Workers’ compensation doctors must actively treat patients, court rules

In Verizon Pennsylvania Inc. v. Workers' Compensation Appeal Board (Ketterer), the Commonwealth Court of Pennsylvania reviewed a provision in the state's workers' compensation laws that requires a physician conducting an impairment rating evaluation of a claimant to be "active in clinical practice" for at least 20 hours per week. The court interpreted this phrase to mean that the physician's clinical practice must involve medical care or treatment of patients. The court decided that an impairment rating evaluation of the claimant was invalid since the physician who conducted the evaluation was not providing treatment or care to any patients at that time.

Pennsylvania law provides for impairment rating evaluations as a means of adjusting the status of workers' compensation benefits between total and partial disability.

Background and procedural history

The claimant worked as a service technician and performed telephone, television and computer service installations and repairs. In 2008, his service vehicle was struck in rear-end collision. The claimant sustained a neck and back strain as a result of the accident. The claimant was approved for total disability benefits.

In 2009, the employer filed proceedings seeking to terminate the compensation. A workers' compensation judge denied the request.

The employer subsequently filed a request asking the Bureau of Workers' Compensation to designate a physician to perform an impairment rating evaluation. The Bureau granted the request.

After the designated physician examined the claimant, the employer filed a request to modify the claimant's status from total disability to partial disability based on the results of the physician's evaluation. However, the workers' compensation judge denied the employer's request, holding that the doctor who performed the impairment rating evaluation did not meet the statutory requirement of being active in clinical practice for at least twenty hours per week.

The ruling was upheld by the workers' compensation appeal board. The employer then filed an appeal in the Commonwealth Court.

The Commonwealth Court's ruling

The Commonwealth Court stated that the statutory requirement that physicians performing an impairment rating evaluation must be "active in clinical practice for at least twenty hours per week" is mandatory. The court noted that the request workers' compensation laws do not define "clinical practice." There were also no court rulings addressing this issue, the court said.

The court examined impairment rating regulations issued by the Bureau of Workers' Compensation where the phrase "active in clinical practice" was defined as including a requirement that the physician be actively providing preventive care and the evaluation, treatment and management of medical conditions of patients on an ongoing basis. The court held that language in the bureau's regulations referencing "patients" signified that patient care was an essential characteristic of a clinical practice.

The court accepted bureau's definition, finding that it was reasonable interpretation that was consistent with the statutory language. A requirement that a physician's work involve medical care or treatment of patients was also consistent with a medical dictionary's definition of "clinical practice," referencing "actual observation and treatment of patients," the court wrote.

The court upheld the board's ruling that the impairment rating evaluation of the claimant was invalid since it was conducted by a physician who was not currently providing any treatment or care to patients. The physician's practice consisted solely of workers' compensation impairment rating evaluations and independent medical examinations, utilization reviews, peer reviews, and physical examinations for certification and qualification requirements.

Contact an attorney

Individuals seeking benefits provided under the workers' compensation laws are urged to consult the professional services of an attorney experienced in such matters, to ensure that their rights are fully protected.