In June 2017, the Pennsylvania Supreme Court struck down as unconstitutional a 1996 provision of the workers' compensation law directing that when a doctor reviews the medical condition of an injured workers' compensation recipient to assign a degree of impairment, the physician is to follow the direction contained in the most recent version of an American Medical Association disability guide. Specifically, in Protz v. Workers' Compensation Appeal Board (Derry Area School District) the court found that the law violated the Pennsylvania Constitution's requirement that the General Assembly may not delegate its legislative authority.
The law gave an employer the right to direct that an employee receiving benefits undergo an "impairment-rating evaluation," referred to as an IRE, performed by a doctor. To evaluate the degree of impairment linked to the particular injury that made the person eligible for benefits, the statute said that the doctor must use the approach set out in the "most recent edition" of the AMA Guides to the Evaluation of Permanent Impairment.
If the impairment rating was under 50 percent, the disability was considered partial and only 500 more weeks of workers' compensation payments were allowed.
Power to legislate in General Assembly
The court explained that the state Constitution prevents the legislature from giving its power to make law to another government or private body, especially without explicit controls, standards and direction. Because the statute gave the AMA the power to make arbitrary and ad hoc changes to its Guides in future editions, without any limits or controls set by the legislature, and without any public input or requirement that it explain its reasoning, claimants, employers and insurers could be subject to potentially extreme standards in the future.
Therefore, the court found the "most recent edition" requirement violated the state Constitution as granting uncontrolled, unfettered power to a private entity to, in essence, make law and impose policy.
The court then looked at whether this part of the statute could be severed, leaving the rest of the language in place. However, finding that the remaining language without the removed provisions made no sense, the court threw out the entire section.
Impact of decision
In essence, this removes the ability of an employer to force an IRE, so employers will be required to find other legal ways to show that the degree of disability has lessened. There is also much speculation about the impact of the opinion on previous claims that were limited because of IREs. Will these be reopened? How will the holding be interpreted in currently pending claims and appeals?
It is extremely important that anyone with a new or pending claim speak with an experienced attorney who is following how state courts, the Workers' Compensation Appeals Board and Workers' Compensation Judges are interpreting the decision in individual cases.
In addition, anyone who has been negatively impacted by the results of an IRE in the past should discuss with a lawyer whether there are now grounds to reopen that claim in light of Protz. The lawyers at Robert Peirce & Associates, P.C., in Pittsburgh represent injured employees in Western Pennsylvania, West Virginia and Ohio in their workers' compensation claims. Contact us today!