Workers’ compensation "unsightly appearance" rule

Pennsylvania Workers' Compensation Act, generally

The Pennsylvania Workers' Compensation Act divides injuries which are work-related into three classifications: (1) Total disabilities; (2) partial disabilities; and (3) permanent injuries, which include loss of body parts, and permanent disfigurements.

Specific losses (including disfigurement)

The Act contains a schedule relating to "specific losses" that lists the specific benefits that are paid for permanent losses of certain functions or limbs of the body. For example, the Act provides 66 2/3 percent of wages for a year for the loss of a hand.

Included with this lists of specific losses is for "serious and permanent disfigurement of the head, neck or face, of such a character as to produce an unsightly appearance" 66 2/3 percent of wages not to exceed 275 weeks. One question that is raised by this provision is, What exactly is "unsightly appearance"?

"Unsightly appearance" (case law)

A number of court cases over the past decade have wrestled with the "unsightly appearance" issue. In 2006, in Agnello v. W.C.A.B., a workers' compensation claimant appealed to the commonwealth court from an order of the workers' compensation appeal board which denied her claim for benefits because she did not suffer a permanent disfigurement when she lost three lower front teeth as a result of a work injury.

The court reversed, holding that such a loss did constitute "disfigurement" in that it produced an unsightly appearance. The court pointed out that , without her lower denture, the claimant had no lower front teeth; even though the claimant lost only three teeth from the work injury, the denture's removal affected her overall appearance for the worse. The court stated that when reviewing cases regarding disfigurement of teeth, the workers' compensation judge must evaluate the claimant without any prosthesis in order to enable the judge accurately assess the damage done and any "unsightly appearance" that the claimant faces daily when not wearing the prosthesis.

In 2012, in Walker v. Workers' Compensation Appeal Bd. (Health Consultants), a claimant appealed to the commonwealth court from a finding of the appeal board that the claimant's on the job nose injury as a result of a fall had not caused a permanent and unsightly disfigurement. The court affirmed, stating that the board had personally viewed the claimant, and although it found there was a visible alteration to the claimant's nose following surgery to repair a fracture, it amounted to a slight crookedness that was not noticeably disfiguring. The court went on to say that the "unsightly appearance" requirement has a commonsense rule that not every mark or residual of an injury to the head, neck or face will constitute "disfigurement."

The "unsightly appearance" rule then seems to boil down to a subjective evaluation by the judicial authorities. Some disfigurement is ok, some is not depending, at least in part, on how noticeable the disfigurement is.

Conclusion

If you are injured at work and suffer what you believe might be a "serious and permanent disfigurement," you should immediately contact an experienced worker's compensation attorney, who will evaluate your case in light of your particular injury and the relevant case law and help you make a determination of whether you are eligible for benefits.