, the judge also found the employer’s medical expert credible. The employer’s medical expert found that the claimant was fully recovered as of the date of the Independent Medical Examination. This limited the receipt of indemnity and medical to fourteen months, rather than an ongoing claim.

The claimant alleged several injuries. The Board denied the claimant’s petition for additional compensation due on all counts, and granted the employer’s petition for review to terminate total disability benefits. Specifically, the Board concluded that (1) a proposed left ankle reconstruction surgery was not reasonable and necessary, (2) there was insufficient evidence to prove a compensable left knee injury, (3) there was insufficient evidence to prove a compensable lumbar spine injury and (4) the claimant was capable of unrestricted return to work. 

In a case of relative first impression in Pennsylvania, we successfully defended a mushroom harvesting company. The claimant sustained a work-related injury to the right shoulder. She underwent surgery and was released to modified duty. The employer offered her a modified job. The claimant returned to work and continued at restricted duty. She was ultimately found to be fully recovered by a renowned Philadelphia shoulder surgeon. The defense then filed a termination petition, alleging full recovery of the right shoulder. The claimant responded by filing a claim petition, alleging a new injury to the opposite shoulder that totally disabled her from employment. After cross examining the claimant, it was determined that she purposely exceeded her work release restrictions upon return to work, despite the employer’s directive to the contrary. The claimant alleged that her voluntary acts exceeding her restrictions caused her new injury. The judge ruled that the claimant was not in the course and scope of employment when she exceeded her restrictions, and that the alleged injuries to her left shoulder were degenerative, not work-related. The judge also found the claimant to be fully recovered from the previously accepted right shoulder injury.

We successfully defended one of Pennsylvania’s largest turkey processing plants in a million dollar amputation claim. The claimant alleged that, due to an alleged exposure to turkey blood and feces at the workplace, he developed an infection in his foot that led to amputation of his leg. The claimant alleged a specific loss of the leg, total disability due to injuries separate and apart from the loss, and disabling psychological injuries. The defense was able to prove through the use of an infectious disease expert that the claimant’s leg amputation was caused by an underlying venous insufficiency and infection stemming from years of uncontrolled diabetes. The defense also established on cross examination that the claimant failed to provide proper notice of a work-related injury within the meaning of the Workers’ Compensation Act. 

We received a favorable decision from the Department of Labor (DOL) denying a coal miner’s claim for benefits when the only evidence submitted by his widow was the death certificate listing severe chronic obstructive pulmonary disease (COPD) as the primary cause of death. The DOL claims examiner agreed with our position that the death certificate alone, was insufficient evidence to sustain the claimant’s burden of proving that her husband had totally disabling coal workers’ pneumoconiosis during his lifetime. Benefits were denied.

We were successful in dismissing the employer and insurer from a fatal claim as a result of COVID-19 infection. The claimant-widower filed the claim on behalf of his deceased wife, alleging she contracted COVID-19 while working in the capacity of a caretaker for a sick client. We argued that the correct employer for workers’ compensation purposes was the claimant’s client, not the named employer. The Workers’ Compensation Judge agreed and dismissed the named employer and insurer as party defendants.

We obtained a favorable decision from the Workers’ Compensation Appeal Board, reversing the underlying judge’s decision pertaining to a school district’s entitlement to a credit for wages paid to a school teacher pursuant to a collective bargaining agreement. The Board granted credits for wages received by the injured worker through the school district’s collective bargaining agreement, allowing offsets against the claimant’s future entitlement to wage loss benefits.

We were successful in obtaining a decision denying a widow’s claim for Federal Black Lung benefits. The deceased miner worked in underground coal mining for 11 years. His lifetime claim for benefits was denied after numerous claim filings and appeals. The widow then sought survivor’s benefits based upon the opinion of her medical expert, who opined that the miner’s death was hastened by coal workers’ pneumoconiosis. The judge rejected the widow’s expert in favor of our expert, who testified the miner’s death was not caused or hastened by pneumoconiosis. The widow requested reconsideration and attempted to submit additional evidence (an additional medical report and 12 medical journal articles) that she had not submitted during the litigation of the claim. The judge again rejected the claim on reconsideration.