Workers’ Comp In-Cites
Welcome to the latest edition of Schaff & Young's Workers' Comp In-Cites. Designed to provide our clients with practical insight, Workers' Comp In-Cites outlines recent developments in Pennsylvania workers' compensation law and explains how those decisions impact our clients and their cases. Barbara Young, Michael Schaff and the other attorneys at Schaff & Young, P.C. are always available to discuss these cases – or any other questions or concerns you might have. Just give us a call at (215) 988-0090 or send an email to We look forward to hearing from you.

An Explanation of Benefits Triggers Fee Review Deadlines

A provider seeking review of a fee dispute must file a fee review application no more than 30 days following notification of disputed treatment or 90 days following the original date for the treatment subject to dispute, according to the Commonwealth Court in Roman Catholic Diocese of Allentown v. Bureau of Workers' Compensation Fee Review Hearing Office (Lehigh Valley Health Network). An employer's Explanation of Benefits qualifies as notification of disputed treatment and a provider has 30 days from an EOB to file a fee review application.

November 2011 Edition
Volume V
Number 11

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More Than Surveillance Needed to Terminate or Reduce Benefits

In Soja v. Workers' Compensation Appeal Board (Hillis-Carnes Engineering Associates), the Commonwealth Court ruled that, although surveillance video is not sufficient evidence to satisfy an employer's burden of proof in a termination petition, a suspension petition, or a petition to reduce benefits from total to partial disability, video may be used to impeach credibility and to establish facts.

Specific Loss & Modification Petition Issues

The Commonwealth Court, in Argyle v. Workers' Compensation Board (John J. Kane McKeesport Regional Center and UPMC Work Partners Claims Management), ruled that, in order for a claimant to establish a specific loss, he must present medical evidence to show that the loss of use is permanent and for all practical intents and purposes. If the medical evidence presented is contrary to the established facts in the record or based on assumptions not in the record, the medical opinion is valueless and not competent. The Court also affirmed that, in a modification petition, a Claimant has the burden to prove, through the presentation of competent medical evidence that his or her condition has changed since the prior petition hearing. A claimant fails to demonstrate a change in physical condition if he or she presents medical evidence that predates the prior WCJ Order that determined the extent of the claimant's injury.