Articles Posted in Case Law Update

On many occasions, we have explored the evolution of the Pennsylvania Workers’ Compensation Act as it pertains to whether an injured worker has “voluntarily left the labor market.” Typically, we see this situation when the injured worker has filed for a retirement pension, or given some other indicia of “retirement.” Until now, we have not seen the Pennsylvania Courts punish an injured worker for merely taking Social Security Disability benefits.

Unfortunately, that ended with Burks v. Workers’ Compensation Appeal Board (City of Pittsburgh), where the Commonwealth Court of Pennsylvania upheld the suspended of workers’ comp benefits merely because the injured worker was receiving Social Security Disability benefits.

In that case, the injured worker had both a work-related injury (knee sprain) and non-work-related conditions (many, primarily involving her hip and low back). The Court found that the injured worker was capable of light duty work with regard to the work injury, but that she was totally disabled with the addition of the non-work-related conditions. As such, the Court concluded:

Generally speaking, the goal is to return an injured worker in Pennsylvania to gainful employment. Along those lines, under the Pennsylvania Workers’ Compensation Act, when an injured worker in PA is not able to keep working, due to the effects of the work injury, workers’ comp benefits should be reinstated.

The key element to whether benefits will be reinstated is often whether the loss of earnings is truly related to the work injury. A good example of this concept came recently in the case of Verity v. Workers’ Compensation Appeal Board (The Malvern School), decided by the Commonwealth Court of Pennsylvania.

Here, Ms. Verity (Claimant) suffered a strain to her left hip and low back. After being released to modified duty, Claimant returned to work under those restrictions. Subsequent to her going back to work, Claimant had additional restrictions placed upon her by her physician, which included “no going up/down stairs.” The employer said they had nothing within those restrictions, and Claimant filed a Petition for Reinstatement.

Many changes to the Pennsylvania Workers’ Compensation Act, much to the detriment of the injured worker, took place in the sweeping 1996 amendments to the Act. One of the more substantial changes was the amendment to Section 204(a), allowing PA workers’ comp insurance carriers to enjoy an offset, or credit, for such things as severance, unemployment compensation and Social Security retirement (known as “Old Age,” though we certainly won’t use that term) benefits.

Looking specifically at Social Security retirement, Section 204(a) permits the PA workers’ compensation insurance company to take an offset equal to 50% of an injured worker’s Social Security retirement benefit. The Supreme Court of Utah found a similar provision in that State’s workers’ compensation system to be unconstitutional. With that decision in mind, attorneys representing injured workers in PA had high hopes for a similar result from the Pennsylvania Court System.

So far, unfortunately, our hopes have been dashed. The Commonwealth Court of Pennsylvania has decided, in Caputo v. Workers’ Compensation Appeal Board (Commonwealth of Pennsylvania), that the PA workers’ comp system is different than that in Utah, and the offset in Section 204(a) of the PA Workers’ Compensation Act is indeed constitutional. Hope remains the Supreme Court of Pennsylvania will review this issue, but for now the 50% offset in Section 204(a) will remain.

Under PA workers’ comp, wage loss benefits are stopped (suspended) when an injured worker returns to work at no loss in wages (medical treatment continues, regardless of wage loss, however). What if the injured worker (“claimant”) voluntarily quits a job? Can he or she get reinstated to workers’ compensation benefits in PA? Well, it depends.

The Commonwealth Court of Pennsylvania faced this issue in Allen v. Workers’ Compensation Appeal Board (Delaware County SPCA, Inc.). Here, on August 24, 2007, the claimant injured his shoulder at work, but then subsequently returned to work, at his pre-injury job, at no loss in wages, causing the workers’ comp benefits to be suspended. The injured worker then voluntarily quit his job on January 3, 2008, because there was a “deterioration of the relationship” with the company, and he was having increased pain in his shoulder. On January 29, 2008, the injured worker saw a doctor who found that he was not physically capable of his pre-injury job as of that date.

A Workers’ Compensation Judge (WCJ) granted the Petition for Reinstatement, as of January 29, 2008, since the injured worker proved he had a change of condition as of that date. Upon appeal, the Workers’ Compensation Appeal Board (WCAB) reversed the WCJ, finding that claimant was not entitled to a reinstatement of his workers’ comp benefits, because he had voluntarily quit his job.

Before recent changes in PA Workers’ Compensation law, an insurance carrier could “accept” a claim using a Notice of Denial (NCD). This left the status of the work injury in doubt, so, in 2011, the PA Bureau of Workers’ Compensation redesigned the NCD form to no longer allow such an action.

With the previous NCD, we had seen a Claim Petition denied, despite an acknowledged work injury. As attorneys who represent injured workers, we found this result illogical, and just plain wrong.

As if in a confirmation that an illogical result was intended, the Commonwealth Court of Pennsylvania decided the case of Zuchelli v. Workers’ Compensation Appeal Board (Indiana University of Pennsylvania), again denying a Claim Petition because disability was not proven (the NCD used to “accept” the claim was done before 2011).

When we settled a workers’ comp case in Pennsylvania (usually done by what is called a “Compromise & Release Agreement”), there was often a question from our client about whether he or she could then file for unemployment compensation benefits. Usually, as part of a workers’ compensation settlement, the employer/insurance carrier wants a resignation as part of the deal. Until recently, we told them the honest answer – maybe. It depended on the identity of the Unemployment Compensation Referee (UCR), the wording of the resignation and the status of the medical clearance (one must be capable of some type of employment to be eligible for unemployment compensation).

When the Commonwealth Court of Pennsylvania recently decided Lee v. Unemployment Compensation Board of Review, however, we were given a pretty specific answer – no, you cannot. Here, the injured worker gave both a resignation and a release (waiving her rights to other causes of action, including unemployment compensation benefits) as part of her workers’ compensation settlement. Following the approval of the settlement, the injured worker filed for unemployment compensation benefits.

Benefits were granted by the UCR, who found the resignation was not “voluntary,” since it was required as part of a workers’ compensation settlement. The Unemployment Compensation Board of Review reversed, finding the injured worker not eligible for unemployment compensation benefits. Upon further appeal, this was affirmed by the Commonwealth Court of Pennsylvania.

When a work injury in Pennsylvania is not obvious, the injured worker must present expert medical testimony to explain how the work duties caused the work injury. This gets even more complicated when the condition at issue is caused by a combination of the work duties and pre-existing pathology, such as in the case of a heart attack (in that situation, the injured worker (known as the “Claimant”) must prove that the work-related cause is a substantial contributing factor to the disability).

Recently, the Commonwealth Court of Pennsylvania addressed this issue in Bemis v. Workers’ Compensation Appeal Board (Perkiomen Grille Corp.). Here, the injured worker, a chef and manager, suffered a heart attack when he was moving kegs of beer and when he was lifting a heavy pot of chili. A Claim Petition was filed and the case was litigated before a Workers’ Compensation Judge (WCJ). The WCJ noted that Claimant’s medical expert said the work duties “certainly could have” and “probably” caused the heart attack. The WCJ found this opinion “equivocal” and denied the Claim Petition. The Workers’ Compensation Appeal Board (WCAB) affirmed.

Upon further appeal, however, the Commonwealth Court of Pennsylvania reversed this decision. The Court observed that the WCJ erred by taking some statements by the doctor out of context. The mere fact an expert witness says “could have” or “probably” does not render an opinion equivocal. The entire testimony must be reviewed. When this is done, said the Court, it is clear the doctor found the heart attack was related to, and caused by, the work duties. Again, in this situation, the work duties do not have to be the sole cause, only a “substantial contributing factor.” As such, the Court felt the Claim Petition should have been granted, and remanded (sent the case back) to the WCJ, to grant the Claim Petition.

It is well-settled law in PA that an aggravation of a pre-existing condition is compensable under the Pennsylvania Workers’ Compensation Act. However, depending on the condition at issue, the work injury may be seen to end when the worker returns to his or her baseline condition (or, in other words, when the “aggravation” ends and the injured worker is left with the same pre-existing condition).

This concept was explored by the Commonwealth Court of Pennsylvania in City of Philadelphia v. Workers’ Compensation Appeal Board (Whaley-Campbell). Here, the injured worker had a long history of allergies and respiratory symptoms for years. The air pollution at work aggravated her conditions and led to chronic conjunctivitis.

The workers’ comp insurance carrier filed a Petition for Termination, saying the work injury had resolved and that the injured worker had returned to baseline. The Workers’ Compensation Judge (WCJ) denied the Petition. Upon further appeal, the workers’ comp insurance company argued the condition is a related to the pre-existing allergies and that a Termination of workers’ comp benefits is warranted.

Under the Pennsylvania Workers’ Compensation Act, and throughout legal process generally, once a matter has been decided, the parties cannot try the matter again. This is called the concept of Res Judicata.

Often, for any of a number of reasons, an attorney representing an injured worker asks a Workers’ Compensation Judge (WCJ) to mark a pending Claim Petition “withdrawn, without prejudice.” This allows the injured worker to continue his fight another day. If a Claim Petition is dismissed “with prejudice,” it cannot be refiled. Obviously, this is a critical distinction.

In Boyertown Foundry and ESIS Wilmington WC v. Workers’ Compensation Appeal