Entitlement to PPD Not Proven
Trevathan v. Loudoun County School Board, No. 226-12-4, 2013 Va. App. LEXIS 205 (Ct. App. Jul. 16, 2013) (mem.)
The Court of Appeals affirmed the Commission's denial of a claim for permanent partial disability benefits made based upon a 25% impairment to the left leg. In his accident, Claimant suffered a dislocated left hip and fractured his left femoral head and left femoral hip, for which benefits were awarded.
The claimant underwent surgery to repair the broken femur, physical therapy, and eventually had a total hip replacement. Claimant filed a claim for permanent partial disability, based upon a 25% impairment rating to the left leg, assigned by his treating physician, Dr. Matthew Gavin. In his impairment report, Dr. Gavin noted that the claimant is no longer able to run and has some persistent pain in the left hip.
The evidence considered at hearing established that the claimant could no longer jump or run because of his hip replacement, but that he walked without a limp and was biking 80 miles per week as of August of 2010.
The Court of Appeals affirmed the Commission's denial of PPD benefits. It was found that though the claimant had received a 25% rating to the leg, the physician did not explain what portion of the impairment was for the claimant's leg as opposed to his hip. The Court noted that §65.2-503(A) provides compensation for permanent partial and permanent total loss and disfigurement of certain scheduled body parts and senses, including the legs, but excluding the hips. As the rating did not clarify what, if any, portion was related to the hips, and what portion was related to the actual leg, the Court affirmed the Commission's denial of benefits.
This case illustrates the need for adjusters to not simply accept ratings at face value, but to evaluate whether the figure is reasonable, permanency has been established, and whether the rating is limited to a specific body part under §65.2-503.
Doctors, trial lawyers oppose workers’ comp fee schedule
A proposal to set a fee schedule for doctors who treat workers' compensation patients in Virginia has been made. The terms of House Bill 946 outline that a fee schedule would be set by the Workers' Compensation Commission that would govern all medical services for injured workers, unless a contract provides otherwise. The fee schedule would initially be based upon Medicare rates. Additionally, the terms provide a new one-year window for health care providers to make claims for payment. This bill is supported by employers and insurance carriers, who believe that the bill will help control rising medical costs. Proponents estimate that the proposed fee schedule could save Virginia employers $57million per year in medical costs. Supporters also note that a majority of states employ a workers' compensation fee schedule for medical care. This bill is opposed by doctors and The Virginia Trial Lawyers Association, who argue that "price-fixing" could drive away high quality providers. The workers' compensation subcommittee is scheduled to take up the bill on February 4, 2014.
