In Pennsylvania, the Workers’ Compensation Act is considered a remedial act that is to be liberally construed in favor of an injured worker. Therefore, it is often difficult for an employer to prevail in terminating benefits based upon a full recovery opinion of a medical expert. However, even if an employer is able to prevail in terminating a claimant’s benefits, the termination does not necessarily mean that it will be the end of the claim.
Rather, a claimant can file a reinstatement petition after the termination of their benefits. While it is considered a “heavy” burden, a reinstatement petition will be granted following the termination of a claimant’s benefits if the claimant can establish that their disability “has increased or recurred since the prior decision and that h[is] physical condition has changed in some manner.” Namani v. Workers’ Comp. Appeal Bd. (A. Duie Pyle), 32 A.3d 850, 854 (Pa. Cmwlth. 2011). Specifically, a claimant must prove the change in their physical condition “by precise and credible evidence of a more definite and specific nature than that upon which initial compensation was based.” Simeone v. Workmen’s Comp. Appeal Bd. (United Parcel Serv.), 580 A.2d 926, 928 n.5 (Pa. Cmwlth. 1990).
For example, in the recent Commonwealth Court Decision in Lackawanna County v. Workers’ Compensation Appeal Board (Rosky), No. 1048 C.D. 2018 (June 4, 2019), the Commonwealth Court affirmed the reinstatement of the claimant’s benefits, after a prior termination, on the basis that his medical expert’s testimony met the appropriate burden of establishing a recurrence of disability after the granting of a termination.
While reinstatement petitions after the granting of a termination are rare, they do occur from time to time, which creates uncertainty for employers/insurers. While not every case warrants settlement through a compromise and release agreement, that can often be the best means to fully close out a Pennsylvania workers’ compensation claim.
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