A Pennsylvania woman recently won injury attorneys fees when she challenged the denial of coverage for counseling that she received. The woman was injured while working; she suffered cervical and shoulder personal injuries as well as lower back vertebrae and nerve damage. She settled with her employer’s insurance company for a lump-sum wage payment. The personal injury settlement terms included continued coverage for her medical expenses related to the work injuries.
The Pennsylvania Workers’ Compensation Act requires that employers maintain insurance to compensate employees injured on the job. Workers’ compensation benefits include partial payment of lost wages and coverage for medical and healthcare costs. The Act includes licensed psychologists, licensed psychiatrists, and licensed therapists as covered healthcare providers.
Depression, limited physical abilities, and a lack of mental alertness stemming from pain medication led the woman to seek counseling from a group of counselors that her primary orthopedic doctor recommended. The employer’s insurance company denied all payments for the counseling, claiming that there was not a reasonable connection to the woman’s work injuries, and that the counselors were not qualified healthcare providers and did not submit adequate written reports.
On appeal, the woman won full coverage for the counseling services. The appeals court found that the depression, physical limitations, and pain medication side effects that the woman related to her counselors were credible and were directly related to her work injuries. The court clarified that necessary counseling services can be provided by psychologists, psychiatrists, or other “licensed” therapists, including licensed social workers.
The court declined to issue a penalty against the insurance company but did award the woman her attorney’s fees.
The referral from the woman’s orthopedic doctor was critical to her entitlement to receive coverage for her counseling. Injured workers who are referred by their doctors to counseling can receive workers’ compensation benefits as long as the counselor is licensed.
If you are an injured worker in need of counseling, carefully check the credentials of any counselor that you consult.