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Pain is Not Enough for Prima Facie Medical Evidence

Jul 12, 2021 | MAD News, NYS Workers Compensation

It’s well known in the Workers Compensation community that the threshold for meeting Prima Facie Medical Evidence (PFME) is extremely low. However, one argument that the Board has found to be quite compelling, is that “pain” is not an injury. There have been some past Board Panel decision which touch upon this argument, but in a very recent Board Panel decision the Board made very clear where they stand on the issue. In EMPLOYER: CONGRGATION MACHNE CHAIM INC, the board found that the diagnosis of “back pain” did not suffice to meet the threshold of PFME. WCB # G281 4719, June 07, 2021. The Board found in that matter that, “The claimant was not diagnosed with a back injury, but rather just with back pain. Pain is a symptom and not a diagnosis and, as such, medical reports that only reference or diagnose pain are not sufficient to constitute PFME of an injury, trauma or illness.” Notably, the Board found that pain was  not sufficient for PFME, despite positive clinical findings, which claimant’s counsel argued were indicative of an injury. Since PFME is an issue which is usually never revisited, as it is interlocutory, it is important to be aggressive at the outset of the claim and recognizing that just because a diagnosis is given with statement of causal relationship, that diagnosis may not be an actual “injury,” and a finding of PFME should be argued against accordingly.

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