eNotes: Workers’ Compensation – October 2023 – Pennsylvania

SIGNIFICANT CASE SUMMARIES

Pennsylvania Case Summaries

Charter v. Lehigh Valley Health Network (WCAB)
Commonwealth Court of Pennsylvania
No. 1152 C.D. 2022

Decided: September 22, 2023

A claimant will not be entitled to litigation costs where he/she does not prevail on a contested issue.

Background

The claimant sustained a work injury on September 15, 2020, and the employer accepted medical-only liability for a low back injury. The claimant testified that the incident caused her low back pain, but not radiating pain into her the legs. Following the work incident, she worked in a light duty capacity for the employer. Subsequently, on November 16, 2020, the claimant felt a pop in her back at home while getting ready for work, after which she started to feel radiating pain into her right leg and into both feet. She stopped working after the November 16, 2020 incident. The claimant then filed a Claim Petition and Review Petition alleging injuries to the low back and right leg. The Claim Petition identified September 15, 2020 as the date of injury, but alleged disability as of November 16, 2020.

Holding

The WCJ found the November 16, 2020 event to be an “intervening incident” and a “new complaint,” and thus denied both of the claimant’s petitions. The WCJ found the employer’s medical expert credible, aside from his testimony that the claimant did not sustain any work injury. On appeal, the claimant argued that she was entitled to litigation costs since she “technically” won on a disputed issue, namely, the occurrence of a work injury. The court found the claimant’s reliance on Jones v. WCAB (Steris Corp.) unpersuasive. In Jones, the claimant prevailed in part by establishing that he sustained a work-related injury, but failed to prove he was entitled to disability benefits. The Jones court only decided that the claimant might be entitled to reasonable litigation costs expended on the matter at issue on which the claimant prevailed. Here, the claimant did not prevail on any issue. The occurrence of a work injury was not contested given the issuance of the NCP. Thus, the claimant was not entitled to litigations costs.

Takeaway

Where an employer issues an NCP, the occurrence of a work injury does not qualify as a contested issue even if the employer’s medical expert denies that a work injury occurred. Thus, a claimant will not be entitled to litigation costs based upon the WCJ’s finding of a work injury under these circumstances.

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

Solutions Construction, LLC v. Sidar Garcia (WCAB)
Commonwealth Court of Pennsylvania
No. 660 C.D. 2022

Decided September 29, 2023

This case involves EDI transactions and their impact on claim handling.

Background

The claimant filed a Claim Petition on May 1, 2018 alleging he sustained a work-related injury on April 5, 2018. On September 18, 2019, the employer issued a Notice of Temporary Compensation Payable (NTCP). Thereafter on September 27, 2019, an Amended Notice of Compensation Payable (Amended NCP) was issued. The employer filed a Petition to Review seeking to set aside the NTCP and Amended NCP, alleging that both documents were erroneously generated by the electronic data interchange (EDI) system and did not admit liability.

Both a representative from the employer’s insurance company and the manager of the EDI system for the Bureau testified regarding the system and the process for generating NCPs. The testimony was conflicting, with the insurance carrier testifying that the Bureau issued the documents and the EDI manager testifying that the claims adjuster must enter certain data to generate the Bureau forms. The Bureau manager also testified that there are ways a claims adjuster could enter information into the EDI system without generating an NCP. The Workers’ Compensation Judge (WCJ) ultimately denied employer’s Petition to Review and found that the carrier did admit liability through the issuance of the NCP. Specifically, the WCJ credited the testimony of the EDI manager over the testimony of the claims representative, finding that she demonstrated a thorough knowledge of the EDI system and the process by which it generated forms.

The employer appealed to the Workers’ Compensation Appeal Board, which affirmed the decision of the Workers’ Compensation Judge. The employer then appealed to the Commonwealth Court.

Holding

The Commonwealth Court affirmed the Appeal Board, holding that the credibility decisions of the WCJ in accepting the EDI manager’s testimony over that of the claims representative was within the “WCJ’s domain” as well as the weight afforded the evidence presented.

Takeaway

This is an extremely important case from the perspective of Bureau forms. Due to the data input process of the EDI system, alleging an “erroneously generated” Bureau form might not hold weight. It is important to know the inner workings of the EDI transaction system to avoid a mistakenly issued Bureau form accepting an otherwise potentially questionable claim.

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

Jeantel v. Success America (WCAB)
Commonwealth Court of Pennsylvania
No. 76 CD 2022

Decided: September 12, 2023

An employer can be deemed to have violated the Act by scheduling a claimant for an appointment with a specific panel provider rather than providing a list of panel providers.

Background

The claimant sustained a work injury, which was accepted by MONCP. When the claimant first reported the injury to the employer, the employer did not provide a list of panel providers or indicate that the claimant had a choice of panel physicians. Rather, the employer scheduled the claimant for an appointment by a particular provider. That provider discharged the claimant from care after the claimant reported significant improvement, and the adjuster closed the claim. The claimant filed a penalty petition due to the employer’s failure to provide a list of panel physicians. The WCJ found that the employer committed a technical violation of the Act by failing to provide the claimant with written notice of his rights and duties immediately after the work injury. However, the WCJ declined to award penalties. The Board affirmed, finding no abuse of discretion. The claimant appealed to the Commonwealth Court.

Holding

The Commonwealth Court affirmed. The court noted that the Act requires employers to provide written notice and acknowledgement of an employee’s rights and duties when the employee is hired and when the employee is injured. If the employer has a list of panel providers, those must be provided to the claimant as well. The court agreed that the employer committed a technical violation of the Act, but also that the WCJ did not abuse her discretion in declining to impose penalties.

Takeaway

This case shows how the panel imposes a burden on the employer, not just the claimant. Careful compliance with the provisions of the Act with respect to panel physicians is critical to avoid potential exposure to penalties.

Questions about this case can be directed to John Morgan, at (267) 861-7580 or jmorgan@tthlaw.com.
Jackiw v. Soft Pretzel Franchise (WCAB)
Commonwealth Court of Pennsylvania
No. 64 CD 2022

Decided: August 10, 2023

A claimant’s benefit rate for specific loss benefits is calculated the same as the claimant’s benefit rate for total disability benefits.

Background

The claimant sustained a crush injury to her arm, which was later amputated. Her total disability rate was $289.85 per week. The parties stipulated that the claimant had sustained a specific loss of the forearm under Section 306(c)(2), and that she was entitled to 370 weeks of compensation with a healing period of 20 weeks. However, the parties disagreed with respect to whether the specific loss benefit rate should be calculated under Section 306(a) or Section 306(c). The WCJ determined that benefits were to be calculated pursuant to Section 306(a), and limited her specific loss compensation rate to 90% of her average weekly wage. The Board affirmed. The claimant appealed to the Commonwealth Court.

Holding

The Commonwealth Court affirmed in a 4-3 unpublished decision. Under Section 306(a), in cases of total disability, a claimant is generally entitled to 2/3 of her average weekly wage. This increases to 90% of the average weekly wage if the benefit calculated is less than 50% of the average weekly wage. Under Section 306(c), the benefit rate is 2/3 of the average weekly wage regardless of the amount, so long as the benefit calculated is between the statewide average weekly wage and 50% of the statewide average weekly wage. The court recognized that 40 years of precedent supported treating claimants equally under both Section 306(a) and Section 306(c).

Takeaway

This case reaffirms that the benefit rate for indemnity and specific loss benefits is the same, despite language in the Act suggesting that the “floor” for specific loss benefits is 50% of the statewide average weekly wage.

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

Lewis v. Lehigh Asphalt Paving & Construction Co. (WCAB)
Commonwealth Court of Pennsylvania
No. 1445 C.D. 2021

Decided: October 19, 2023

The claimant’s injury, which occurred as he was trying to enter the cab of a work vehicle on the employer’s property, was unrelated to the condition of the premises, and thus, was not compensable.

Background

The claimant appealed a Workers’ Compensation Appeal Board (Board) decision that upheld a Workers’ Compensation Judge’s (WCJ) denial of his Claim Petition and Penalty Petition. The claimant alleged an injury to his Achilles tendon sustained on November 12, 2018, after his work shift had ended. The injury occurred on the employer’s premises as he attempted to enter the cab of a work vehicle. The claimant argued that his injury was work-related and that he was entitled to compensation benefits and penalties.

The WCJ initially granted the Claim Petition, but denied the Penalty Petition, stating that the employer had a reasonable basis to contest the claim. The Board remanded the case for clarification on whether the claimant’s injury occurred within the course and scope of his employment. On remand, the WCJ determined that the injury was not related to the condition of the employer’s premises or the operation of the business and denied the Claim Petition. The Board affirmed this decision, and claimant petitioned for review.

Holding

The court found no error in the Board’s decision, reasoning that the claimant’s injury did not result from a condition of the employer’s premises or the operation of the business. It was caused by his own act of stepping into the vehicle, which was not related to the condition of the premises. Therefore, the claimant failed to satisfy the Slaugenhaupt test for compensability, which requires that an injury (1) must occur on the employer’s premises, (2) be directly connected to the employee’s work, and (3) stem from a condition within the premises or the employer’s business operations. Additionally, the court concluded that the Penalty Petition was properly denied because the employer had a reasonable basis to contest the claim. The claimant’s arguments regarding his status as a traveling employee and the alleged lack of notice were not addressed, as they were not raised before the WCJ and were not within the scope of the remand. Consequently, the court affirmed the Board’s decision.

Takeaway

Even if a claimant is injured on an employer’s premises, an employer may not be liable where the premises itself did not cause the injury.

Questions about this case can be directed to Matthew Mangapora at (412) 926-1437 or mmangapora@tthlaw.com.