August 28, 2019
Defendant’s Modification Petition and Petition for Review of Utilization Determination denied and Claimant’s Review Petition to expand the accepted description of injury granted.
Bennett (name changed for this summary), an Iron Worker, was injured in the course of his employment in Ephrata, PA. State Workers’ Insurance Fund, the workers’ compensation insurance carrier for the employer, had issued a Notice of Compensation Payable (NTCP) on January 20, 2006 for Mr. Bennett’s August 17, 2005 injury described as groin / bilateral inguinal hernia.
Defendant filed a Modification Petition based upon a labor market survey seeking to have Mr. Bennett’s benefits modified (reduced). Defendant also filed a Utilization Review regarding Dr. Midcap’s treatments. A Utilization Review Determination was issued which found that Mr. Bennett’s treatment with Dr. Midcap, including prescription medications, were unreasonable and unnecessary for his work injury. We filed a Petition for Review of the UR Determination. We also filed a Review Petition seeking to have the accepted description of injury amended to include entrapment of the genitofemoral nerve and ilioinguinal nerve.
Mr. Bennett testified that he has had four surgeries for his work injury and that he continues to have pain and symptoms that keep him from working and that he has been treating with Dr. Midcap since 2008. Mr. Bennett also testified that he had applied for the jobs listed in the Labor Market Survey but that none were offered to him. Dr. Midcap testified at a deposition that he continues to treat Mr. Bennett monthly, he disapproved the jobs listed in the Labor Market Survey, that he has not released him to any level of work and that Mr. Bennett is 100% disabled from any type of work. Mr. Bennett also underwent a Functional Capacity Evaluation (FCE) which found that he did not meet the sedentary physical demand level standards. Dr. Pharo, the IME physician, had previously testified that an FCE provides a more definitive and objective assessment of restrictions. The FCE clearly demonstrated Mr. Bennett could not perform sedentary work.
The parties stipulated that based upon Dr. Pharo’s deposition, Mr. Bennett’s description of injury would be amended to include entrapment of the genitofermoral nerve and the ilioinguinal nerve, a recurrent hernia and a labral tear of the right hip which required arthroscopic surgery.
The Judge granted Mr. Bennett’s Review Petition based upon the stipulation outlined above. The Judge denied Defendant’s Modification Petition finding that Defendant failed to meet its burden of proving that there was work available within Mr. Bennett’s restrictions. He found Dr. Midcap to be more credible than the IME opinion. The Judge also granted our Petition for Review of Utilization Review Determination finding that Dr. Midcap’s treatment rendered to Mr. Bennett was reasonable and necessary for his work injury.
The Judge awarded the continued payment of Mr. Bennett’s wage loss benefits and medical benefits related to his work injury as well as costs of litigation.
If you have been injured in a work-related accident, you may be entitled to Pennsylvania workers’ comp benefits. Contact an experienced Harrisburg workers’ compensation lawyer at Calhoon and Kaminsky P.C., at 717-695-4722 for more information.
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