Articles Posted in Case Law Update

As loyal readers of our blog know, “retirement” is a popular tool being used by the workers’ compensation insurance carriers in Pennsylvania to attack the benefits of injured workers in PA. Indeed, the fact that an injured worker can take such an innocent act as applying for a pension, or Social Security Retirement benefits, and jeopardize their entire workers’ comp case, is a large reason why we encourage all injured workers in Pennsylvania to be represented by experienced workers’ comp attorneys, who, like the attorneys at Brilliant & Neiman LLC, are Certified as Specialists in the Practice of Workers’ Compensation Law.

Today, the Commonwealth Court of Pennsylvania decided the case of Turner v. Workers’ Compensation Appeal Board (City of Pittsburgh), which dealt with this “retirement” issue. Here, the injured worker was a police officer who hurt her neck, left shoulder, back, right wrist, and right knee in a work-related car accident in 1994. The injured worker performed a modified duty job for the City of Pittsburgh until 2003, when the City stopped the modified duty program. At that time, Claimant applied for, and received, a disability pension from the City of Pittsburgh.

The workers’ compensation insurance carrier filed a Petition for Suspension, alleging that the application for this pension meant that the injured worker had voluntarily left the labor market, retired in other words, causing a shift of the burden of proof to the injured worker, to show that she was either disabled from all employment, or that she continued to look for work.

The 1996 amendments to the Pennsylvania Workers Compensation Act (Act 57) were largely a disaster for every worker in PA. Any thought that, as Pennsylvania’s appellate courts like to spout, the PA Workers’ Compensation Act is a piece of “remedial legislation” intended for “humanitarian purposes” and to “benefit the injured worker,” was clearly removed by Act 57.

One of the most ridiculous aspects of Act 57 was the creation of the Impairment Rating Evaluation (IRE). As we have previously noted, once an injured worker has received 104 weeks of temporary total disability benefits, the workers’ compensation insurance carrier can request an IRE. As the Act itself states, in Section 306(a.2)(1), the IRE is used “to determine the degree of impairment due to the compensable injury, if any.” If this permanent impairment rating is less than 50% (a preposterously high standard), the status of the injured worker may be changed to “partial” disability status.

Now, logically, one can only have a permanent impairment rating if the impairment is, well, “permanent.” Our handy dictionary tells us that “permanent” means “lasting or intended to last or remain unchanged indefinitely.” Therefore, again applying logic, if an injured worker has a “permanent” impairment, he or she cannot, at the very same time, be “fully recovered.”

When an employee in Pennsylvania is injured on the job, and disabled from work as a result of the injury, workers’ compensation benefits should start. These benefits usually stop either when the injured worker is fully recovered or goes back to work (they can be stopped for other reasons, such as incarceration or refusal to undergo reasonable and necessary medical treatment, but that’s for another blog entry).

An injured worker who goes back to work has a period during which he or she may file to reinstate workers’ comp total disability benefits, if the disability recurs. The Pennsylvania Workers’ Compensation Act was a bit unclear on whether this period was three years from the date of the most recent payment of compensation, or 500 weeks from the date of the reduction or stoppage of benefits. Recently, the Supreme Court of Pennsylvania clarified this answer for us all, in the decision of Cozzone v. Workers’ Compensation Appeal Board (East Goshen Township).

In this case, Mr. Cozzone, the injured worker (claimant), suffered a serious injury to his back in 1989. Despite the severity of his injury, claimant went back to work in 1989 and his benefits were stopped. Claimant then continued to work, with no loss of wages, for over 13 years. In 2003, claimant and the workers’ comp insurance carrier entered into a Supplemental Agreement, reinstating total disability benefits (Additional Supplemental Agreements were also entered into between the parties, reinstating benefits again, in 2005 and 2007).

Sadly, we see many catastrophic injuries which occur on the job. While all such tragic situations are devastating to the family of an injured worker, the most devastating must be the cases where the worker is actually killed by the work injury. Though justice is important in every case, somehow it just seems that much more important when the injured worker is not here to fight for him or herself.

When a worker has a fatal injury, the key question is whether the incident at work was a “substantial contributing factor” in causing the death. Sometimes, the issue gets a bit confusing when some other medical condition, having nothing to do with work, also plays some role in the situation. Recently, in Manitowoc Co., Inc. and Sentry Insurance v. Workers’ Compensation Appeal Board (Cowan), the Commonwealth Court of Pennsylvania was confronted with such a case.

Here, the worker was killed when he fell about six feet from a crane platform. A witness described that the worker was on the platform and, while crouching, his eyes rolled back, and he fell off the platform striking his head on the floor. The worker initially had a pulse, but then stopped breathing. He was then resuscitated and transported to the hospital, where he passed away. An autopsy concluded that the cause of death was “cardiac dysrhythmia due to mitral valve prolapse.”

Previously, we have discussed when the Commonwealth Court of Pennsylvania has addressed whether an employee was in the “scope and course” of his or her job at the time of the work injury. This issue has once again risen on appeal.

In the case of Trigon Holdings, Inc. v. Workers’ Compensation Appeal Board (Griffith), the injured worker was a supervisor in a machine shop. After he made sure his guys were set up, and the machines were all running properly, he told them he would be in another room for a few minutes. Five minutes later, his left thumb was caught in a machine while he was polishing a part for his child’s go-cart, severely injuring the thumb. As a result of the thumb injury, the injured worker was disabled from his job.

A Claim Petition was filed and litigated before a Workers’ Compensation Judge (WCJ). The injured worker, and witnesses he offered, testified that employees at the machine shop were permitted to work on personal things at the shop, and this was something done on a frequent basis. The general manager of the company testified that this action was never permitted and was totally unacceptable. In granting the Claim Petition, the WCJ found the testimony of the injured worker, and his witnesses, more credible than of the general manager. Specifically, the WCJ found that “a small temporary departure from work does not break the course of employment[,] and that an incident necessary to constitute a break in the course of employment must be of a pronounced character.'” On appeal, this decision was affirmed by the Workers’ Compensation Appeal Board (WCAB).

While an injured worker in Pennsylvania generally cannot sue his or her employer for causing a work injury (since Pennsylvania workers’ compensation is an “exclusive remedy”), the injured worker is able to sue a third party for causing a work injury. We see this situation with car accidents, slip and fall cases and products liability cases.

When an injured worker in PA does sue another party for causing his or her work injury (called a “third party”), and is awarded money, the workers’ compensation insurance carrier is entitled to be repaid money that it paid in medical expenses and wage loss benefits (this is called “subrogation”). Ultimately, unless the attorney negotiates something better (which is what happens normally), the injured worker ends up with no money from this third party case.

Not every law suit involving a work injury creates a right to subrogation, however. For example, a PA workers’ compensation insurance carrier is not entitled to subrogation in a medical malpractice award, if the work injury was not aggravated by the malpractice. The key is whether the award in the third party case is a direct result of what caused the disability.

Say you are coming home from work and you are injured; are you entitled to workers’ compensation benefits in Pennsylvania? As we have mentioned previously, generally, an employee is not eligible for injuries suffered in the commute to or from work (known as the “Going and Coming Rule”). Recently, the Commonwealth Court of Pennsylvania addressed this issue again in Mansfield Brothers Painting and Selective Insurance Company of America v. Workers’ Compensation Appeal Board (WCAB).

A union painter was assigned to work full-time for his employer at the University of Pennsylvania. While on his way home from the job one day, the painter fell near the train station, and hurt his left shoulder, neck and back. A Claim Petition was filed and litigated before a Workers’ Compensation Judge (WCJ).

The facts were not in dispute. The painter was hired to work at a specific building on the Penn campus, which only had a single entrance. He elected to commute to work by train. On the walk to the train station, about 150 feet from the exit of the building in which he worked, the painter fell on an uneven slate walkway and suffered these injuries. The fall took place while the painter was still on Penn’s campus.

Once an injured worker in Pennsylvania has an accepted work injury (whether by decision of a Workers’ Compensation Judge (WCJ), or the issuance of a Notice of Compensation Payable or Agreement for Compensation), such benefits can only be suspended for a limited number of reasons. A return to gainful employment, with no loss of wages, is obviously the most desirable reason. Other reasons can include incarceration after a conviction and proof of available employment at the pre-injury wages.

An additional reason, though rarely seen, is an intervening injury, not related to work, which renders the injured worker totally disabled. The case that first established this principle was Schneider, Inc. v. Workers’ Compensation Appeal Board (WCAB), decided by the Pennsylvania Supreme Court in 2000. This case involved a unique set of facts, and it was hoped the principle would be limited to facts so extreme.

The injured worker in the Schneider case was receiving benefits for a work injury involving his head and neck. He was then involved in a serious non-work-related incident which left him with severe brain damage and paralysis. A Petition for Suspension was granted, stopping the workers’ compensation benefits, without any requirement that the workers’ compensation insurance carrier show any jobs were available within the restrictions of the work injury. The WCJ found the opinion of the insurance carrier’s medical expert credible, that the injured worker was capable of some type of work (from the standpoint of the work-related injuries), though totally (and permanently) disabled by the non-work-related incident. The Court reasoned that it would be an “exercise in futility” to require the insurance company to show job availability, since the injured worker was totally disabled by a non-work-related cause.

The term “collateral estoppel” essentially means that once an issue is fully litigated, it cannot be litigated again. The primary example of this concept, as it applies to PA workers’ compensation, is the Weney case. Whenever we have seen the use of “collateral estoppel” in Pennsylvania workers’ comp, however, we have seen it used to the detriment of the injured worker. For once, however, the Commonwealth Court of Pennsylvania used this concept to benefit the injured worker.

In Channellock, Inc. v. Workers’ Compensation Appeal Board (WCAB), the Claimant suffered an annular tear and a herniated disk at the L5-S1 level at work in 2001. The injured worker was offered a “no work” job at the employer, which he accepted (a “no work” job is literally a job where the injured worker reports to the employer to do nothing; this is a frequent tool used by devious employers, as was attempted here, to subvert the workers’ comp process). Due to his pain medications, and the inactivity inherent in a “no work” job, Claimant fell asleep and was promptly terminated.

Litigation ensued before a Workers’ Compensation Judge (WCJ). A decision was rendered by the WCJ, denying a Petition for Termination (since the injured worker was not found to be fully recovered) and granting a Petition for Reinstatement (finding that “the no duty position was not within Claimant’s capabilities because Claimant had difficulty staying awake due to his prescribed medication”).

As a general rule, an injured worker is entitled to benefits under the Pennsylvania Workers’ Compensation Act when he or she is disabled as the result of a work injury. A spouse or dependent of an injured worker is usually entitled to death benefits (which vary, depending on the relationships of the dependents who exist) when the injured worker dies as a result of the work injury. There are, of course, exceptions to this rule. One of those exceptions is the time involved between the work injury and the injured worker’s death. In this situation, we can see a terribly unfair result.

Recently, there was an example of this situation, and its inequitable results. In Whitesell v. Workers’ Compensation Appeal Board (WCAB), the injured worker suffered a back injury at work in 2003. Initially, the injury was accepted by the workers’ compensation insurance carrier by Notice of Compensation Payable (NCP), which described the injury as a lumbar strain and sprain. In 2006, there was litigation in which the description of injury was amended to include “lumbar disc disruption L4-L5, resulting in total disc arthroplasty at L4-L5 level.” Tragically, the injured worker died in 2011, as a result of “mixed drug toxicity,” from the medications she was taking for the work injury.

Since the death was related to the work injury, one would presume that death, or fatal claim, benefits would be available to the surviving spouse/dependents. One would be wrong. The Pennsylvania Workers’ Compensation Act, states, in Section 301(c)(1), ” . . . wherever death is mentioned as a cause for compensation under this act, it shall mean only death resulting from such injury and its resultant effects, and occurring within three hundred weeks after the injury.” Since the death here did not take place within 300 weeks of the original injury, death benefits were denied by the Workers’ Compensation Judge (WCJ). This was affirmed by the WCAB.