Articles Posted in Case Law Update

As followers of our blog are aware, we filed a workers’ compensation case on behalf of a PA liquor store clerk who was the victim of an armed robbery (and suffered post-traumatic stress disorder (PTSD) as a result). We were successful before the Workers’ Compensation Judge (WCJ), and the matter is currently pending before the Workers’ Compensation Appeal Board (WCAB). Though we, of course, follow all PA court decisions in the workers’ comp area, we have a particular interest in those dealing with this issue.

Yesterday, the Commonwealth Court of Pennsylvania issued a decision in the matter of PA Liquor Control Board v. Workers’ Compensation Appeal Board (Kochanowicz). In what can only be described as a staggeringly repulsive decision, the Court reversed both the WCJ and WCAB, who both found that the claimant in that case suffered PTSD as a result of an armed robbery, and that the armed robbery was an “abnormal working condition.” Both the injured worker’s treating doctor, and the Independent Medical Examiner (IME)[Who often is anything but “independent”], found that the injured worker suffered PTSD as a result of the armed robbery.

In its infinite wisdom, the Court found that armed robberies at liquor stores in Pennsylvania are common; perhaps, if we are understanding their logic correctly, an armed robbery at a liquor store these days is akin to taking out the trash. Just another part of a clerk’s daily routine.

Often, injured workers in Pennsylvania have their claims denied by the workers’ comp insurance carrier because their disability is said to be related to a “degenerative” condition, rather than a traumatic one. In fact, almost inevitably, if the word “degenerative” appears in the medical records, the workers’ compensation claim will be denied by the workers’ comp insurance company, forcing the injured worker to litigate his or her claim.

Yet, these degenerative conditions are ones that allowed the injured worker to do his or her job, frequently even without difficulty, until the work injury. The fact that the work injury makes the degenerative changes disabling is what truly matters. In that situation, the injured worker is entitled to PA workers’ compensation benefits.

Recently, the Commonwealth Court of Pennsylvania confirmed this premise in Green v. Workers’ Compensation Appeal Board (US Airways). The case began when Ms. Green was injured at work in 1993. A Notice of Compensation Payable (NCP) was issued, accepting the injury as a meniscal tear in the right knee. The description of injury was later amended to include left tibial plateau cartilage damage and lateral femoral condyle defect. Workers’ compensation benefits were suspended in 2003.

Under the Pennsylvania Workers’ Compensation Act, Section 440(a), “where a claimant succeeds in a litigated case reasonable counsel fees are awarded against the employer, as a cost, unless the employer meets its burden of establishing facts sufficient to prove a reasonable basis for the contest.” The Act, as you can see, clearly states that this is to be the rule, not the exception. The employer/insurance carrier has the burden to prove that there was a reasonable contest. One would read that language and believe unreasonable contest counsel fees are often awarded. One would be dead wrong.

The reason why unreasonable contest counsel fees are rarely found these days is reflected in a recent decision by the Commonwealth Court of Pennsylvania, Grady v. Workers’ Compensation Appeal Board (Lutz t/a Top of the Line Roofing). Here, a roofer suffered a T12 burst fracture resulting in paraplegia of both lower extremities and depression when he fell from a rooftop.

Ultimately, a Claim Petition was filed against the Employer and the Uninsured Employers’ Guaranty Fund (UEGF). Initially, the parties asked the Workers’ Compensation Judge (WCJ) to “bifurcate” the case, to decide whether the injured worker was actually an employee (as opposed to an independent contractor). This lets the parties get past a threshold issue, before litigating the remainder of a case.

Once workers’ compensation benefits are suspended in Pennsylvania, for example when an injured worker goes back some type of gainful employment, the general rule is that workers’ comp benefits can be reinstated by simply proving his or her earning power is again adversely affected by the injury, and that the new disability is related to the original injury. As a general rule, the injured worker need not demonstrate that there has been a change in his or her condition.

This gets a bit more complicated when there is another condition impacting the employability of an injured worker. For instance, take the matter of Upper Darby Township v. Workers’ Compensation Appeal Board (Nicastro), decided by the Commonwealth Court of PA. Here, the claimant injured his low back at work in 2002 dumping a can into the garbage truck. A Notice of Temporary Compensation Payable (TNCP) was issued, accepting a low back strain. The TNCP subsequently converted to a regular Notice of Compensation Payable (NCP).

The claimant returned to his regular duties in March, 2004, and workers’ comp benefits were suspended. On June 8, 2004, claimant again injured his low back lifting a trash can. A Petition was filed, but before there could be a decision by a Workers’ Compensation Judge (WCJ), the parties resolved the case by Stipulation. Specifically, in the Stipulation the parties agreed that claimant was disabled by the work injury from June 8, 2004 until October 7, 2004, that claimant was able to go back to his regular job as of October 7, 2004 and that claimant left the employ of the company in December, 2004, because of “injuries unrelated to his back.”

Under the Pennsylvania Workers’ Compensation Act, mental injuries caused by a psychic, or mental, incident, require an injured worker to prove that the psychic, or mental, onset was an “abnormal working condition.” We have discussed psychological injuries under PA workers’ comp previously. We call these types of cases “mental/mental” cases.

But, what about a mental, or emotional, onset that leads to a physical injury (what we call a “mental/physical” case)? Back in 1981, the Supreme Court of Pennsylvania decided Krawchuk v. Philadelphia Electric Company, wherein the Court granted workers’ comp benefits to an employee who suffered a heart attack at home, after having a great deal of stress at work. This was followed, however, by the Court’s decision in Davis v. Workmen’s Compensation Appeal Board (Swarthmore Borough) in 2000, finding that abnormal working conditions were required in a case with an emotional or mental onset. Finally, the Court clarified things in 2005 in the case of Pankyo v. Worker’s Compensation Appeal Board (U.S. Airways) (Pankyo).

In the Pankyo case, the Court found that the holding in Davis was limited. Specifically, the Court noted, “given the facts in Davis, that case only stands for the proposition that where a claimant suffers a psychic injury with attendant physical symptoms, the claimant must meet the abnormal working relations test.” On the other hand, where the injury itself is physical (again, such as a heart attack), the “abnormal working conditions” requirement does not apply (even though the onset was a mental incident).

Under Section 312 of the Pennsylvania Workers’ Compensation Act, an injured worker must provide notice to his or her employer that he or she “received an injury, described in ordinary language, in the course of his employment on or about a specified time, at or near a place specified.” This notice, under Section 311, must be given within 120 days of the injury, or the claim may be precluded. In reality, giving notice to an employer may not be so simple.

Take, for example, the facts in Gentex Corp. v. Workers’ Compensation Appeal Board (Morack), a decision recently rendered by the Supreme Court of Pennsylvania. The injured worker toiled on an assembly line for many years, repetitively using her hands. Eventually, she began to have pain and swelling in her hands, and her fingers would become “stuck.”

Finally, on January 17, 2005, Ms. Morack told her boss that her hands were hurting so bad, she did not know what to do. The injured worker saw a doctor that same day and got a note keeping her out of work. According to the company policy, Ms. Morack called her employer every day for the first five days she was out, advising the employer each day that she could not work because of the swelling in her hands. She did not specifically tell the employer that the swelling was from her work duties, because she was not sure what caused the problem. A short-term disability application was made, indicating the condition was the result of “sickness” rather than “injury,” since, at that time, Ms. Morack believed her condition was related to pre-existing fibromyalgia, not her work duties.

One of the ways a workers’ compensation insurance carrier in PA can be relieved of paying workers’ comp benefits to an injured worker in Pennsylvania is by showing that employment is “available” to the injured worker, as described previously in our blog.

Prior decisions by both the Supreme Court of Pennsylvania, and the Commonwealth Court of Pennsylvania, make clear that if an injured worker would not reasonably be aware of the duties involved with a modified job offer, the job offer is not sufficient. Typically, if the injured worker has not previously worked in the position to which he is being offered, “the employer must provide information related to the job duties and classification so that the claimant can make an informed decision regarding whether the position offered is within (his or) her capabilities.” [Quoting language in the decision of Eidem v. Workers’ Compensation Appeal Board (Gnaden-Huetten Mem’l Hospital) from the PA Supreme Court].

This brings us to the recent decision by the Commonwealth Court of Pennsylvania in Vaughn v. Workers’ Compensation Appeal Board (Carrara Steel Erectors). Here, Mr. Vaughn was a union ironworker, who injured his back while performing heavy duty work. Some time after the injury an “Independent” (Which we know is anything but) Medical Examination (IME), released Mr. Vaughn to light duty work.

Under the Pennsylvania Workers’ Compensation Act, when an injured worker in PA is disabled from his or her job due to a work injury, the injured worker is entitled to workers’ compensation wage loss benefits. This rate is based on the earnings the injured worker had prior to the injury. Those earnings are called the Average Weekly Wage (AWW).

Assuming the injured worker had been working for his or her employer for more than a year before the work injury, the AWW is calculated by taking the average earnings of the injured worker for each of the four 13-week quarters immediately before the injury. The lowest quarter is disregarded and an average is taken of the remaining three quarters. The resulting number is the AWW. The workers’ compensation rate is typically two-thirds of the AWW (if the AWW is very low, the rate could be as high as 90%, if the AWW is very high, the rate is capped at a certain level each year).

Sometimes, these calculations result in a terrible injustice. The most egregious example was fixed by the Supreme Court of Pennsylvania in their decision in Hannaberry HVAC v. Workers’ Compensation Appeal Board (Snyder Jr.) in 2003. There, the injured worker was a part-time employee for most of the year preceding the injury. Shortly before the accident, the injured worker had graduated school and become a full-time employee, earning a wage four times what he had been earning. The accident (in which he was pinned under a forklift) left the injured worker a quadriplegic.

When a PA workers’ compensation claim is denied by the insurance carrier, it is up to the injured worker to file a Claim Petition. In litigating a Claim Petition before a Workers’ Compensation Judge (WCJ), the injured worker bears the burden to prove that he or she suffered an injury, which was related to his or her job, and was rendered disabled by such injury.

It is the WCJ who makes the critical determination of who is credible in this litigation. Neither the Workers’ Compensation Appeal Board (WCAB), nor the Pennsylvania system of Courts, can substitute their opinions on credibility of witnesses. However, the testimony of the credited witness must be “unequivocal.”

This area was highlighted recently by the Commonwealth Court of Pennsylvania in Potere v. Workers’ Compensation Appeal Board (KEMCORP). Here, the WCJ found the Independent Medical Examiner (IME; in reality, a Defense Medical Examiner [DME]) credible, and denied the Claim Petition filed by the injured worker. The WCAB affirmed.

Cases dealing with benefits stopping in PA workers’ compensation, due an alleged “retirement” of the injured worker, are frequent on our blog. Usually, Pennsylvania Courts are reading the PA Workers’ Compensation Act ever more strictly. A recent case, however, gives hope to the injured worker in Pennsylvania.

In Keene v. Workers’ Compensation Appeal Board (Ogden Corp.), the Commonwealth Court of Pennsylvania reversed the Workers’ Compensation Appeal Board (WCAB), who in turn had reversed the Workers’ Compensation Judge (WCJ), when the WCJ denied a Petition for Suspension (for an alleged voluntary withdrawal from the labor market).

The WCJ found that the injured worker, who had hurt her knee at work in 1989, had not voluntarily withdrawn from the labor market, and denied the workers’ comp insurance carrier’s Petition for Suspension. The injured worker said she had looked for work for a long time and the failure to find any work had depressed her, so she stopped even looking. The WCAB reversed, finding that the injured worker failed to look for a job for a two-year period, showing that she had withdrawn from the labor market.