Articles Posted in Case Law Update

“Notice” of a Pennsylvania work injury is an issue which we have previously addressed in this blog.  Essentially, an injury must be reported to the employer within 21 days to have benefits date back to the first day, and within 120 days of the injury to have an entitlement to PA workers’ compensation benefits at all.  Often, the disputed aspect of a case is whether the notice provided to an employer is sufficient under the Pennsylvania Workers’ Compensation Act.

Importantly, proper notice does not mean that an employee must give a report with specifics or certainty.  What matters is whether the notice provided makes the employer aware that there is a possibility of a work-related injury.  Recently, the Commonwealth Court of Pennsylvania dealt with this very issue in City of Pittsburgh and UPMC Benefit Management Services, Inc. v. Workers’ Compensation Appeal Board (Flaherty).

Here, the injured worker (Claimant) was a firefighter for 16 years.  She was diagnosed with breast cancer in 2004, and was no longer able to continue performing the required duties of the position.  After Act 46 was enacted in 2011, creating a presumption dealing with cancer and firefighters, Claimant received a letter from her union describing the benefit to the new law.  Shortly thereafter, she filed a Claim Petition giving her employer notice that her condition may have been work-related.  She did not receive an opinion from her doctor, that her condition was, in fact, related to work, until a few months later.

Whether an employee hurt during the commute to work is covered by the Pennsylvania Workers’ Compensation Act (Act) is always a difficult analysis, and one we often encounter here.  Each case depends on the specific facts involved. While most employees (those who are “stationary” employees) are not covered for the commute to work, one reaches a point in the commute when the employee is no longer still commuting, but has, for the purposes of the law, arrived at work.  “Parking lot” cases are frequently an aspect of this situation.

Recently, the Commonwealth Court of Pennsylvania made a decision in the matter of  US Airways, Inc. v. Workers’ Compensation Appeal Board (Bockelman).  This was one of those “parking lot” cases.  Here, the employee (Claimant) labored for US Airways as a Philadelphia-based flight attendant.  Employees were not required to drive to work, but, if they did so, there were two designated employee parking lots.  These lots were owned, operated, and maintained by the City of Philadelphia/Division of Aviation (DOA), for the use of all airport employees, not just those of US Airways.  An employee identification badge was required to park in these lots.  A shuttle bus, operated by DOA (and not US Airways) then took the employee from the lots to the airport terminal.  Claimant hurt her left foot when she slipped while riding this shuttle bus after parking her car.

As could be expected, the Employer denied that Claimant was entitled to workers’ compensation benefits, since her injury was sustained while on the commute to work.   A Claim Petition was filed.  After considering the evidence, the Workers’ Compensation Judge (WCJ) found that Claimant was within the scope and course of her employment at the time of the injury, and granted the Claim Petition.  This was affirmed by the Workers’ Compensation Appeal Board (WCAB).

Several years ago, we were excited to tell everyone about the Supreme Court of Pennsylvania decision in Phoenixville Hospital v. Workers’ Compensation Appeal Board (Shoap).  It was this case that made clear workers’ compensation insurance carriers in PA could not simply use a classified “help wanted” ad to reduce every injured worker’s benefits.

If a workers’ compensation insurance carrier in Pennsylvania wants to reduce the benefits of an injured worker, said the Court, the jobs shown must not only be open at the time they are found, the potential jobs in a Labor Market Survey (LMS) or Earning Power Assessment (EPA) should “remain open until such time as the claimant is afforded a reasonable opportunity to apply for them.”  The reasoning behind this, of course, is that an LMS/EPA is not just a tool to cut the benefits of injured workers; it should be a device to assist an injured worker back to gainful employment.

The Commonwealth Court of Pennsylvania recently had to address exactly what a workers’ compensation insurance carrier needs to prove in this regard.  In Smith v. Workers’ Compensation Appeal Board (Supervalu Holdings PA, LLC), the injured worker (Claimant) hurt his neck and back.  At the time he was injured, he was earning an “Average Weekly Wage” (AWW; the calculation we do under the PA Workers’ Compensation Act to see the amount of benefits due to the injured worker) of $992.50.  The injury was accepted by the insurance carrier as a cervical strain and sprain (making eventual fusion surgery required due to the work injury a curious fit to that modest diagnosis).

Among the benefits available under the Pennsylvania Workers’ Compensation Act (Act), are “fatal claim” benefits.  Since these are only relevant for work accidents which involve the death of a worker, these are not things we like to often see.  Unfortunately, sometimes these things do happen, and they are cases which need attention.

In addition to modest “burial expenses,” fatal claim benefits also include benefits for any surviving minor children, and, potentially, a spouse (among other categories of possible recipients beyond this topic).  We say “potentially” since benefits to a spouse are not automatic.

Recently, the Commonwealth Court of Pennsylvania dealt with this issue in Grimm v. Workers’ Compensation Appeal Board (Federal Express Corporation).  Here, the worker who died (Decedent) was employed by Federal Express.  She suffered a fatal heart attack while delivering packages in her normal course of work.

Sometimes odd facts in a Pennsylvania workers’ compensation case make for an odd decision.  Yet, even then, we can often find something of use in that decision.  Seeing how appellate courts approach different situations helps us understand how that may translate to other fact patterns and enable us to better represent injured workers in PA.

Recently, the Commonwealth Court of Pennsylvania issued a decision in Dorvilus v. Workers’ Compensation Appeal Board (Cardone Industries).  Here, the injured worker hurt his low back in 2009.  A Claim Petition was filed, and a Workers’ Compensation Judge (WCJ) granted the Petition, awarding both disability and medical benefits.

On appeal, the Workers’ Compensation Appeal Board (WCAB) reversed the decision of the WCJ as to the award of disability benefits (though the injured worker received disability payments until this reversal in 2013).  Though the injured worker did prove that a work injury took place, said the WCAB, he failed to prove that he was “disabled” as a result of that injury.  This was affirmed by the Commonwealth Court of Pennsylvania (not the decision we are discussing here).  Though requested, an appeal to the Supreme Court of Pennsylvania was not accepted (unlike the WCAB and Commonwealth Court of PA, the Supreme Court of PA has the discretion to accept or decline an appeal).

One of the tools in the arsenal of the workers’ compensation insurance carrier in Pennsylvania, in their fight to take away benefits from injured workers, is the “Labor Market Survey” (LMS), also known as an “Earning Power Assessment” (EPA).  Once an injured worker in PA has shown an entitlement to workers’ comp benefits, then the insurance carrier can use an LMS or EPA to show there are jobs available in the general community that the injured worker could get if he or she wished.  A “vocational expert” is used to locate these jobs.  This is typically followed by a Petition for Modification, seeking a reduction of workers’ compensation benefits based on the amount these potential jobs would pay.

As we discussed several years ago on this blog, the Supreme Court of Pennsylvania, in Phoenixville Hospital v. Workers’ Compensation Appeal Board (Shoap), found that a defense to one of these Modification Petitions is for the injured worker to show that he or she applied to these supposed “open and available” jobs and did not receive an offer of employment.  This is a critical part of defending these Modification Petitions (typically).  However, the Court in Shoap did not specify exactly what the injured worker had to show to refute that the jobs were open and available (or how the insurance company could overcome the injured worker not receiving an offer of employment).

This brings us to a recent decision from the Commonwealth Court of Pennsylvania in Valenta v. Workers’ Compensation Appeal Board (Abington Manor Nursing Home and Rehab and Liberty Insurance Company).  Here, the injured worker suffered serious damage to  her neck and shoulder.  In fact, the injured worker required a cervical fusion due to the work injury.  After that surgery, the workers’ comp insurance company had a LMS/EPA performed.  The injured worker attempted to apply for each of the six jobs that were identified (Though she was only able to contact three of the six potential employers, and only able to actually apply for two of the jobs, she had a vocational expert testify regarding all six jobs).  No offer of employment was received by the injured worker.

Though the phrase “scope and course of employment” does not appear anywhere in the Pennsylvania Workers’ Compensation Act, this is a frequent issue involved with appellate cases.  After all, a work injury is only compensable if one was performing his or her job at the time of the injury.  This issue often depends on the particular facts of each case.  A recent decision by the Commonwealth Court of Pennsylvania continues this concept.

In Rana v. Workers’ Compensation Appeal Board (Asha Corporation), the injured worker (“Claimant”) was a manager-in-training for a Dunkin Donuts franchisee.  The franchisee owned locations in Wyncote, Horsham, and Hatfield.  Claimant primarily worked as a manager at the Wyncote location, but would be expected to travel to the other locations occasionally for operational issues.  One night, after Claimant finished his regular shift at the Wyncote store, Claimant’s boss called him at home at 10:00 pm, and said an employee at the Hatfield location had a medical issue.  Claimant told his boss he would go in and see what was happening.  While heading to the location, Claimant was in a motor vehicle accident, and unfortunately was fatally injured.

A Fatal Claim Petition was filed by Claimant’s parents, who were dependent upon him.  After hearing the evidence, the Workers’ Compensation Judge (WCJ) granted the Fatal Claim Petition, finding that Claimant “was furthering Employer’s business and was on a special assignment for Employer. Thus, Decedent was in the course and scope of his employment at the time of the accident and Claimants were entitled to collect compensation.”

The Pennsylvania Workers’ Compensation Act sets forth that medical treatment related to a work injury is to be paid for by the workers’ comp insurance carrier (provided the treatment is reasonable and necessary).  If there is a dispute as to whether treatment is related to a work injury, a petition must be filed.  If, on the other hand, the dispute is whether treatment is reasonable and necessary, then the Utilization Review process is to be used.  Whether treatment is related to a work injury is not a factor in a Utilization Review.  A recent decision from the Commonwealth Court of Pennsylvania dealt with this distinction.

In Haslam v. Workers’ Compensation Appeal Board (London Grove Communication), the injured worker (“Claimant”), fell from a building.  He suffered fractures to his right ankle, tibia, and fibula, a left calcaneus fracture, and injuries to his neck and low back.  After some time, the indemnity aspect (wage loss part) of the work injury was settled by Compromise & Release Agreement.  The settlement documents described the work injury as “R and L Foot Fracture.”

After the settlement, the workers’ compensation insurance company filed for Utilization Review against the treating doctor, seeking a ruling of whether ongoing medical treatments, including compound creams, were reasonable and necessary.  The Utilization Review Determination found all treatment to be reasonable and necessary.