eNotes: Workers’ Compensation – May 2023 – Pennsylvania

SIGNIFICANT CASE SUMMARIES

Pennsylvania Case Summaries

Solid Waste Services, Inc. v. St. Luke’s Hospital (Bureau of Workers’ Compensation)
Commonwealth Court of Pennsylvania
No. 69 C.D. 2022

Decided: April 25, 2023

It remains an unanswered question whether the Protz decision renders the trauma billing exception an unconstitutional delegation of legislative authority.

Background

Following a significant work injury, the claimant was transported to a Level I trauma center hospital, where he received inpatient treatment for 31 days. The hospital send the employer a bill for $1.3 million for trauma-related services, which the employer failed to pay within 30 days. The hospital filed an application for fee review, and the Fee Review Section determined that the employer was obligated to pay the full amount of the bill. The employer requested a de novo hearing, asserting that Section 306(f.1)(10) of the Act, which requires payment of 100% of usual and customary charges for care rendered for “urgent” or “life-threatening” injuries, was unconstitutional under the non-delegation doctrine. The Hearing Officer disagreed, and ordered the payment of the outstanding bills. The employer appealed to the Commonwealth Court.

Holding

With respect to whether an injury is “urgent” or “life-threatening,” and therefore the need to reimburse a provider at 100% of the usual and customary charge for treatment thereof, the Act incorporates the definition used in the American College of Surgeons’ triage guidelines. The employer took the position that this was similar to the Act’s incorporation of “the most recent edition” of the American Medical Association Guides to the Evaluation of Permanent Impairment, which was found to be an unconstitutional delegation of legislative authority in the notorious Protz decision. The Commonwealth Court noted that the employer did not show how it was harmed by the definitions of “life-threatening injury” and “urgent injury,” and held that the employer had nonetheless waived the argument for failing to develop the issue in a meaningful fashion capable of review.

Takeaway

This case could have served as a vehicle to determine whether the holding in Protz also invalidates the trauma billing exception under the Act, but the Court did not believe that the argument was properly developed in the employer’s brief. Unless this case is appealed to the Pennsylvania Supreme Court, or until another similar case is appealed with more fully developed constitutional arguments, this issue will unfortunately remain unresolved until further notice.

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

Steets v. Celebration Fireworks, Inc. (WCAB)
Commonwealth Court of PA
No. 512 C.D. 2022

Decided: May 8, 2023

The Court affirmed the decision of the WCJ that the Claimant’s estate was not entitled to specific loss benefits following the Claimant’s death which resulted from the work injury.

Background

Claimant sustained a work related injury on June 30, 2017, when an explosion occurred, and the injury was accepted by way of a NCP. Claimant subsequently filed Claim and Review Petitions, alleging a loss of use injury separate and apart from a brain injury, which were ultimately granted by the Judge. The Judge declared that once Claimant’s total disability benefits ceased, claimant would be entitled to specific loss benefits under the Act. The Employer appealed the decision and the Appeal Board confirmed. The Employer also filed an appeal to the Commonwealth Court and the Court affirmed the decision of the Judge.

The Claimant died on November 28, 2020 as a result of complications from bilateral pneumonia caused by her work related respiratory deficiency. (The Commonwealth Court affirmed the Judge’s initial decision on May 24, 2021.) The Employer ceased payment of TTD benefits upon the claimant’s death. Claimant’s estate filed Claim, Review and Penalty Petitions seeking payment of claimant’s funeral expenses, payment of claimant’s specific loss benefits and penalties based upon the failure to pay the previously awarded specific loss benefits. (In a footnote, the Court noted that the claimant’s estate was raised by claimant’s “non dependent sister.”) The Judge granted the Claim Petition and ordered, pursuant to Section 306 (g) of the Act, that the Employer to pay the funeral expenses, but denied the Review and Penalty Petition. The estate appealed to the Board, which affirmed the Judge’s decision.

Holding

On appeal, the claimant’s estate argued that specific loss benefits should be payable following an injured workers’ death that resulted from the work injury. The Court reviewed the language of the Act (specifically, Sections 410 and 306 (g)) and recent case law for the proposition that when an employee dies due to a work injury while collecting total disability benefits and before specific loss benefits are payable, but without dependents, the only specific loss payments due are reasonable (up to $7000) funeral expenses to be paid to the funeral home. Section 410 of the Act provides that benefits due to a claimant who dies before the final adjudication of her claim are payable to the claimant’s estate or dependents, but Section 410 does not provide an independent or supporting basis for a specific loss award. The Court noted prior decisions holding that Section 306 (g) related directly to the receipt of specific loss benefits and was, therefore, the more particular provision. The Court further noted that because the Judge had adjudicated the claimant’s TTD and specific loss claims before claimant died, Section 410 did not control. In the instant case, claimant’s work injury caused her death and she had no dependents with right to either her total disability or specific loss benefits when she died. The Court held that, under these circumstances and under Section 306 (g) of the Act, the Employer’s only statutory obligation was to pay $7000 in funeral expenses, which it did. Claimant’s estate tried to distinguish the instant case because specific loss benefits had been awarded to the claimant prior to her death. The Court affirmed the Judge’s finding that there was nothing in Act or in the case law to support this argument. Specifically, the Court cited its 2004 decision in Estate of Harris v. WCAB (Sunoco, Inc.), 845 A2d 239 (Pa. Cmwlth. 2004), for the holding that where a claimant is awarded specific loss benefits and dies without a dependent, the specific loss benefit is to be made to the estate of the deceased but in an amount not exceeding reasonable funeral expenses. The Court held that the facts of the instant case were “nearly identical” to those of Harris, in that Harris had sustained a work related injury for which the employer paid her TTD benefits until her death due to her work related injuries and because Harris died without statutory dependents, the estate was paid only her funeral expenses.

Judge Ceisler filed a dissenting opinion, arguing that specific loss benefits should have been paid to the estate under Section 410 of the Act. The Judge reasoned that the language of Section 410 did not condition the payment of compensation upon a specific cause of death. The Judge reasoned that at the time the clamant in the instant case died, the Employer challenge’s to the Judge’s award of specific loss benefits was pending before this Court and, therefore, the claimant died prior to a final adjudication of her claim for specific loss benefits. The Judge further reasoned that the General Assembly did not intend to prevent the payment of specific loss benefits to the dependents or estate of a claimant whose death was caused by the work injury, despite the language of Section 306 (g). The Judge further distinguished the instant case from Harris, maintaining that in Harris the claimant had not been awarded specific loss benefits nor had she filed a claim petition seeking specific loss benefits prior to her death.

Takeaway

The Court’s decision in this case may seem surprising, but it is consistent with the language of Section 306 (g) of the Act. The dissenting opinion does seem to make a good argument for the payment of benefits in this matter, but the dissent does not address the fact that it did not appear that the claimant in this matter had dependents (as defined by Section 306 (g)) at the time of her death- so under the plain language of Section 306 (g) it would appear that the Judge’s decision was correct. Please note, however, that the majority opinion did concede that, Section 410 might have applied in the instant case if claimant had died before her specific loss claim was adjudicated and if the Court had not previously ruled that Section 306 (g) of the Act more specifically applied over Section 410 of the Act in these circumstances.

Questions about this case can be directed to Lee Ann Rhodes, at (412) 926-1453 or lrhodes@tthlaw.com.

Franczyk v. The Home Depot, Inc.
Supreme Court of Pennsylvania
No. 11 WAP 202 J-62-2022

Decided April 19, 2023

Court affirms “exclusivity provision” of the Workers’ Compensation Act

Background

The Plaintiff (Franczyk) was working at a The Home Depot store when she was bitten by a customer’s dog. She reported the incident to her supervisors, who allegedly barred her from contacting the dog owner or any other witnesses. The supervisors spoke to several customers about the incident when it occurred but did not obtain any contact or identifying information. As a result of the dog bite, Plaintiff developed cubital tunnel syndrome, which required surgery. She claimed and received workers’ compensation benefits.

Plaintiff sued The Home Depot and her supervisors, asserting that their acts and omissions denied her the opportunity to file a third-party suit against the dog owner. Specifically, she alleged that the failure to adequately investigate the incident and obtain identifying information from witnesses prevented her from pursuing a claim. The Home Depot moved for summary judgment, claiming immunity under the Pennsylvania Workers’ Compensation Act’s exclusivity provision which precludes civil suits against employers for workplace injuries.

The trial court denied the motion, and the Superior Court affirmed, finding that an employer cannot claim protection under the Workers’ Compensation Act’s exclusivity provision when its own actions prevented an employee from filing a third-party claim against the person responsible for her injury. The Superior Court noted in its Decision that the Act’s exclusivity provisions were not absolute under all circumstances. The Home Depot then appealed to the Supreme Court arguing that the exclusivity provisions of the Workers’ Compensation Act prevented Plaintiff from bringing suit against her employer for injuries sustained at work.

Holding

The Supreme Court reversed the decision of the Superior Court finding that the plain language of the Workers’ Compensation Act barred suit against an employer for any recovery beyond the remedies provided by the Act itself, even in the instance of intentional acts or wrongful conduct by the employer.

The exclusivity provision provides: “liability of an employer under this act shall be exclusive and in place of any and all other liability to such employees … entitled to damages in any action at law or otherwise on account of any injury or death….” Plaintiff argued that her claim was not barred under this provision because she did not seek relief for her physical injury – the dog bite. Rather, she sought relief from the economic harm suffered when she lost the opportunity to file a third-party claim.

The Court rejected this argument, finding that the employer did not have a duty to protect and preserve the employee’s interest in pursuing a third-party claim arising from a work injury. The Court acknowledged that although the Act’s definition of an “injury” clearly includes some specific exceptions, such as scenarios involving acts of third parties that are not considered “injuries” for the purposes of the Act, Plaintiff’s claim was not one of the limited exceptions.

Takeaway

This case affirms the exclusivity provisions of the Workers’ Compensation Act, precluding employees from bringing civil suits against their employers for workplace injuries. The Court took a broad view of the exclusivity provision, applying it to insulate employers even in cases of malfeasance.

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

Edinger v. Rhodes Salvage/Edward Rhodes (Workers’ Compensation Appeal Board)
No. 916 C.D. 2021
Decided: April 25, 2023

The Commonwealth Court affirmed the WCAB’s reversal of the WCJ’s denial of a suspension petition, and affirmed the WCAB’s award of a dollar-for-dollar credit to Defendant due to Claimant’s violation of the WCJ’s Section 314 Order.

Background

On August 5, 2019, the WCJ granted Defendant’s Petition for Examination due to a missed IRE appointment. Claimant’s counsel advised Claimant to not attend the appointment because he believed Act 111, which reinstated the IRE process, was unconstitutional. Claimant violated the WCJ’s Section 314 Order by failing to attend the rescheduled IRE. In the interim, Claimant appealed the WCJ’s Order. Defendant filed a Motion to Quash Claimant’s appeal, arguing that the WCJ’s Section 314 was interlocutory. Defendant filed a Suspension Petition following Claimant’s failure to attend the rescheduled IRE in violation of the WCJ’s Order. On December 18, 2019, the WCJ issued a Decision denying the Suspension Petition, finding that he was foreclosed from granting the Suspension Petition while Claimant’s appeal remained pending before the WCAB. The WCJ also felt that Claimant’s appeal provided a reasonable excuse for failing to attend the IRE. Defendant appealed to the WCAB. Shortly thereafter, the WCAB quashed Claimant’s appeal of the WCJ’s Section 314 Order, concluding that it constituted an interlocutory order which was not subject to appeal. Claimant appealed and the Commonwealth Court affirmed that the Section 314 Order constituted an interlocutory order.

With regard to Defendant’s appeal of the Suspension Petition, the WCAB overturned the WCJ’s denial of the same. The WCAB found that the Claimant was not entitled to appeal the WCJ’s Section 314 Order because it was interlocutory. The WCAB found that Claimant was not entitled to further indemnity benefits because the remedy for violation of a Section 314 Order is to deny the claimant a right to compensation. The WCAB noted that an appeal of a Section 314 Order does not operate as an automatic supersedeas and Claimant did not request supersedeas in his appeal. The WCAB further awarded Defendant a dollar-for-dollar credit against Claimant’s future indemnity benefits, as Defendant would have no other way to recoup its overpayment during the pendency of the appeals. Claimant appealed the WCAB’s Opinion to the Commonwealth Court.

Holding

The Commonwealth Court affirmed the Opinion and Order of the WCAB. The Commonwealth Court held that a Section 314 Order compelling attendance at an examination cannot be appealed, as the same constitutes an interlocutory order. The Court further held that an interlocutory appeal is not a reasonable excuse for a claimant’s failure to comply with an order directing a claimant to attend an examination. The Court also affirmed the WCAB’s award of a dollar-for-dollar credit against Claimant’s future indemnity benefits. The Court found that Section 314 specifically provides a statutory basis for the WCAB’s award, as Section 314 provides an employer the right to charge against future compensation payments when a claimant does not appear, as ordered, for a medical examination. The Court dismissed Claimant’s argument that his financial situation should have been considered by the WCAB when it fashioned its recoupment remedy. The Court finally noted that Claimant did not request supersedeas when he appealed the WCJ’s Section 314 Order. Accordingly, the WCAB’s Opinion and Order was affirmed in full by the Commonwealth Court.

Takeaway

The takeaway from this case is that a claimant cannot appeal a Section 314 Order entered by a WCJ ordering him or her to attend a medical examination, as the same constitutes an interlocutory order. A suspension petition should still be filed for a missed examination and a motion to quash the claimant’s interlocutory appeal should be filed with the WCAB. If the suspension petition is decided by the WCJ, this case should be cited and discussed in a legal brief.

Questions about this case can be directed to Joseph J. Shields at (570) 825-7227 or jshields@thlaw.com.