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AMA injury guides used in unconstitutional manner, court rules

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An appellate court in Pennsylvania vacated a reduction in benefits to an injured worker because of an unconstitutional application of updated American Medical Association's guidelines.

The Commonwealth Court of Pennsylvania on Friday vacated and remanded a decision by the state's Workers' Compensation Appeal Board to affirm the reduction from total disability benefits to partial disability benefits because the section of the Pennsylvania Workers' Compensation Act allowing for the use of the most current version of the association's guidelines was unconstitutional, according to the decision.

In April 2007, Mary Ann Protz injured her right knee while working for the Derry Area School District in Derry, Pennsylvania, and received workers compensation benefits, which were suspended when she returned to work in August 2007, according to court documents. In February 2008, her injury recurred, and her benefits were reinstated. The district filed for an impairment rating evaluation under which the designated physician evaluated Ms. Protz and provided a 10% impairment rating under the sixth edition of the AMA's Guides to the Evaluation of Permanent Impairment, according to the court documents.

In April 2012, the district sought to convert her total disability benefits to partial benefits, reducing the amount of compensation that can be paid to 500 weeks, as a claimant is partially disabled if he or she has a total impairment rating of less than 50% percent, according to court documents. In granting the district's requested modification, a workers compensation judge determined Ms. Protz was only entitled to partial benefits as of January 2012, a decision later affirmed by the board.

While the fourth edition of the guides was in effect when the statute was enacted, Ms. Protz's evaluation was conducted according to the sixth edition, with each edition possibly changing the impairment rating for the same injury, according to court documents. But the use of the current version of the guidelines represented an unconstitutional delegation of legislative authority because it proactively approved updated versions of the association's guidelines without review, according to the court's ruling.

The court found a lack of any public policy governing and restraining the association's issuance of guidelines that physicians and workers compensation judges are bound by, and the absence of a mechanism requiring government review of the association's guidelines in the statute. Even if delegation of this authority to a government agency were allowed, the statute would still be unconstitutional because the delegation in this case was to a private party, meaning the association, the court ruled.

“Unlike governmental agencies, which are supposed to act disinterestedly and only for the public good, that presumption cannot be made with regard to private entities,” the court ruled. “There is no accountability to the public, either directly through the rulemaking process providing for public input and comment or indirectly through the appointment and confirmation power and the power of the purse.”

District officials and the association could not be immediately reached for comment.