After suffering from a workplace injury, there are times when the injured worker may want to delay or refuse the medical treatment suggested by their treating doctor — especially if that doctor is one from their employer’s physician’s list. They may be concerned about the necessity of the suggested treatment or its potential risks. And in some situations, the delay of medical treatment can be caused by outside forces, such as the COVID-19 pandemic. There are many reasons that could factor into the delay or refusal of specific treatment. But what kind of impact could this have on your claim to compensation?
Potential Forfeiture of Compensation
According to Section 306(f.1)(8) of Pennsylvania’s Workers’ Compensation Act, an injured worker may forfeit their right to compensation by denying reasonable medical treatment. Here, “medical treatment” can refer to surgical procedures, prescribed medications, medical supplies, and more. However, it is also important to keep in mind that it only sets up the possibility for an injured worker who denies or delays treatment to lose their compensation. The loss of compensation is not guaranteed.
All this section of the Act does is lay the foundation for when an employer or their insurance company can seek the stoppage of benefits through what is known as a suspension petition.
A suspension petition can be filed by your employer or their insurance company for a few reasons, the denial or delay of treatment being one of them. The purpose of such a petition is to stop your wage loss checks. However, the good news is that the burden of proof is entirely on them, not you. They must prove that the treatment being proposed to you has a high probability of curing the problems or will enhance your prospect for gainful employment. The reasonableness of your refusal will depend on the specific facts of each case. The treatment must also actually be available. If the IME physician recommends surgery, but no treating doctor has recommended or offered surgery, there is no refusal of treatment.
You may have valid concerns about the necessity or even safety of the treatment that is being proposed. Your employer or their insurance will have to address these concerns. And they may have to prove that the cause of the delay is not due to external factors. For example, if your denial or delay of reasonable medical treatment is due to something out of your control, such as COVID-19 restrictions on certain medical procedures, your benefits are likely to continue.
What is “Reasonable” Treatment?
When it comes to workers’ compensation, what is considered to be “reasonable” treatment for an injury? First, a reasonable treatment must come with a relatively high success rate compared to the risk it poses. For example, a spinal surgery that has a low chance of improving your ability to function and a significant risk of causing paralysis would probably not be considered reasonable.
The most common situation in which a carrier pursues this remedy is when the injured worker refuses surgery. When deciding whether to undergo the recommended treatment, the injured worker should discuss the potential benefits and likelihood of success with the doctor and also explore all of the risks.
Additionally, if you are receiving an alternative treatment, that can also be considered reasonable as long as it has a relatively high chance of success compared to the proposed treatment. Your employer or their insurance may claim that their preferred treatment will heal you faster or to a greater extent. How successful their claim is will depend on the merits of your alternative treatment. Would their proposed treatment speed up your recovery and enhance your ability to find future employment compared to your alternative treatment?
My name is Geoffrey Hillsberg, and I have been solely practicing workers’ compensation law in the State of Pennsylvania since 1995. If you have been injured on the job in Delaware County, please contact my law office today. I will fight for your right to compensation after a workplace injury.
The advice offered above is general in nature and may not be applicable to every case. Consultation with an attorney is highly recommended. Reliance on this advice does not represent the formation of an attorney-client relationship in the absence of a fee agreement with Mr. Hillsberg.