eNotes: Workers’ Compensation – February 2023 – Pennsylvania

SIGNIFICANT CASE SUMMARIES

Pennsylvania Case Summaries

Lingelbach v. Cummings Bridgeway, LLC (WCAB)
Commonwealth Court of Pennsylvania
No. 1092 C.D. 2021

Decided: January 4, 2023

A carrier is permitted to recoup overpayment of future benefits.

Background

Following litigation of a Petition to Modify, the Claimant began receiving reduced compensation. Employer mistakenly paid Claimant’s 20% attorney fee in addition to the Claimant’s full weekly disability rate. This resulted in an overpayment to the Claimant.

Employer filed Petitions to Review requesting a credit for the overpayment. The WCJ granted the Review Petitions, finding that the Claimant was “unjustly enriched” by the Employer’s overpayment. The WCJ concluded that it was appropriate for the Employer to recover overpayments made through future payments to prevent a double recovery.

The Claimant appealed to the WCAB, which affirmed. The Claimant then appealed to the Commonwealth Court.

Holding

The Commonwealth Court held that it was appropriate for the Employer to recoup the overpayment from Claimant’s future benefit payments. The Commonwealth Court looked to prior cases which allowed employers to recoup overpayments of compensation made in error as a result of a miscalculation. The Court also held that it was appropriate to consider equitable principals, such as “unjust enrichment,” as long as the overpayment did not involve counsel fees or litigation costs.

Takeaway

This case confirms the availability of recoupment or credits against claimant’s future benefits until the overpayment is satisfied, as long as the overpayment involved benefits paid to the claimant, and not unreasonable contest fees, attorney’s fees, or litigation costs.

Questions about this case can be directed to A. Catherine McLaughlin, Esquire at (412) 926-1421 or cmclaughlin@tthlaw.com.

Oak HRC Suburban Woods LLC v. Burroughs (WCAB)
Commonwealth Court of Pennsylvania
No. 1370 C.D. 2021

Decided: January 23, 2023

A Claimant was entitled to reinstatement of benefits after she was terminated from a subsequent employer following an unrelated elective medical procedure.

Background

The Claimant sustained a work-related injury while working for the employer, and continued working light duty for nearly one year before leaving her job. Several months later, the Claimant returned to work for a new employer and continued working light duty. About six months after the Claimant started working for the new employer, she underwent surgery for a non-work-related condition, and was terminated by the new employer because she had not accrued enough FMLA leave for recovery time. The Claimant’s treating doctor subsequently found that she was totally disabled from the work injuries. The Claimant filed a claim petition seeking total disability during the periods in which she was out of work and partial disability during the time the claimant worked for her new employer, which was granted and not appealed. The Claimant then filed a reinstatement petition seeking total disability effective the date she was found to be totally disabled, which the WCJ granted and the Board affirmed. The employer appealed to the Commonwealth Court.

Holding

The Commonwealth Court affirmed the Board’s decision. The court held that where a Claimant is laid off while on work restrictions, it is presumed that the loss of earning power is attributable to the work injury. The burden is therefore on the employer to show that the loss of earnings was caused by bad faith or by some other circumstance specifically provided for under the Act. The employer never challenged the treating doctor’s determination that the Claimant was totally disabled, and the Claimant’s termination due to an elective surgical procedure was found to be involuntary. Accordingly, the decision below was affirmed.

Takeaway

A Claimant’s loss of earning power is presumed to be work-related and an employer bears the burden of proving bad faith.

Questions about this case can be directed to John T. Morgan, Esq., at (267) 861-7580 or jmorgan@tthlaw.com.

Davis v. Crothall Healthcare, Inc. (WCAB)
Commonwealth Court of Pennsylvania
No. 70 C.D. 2022

Decided February 1, 2023

When a Claimant is granted a Yellow Freight motion, he/she is entitled to a rebuttable presumption that the disability continued after the last date upon which the employer could have filed a timely answer to the claim petition. The employer bears the burden of refuting that presumption.

Background

In an unpublished opinion, the Pennsylvania Commonwealth Court reversed the WCJ’s granting of a termination petition, which the WCAB affirmed. The WCJ erroneously placed the burden on the Claimant to demonstrate ongoing disability. The Court acknowledged that the misapplication of the burden of proof may constitute harmless error if the result would not have changed had the burden been correctly placed. However, the Court nonetheless reversed the granting of the termination petition because the employer’s medical expert failed to acknowledge that the Claimant sustained the work injuries alleged in the claim petition, that were deemed admitted by way of the granted Yellow Freight motion.

Holding

The claim petition alleged that the Claimant sustained work injuries in the nature of cumulative trauma to his lower back and bilateral knees. After the WCJ granted Claimant’s Yellow Freight motion, Claimant presented for an IME with employer’s medical expert. The employer’s medical expert opined that the Claimant may have sustained a lumbar strain or sprain “at some point,” but did not believe that the Claimant’s work duties were repetitive in nature. The IME doctor thus concluded that the Claimant did not sustain the lumbar strain/sprain from cumulative trauma, but rather the symptoms were more so a result of the aging process. The doctor rejected that the Claimant sustained any injuries to his knees. In sum, the IME doctor failed to acknowledge that Claimant sustained the alleged cumulative trauma to his lower back and bilateral knees. Thus, the employer’s medical evidence was insufficient to support a conclusion that the Claimant had fully recovered from the work injury.

Takeaway

In order for medical evidence supporting a termination petition to be sufficient, the IME doctor must acknowledge that the Claimant sustained all accepted injuries.

Questions about this case can be directed to Cailey Farinaro, Esquire at 610-332-7008 or cfarinaro@tthlaw.com.