Source: http://www.pawcj.com/2006/
Timestamp: 2019-04-24 18:10:45+00:00

Document:
The Supreme Court held in Pitt Ohio Express v. WCAB (Wolff) that a job the Claimant rejects in bad faith remains available in perpetuity (unless the facts of the original job offer show otherwise).
The Claimant's benefits were suspended based on his rejection of a modified duty job with the Employer. Benefits were then reinstated after surgery. The Employer filed a subsequent Petition for Suspension alleging the Claimant recovered to the point where he could have performed the modified duty job. The job was not available. The WCJ suspended, the WCAB reversed, and the Commonwealth Court reversed the WCAB.
The Supreme Court stated the Claimant's earning power was adversely affected through fault of his own. Under these circumstances, the Employer does not have the burden to show job availability.
The Court also affirmed per curiam the Commonwealth Court decision in Motor Coils MFG/WABTEC, v. WCAB (Bish). The Court did not disturb the Kachinski analysis applied to a post Act 57 modified job offer with the Employer, including the requirement that the job be within reasonable commuting distance of the Claimant.
A review of 2006 cases from the defense perspective by Daniel Diloreto for the Legal Intelligencer.
In R. Gazzola v. WCAB (Ikon Office Solutions) the Employer's Utilization Review was granted when the treating physician did not provide records. The WCJ dismissed the Claimant's Petition to Review the Utilization Review Determination under County of Allegheny v. Workers’ Compensation Appeal Board (Geisler), 875 A.2d 1222 (Pa. Cmwlth. 2005).
The WCJ stated, however, that the better procedure would be to take evidence on whether the treating physician had an excuse for not providing records.
I presumed this authority in my post on Geisler on June 6, 2005.
The Court endorsed the procedure as stated by the WCJ. The WCJ may take evidence on whether there was an excuse for the failure to provide records, and if there is a reasonable excuse, the WCJ may Order that the URO be performed on the treatment at issue.
The New York Times covered a recent study from JAMA finding patients with ruptured lumbar disks recovered with or without surgery. The study also found there was no harm in choosing the non surgical route.
Abstract of a study comparing MRI findings in nurses and secretaries with and without low back pain.
In P. Agnello v. WCAB (Owens-Illinois), the claimant lost three lower teeth as a result of a work injury. The WCJ observed her on two occasions and stated he could not see a difference in her appearance with her prosthesis out. He denied the Claimant’s petition for disfigurement benefits and the Board affirmed.
The Court noted the Board affirmed on the basis that the Claimant has a prosthesis, which is irrelevant to the disfigurement analysis. The disfigurement is to be viewed without the prosthesis. "Although Gardiner did not specifically hold that dentures should not be considered when determining whether there was a disfigurement, we now do so because they do not resolve the disfigurement, only mask it."
The Court held the absence of the teeth had to make some difference, and the WCJ abused his discretion in denying an award. The Court reversed the Board and remanded the case to the WCJ to make an award.
The Supreme Court has addressed the cases in which IME physician Dr. Eagle desires to not respond to the Order of the Common Pleas Court that he produce three years of 1099s from insurance companies and defense attorneys. The Judge found the discovery request was appropriate upon which to found a demonstration of bias. The Superior Court affirmed.
In Cooper v. Schoffstall; Appeal of: Eagle, M.D. the Supreme Court held a deposition by interrogatories is required before a Judge can order that 1099s be produced. The Court felt the IME doctor's answers to the interrogatories will be sufficient upon which to demonstrate bias in most cases where it exists.
Madame Justice Newman authored an excellent concurring opinion reminding the bar that requiring an expert witness to produce personal financial information is generally an abuse of the discovery process.
No one can deny, however, that IME physicians can underestimate the IMEs they perform for defendants, overestimate the IMEs they perform for Claimants, or both. The doctor's testimony can't be challenged without hard evidence, such as 1099s. One has to question the doctor's veracity when the doctor says he or she does one IME a week and all the Judges in our part of the state see the doctor's evaluations twenty times a year or more.
The Supreme Court decision still allows discovery that digs deeper than questioning the doctor without his financial records. The first step, however, will be to direct interrogatories to the doctor.
In workers' compensation, there is no provision in the Rules of Practice and Procedure before WCJs to conduct a deposition by interrogatories. Claimant's counsel will have to direct these questions to the IME physician at deposition. If the answers seem incredible to counsel, they will probably seem incredible to the Judge. In a rare case, counsel may seek additional documentation.
Dr. Jack Wilberger's comments on the x-stop device to relieve spinal stenosis.
Act 109 of 2006 becomes effective on September 5, 2006. The Act provides that WCJ’s must direct reimbursement of outstanding support liens to PASCDU when a net award of benefits to the Claimant exceeds $5,000.00. The lien value that will be used is the amount posted at www.childsupport.state.pa.us. Attorneys may register and obtain the information for use in Act 109 compliance. One other important consideration is that the Claimant information upon which verification of the lien is based must be presented to the WCJ in writing, with verification subject to 18 Pa.C.S.A. Section 4904.
Disputes will arise, particularly due to a collection authority placing an entire month’s obligation as a lien on the first of the month. A printout should be requested on the last day of the month to avoid this issue.
In the event of a dispute, the WCJ has the authority to order that the undisputed amount be paid to PASCDU and the disputed amount escrowed by Claimant’s Counsel. Since there is no workers’ compensation issue beyond the validity of the support arrearage data, the WCJ will ordinarily not exercise the WCJ’s authority under Rossa v. WCAB (City of Philadelphia) to resolve the dispute.
In M. Knechtel v. WCAB (Marriott Corporation), the Claimant elected to have a health care provider of her choosing attend an independent psychiatric evaluation. The Claimant further requested of the WCJ that her designated health care provider be permitted to video or audio tape record the examination, question the examiner, comment on the examination process and assist the Claimant during the examination by rephrasing questions and asking additional questions during the examination.
The WCJ denied all of these manners of participation, holding the Claimant’s representative may only observe, take notes, and request brief recesses during the evaluation to confer with the Claimant. The Board and the Court affirmed. The Court reasoned it had ruled in Wolfe v. Workmen’s Compensation Appeal Board (Edgewater Steel Company), 636 A.2d 1293 (Pa. Cmwlth.), appeal denied, 537 Pa. 669, 644 A.2d 1205 (1994) that the Claimant is not able to be represented by her attorney at the examination. Participation of the type the Claimant was requesting was tantamount to an adversarial proceeding.
The Court stated the role of the Claimant’s designated health care provider is to obtain a firsthand view of the exam process as a foundation for later rebutting in testimony the validity of the exam results.
Law.com has an article from the Legal Intelligencer about argument before the Supreme Court in Motor Coils MFG/WABTEC, v. WCAB (Bish). The Employer is clearly arguing it can make light duty available to a Claimant who has moved out of state and suspend benefits when she refuses the job. If a labor market survey proves there is light duty work available under these circumstances, benefits can be suspended.
The difference in the Bish case is that the job was created by the Employer. There is no evidence the Claimant could have found the job in the general labor market. If this tactic does not deny equal protection as discussed in Shapiro v Thompson, 394 U.S. 618 (1969), the Supreme Court may validate it.
In an article in the Legal Intelligencer, President Judge James Gardner Colins and G. Ronald Darlington, the Executive Administrator of the Commonwealth Court, identified compromise and release and its progenitor, workers' compensation mediation, as factors in the fourteen per cent (14%) decline of workers' compensation filings in the Commonwealth Court.
In mediations I conducted last week I settled two out of two, and achieved very fair results for parties that were situated to enter into a compromise and release. The expertise of the Workers' Compensation Judges who mediate as well as the Mediating Commissioners of the WCAB and the Mediating Judges of the Commonwealth Court is directly responsible for the reduced filing numbers and the resulting improvement in disposition time.
Judge Colins also acknowledged the requirement of Harkness v. UCBR that Employers be represented by attorneys in unemployment compensation cases was a factor in an 18% drop in appeals from the Unemployment Compensation Board of Review to the Commonwealth Court.
The Commonwealth Court issued its decision in M. Blong v. WCAB (Fluid Containment, et al.), a case I posted on in connection with the Supreme Court's grant of appeal in Motor Coils MFG/WABTEC, v. WCAB (Bish). These are cases where the claimant was released to return to work with restrictions, but the Claimant has moved out of state.
The twist in these cases is the amendment to Section 306(b)(2) that provides when the Claimant does not reside in the Commonwealth, earning power can be shown using a labor market survey in the usual employment area where the injury occurred. In both of these cases the Employer could have filed for modification or suspension based on a labor market survey of jobs in Pennsylvania.
In Bish, the Employer made a job available at the Employer's facility. The Commonwealth Court denied modification or suspension because the job was not local to the Claimant as required by Kachinski. The Supreme Court granted the Employer's petition for appeal.
In Blong, no work was made available and there was no labor market survey. The Claimant had moved to New Zealand. In prior litigation I denied a petition for termination, but found the Claimant was capable of working with restrictions.
I suspended benefits based on Smith v. WCAB (Dunhill Temporary Systems), 725 A.2d 1285 (Pa. Cmwlth. 1999). In Smith the Claimant's benefits were suspended when he joined the Peace Corps and relocated to Africa. I was convinced a labor market survey in the Mt. Union, Pennsylvania area would be "irrelevant and fruitless" in the words of the Commonwealth Court in Smith. The Board and the Court affirmed.
The Commonwealth Court said the critical factor is removal. The Court held the Claimant was as removed from the workforce as he would be if he was incarcerated or retired. In effect, the Claimant "quit" the Mt. Union, Pennsylvania job market, so that the Employer doesn't have to show job availability.
Under Kachinski and Bish the Court could have analyzed whether the move was in good faith. There was no evidence it was not -- Mr. Blong's wife is a native of New Zealand.
In Bish, the Supreme Court may address how the amendment to Section 306(b)(2) and its interaction with Smith affects the Kachinski requirement that available work must be local to a claimant who has moved out of state in good faith. Employers may not be excused from conducting the labor market survey in all of these cases. The Constitutional right to travel as stated in Shapiro v Thompson, 394 U.S. 618 (1969) may even be implicated.
In my post on County of Allegheny (Department of Public Works) v. WCAB (Weis) I indicated the Commonwealth Court's holding allows an employer to file against a claimant a rule to show cause why the claimant's benefits should not be suspended. The employer filed one of these in E. Hepler v. WCAB (Penn Champ/Bissel, Inc.).
The scenario arises when a claimant takes a disability retirement. If a physician has released the claimant to any level of work, the employer can file a rule on the claimant to show cause why the claimant's benefits should not be suspended. This is done by filing a modification/suspension petition alleging the claimant has voluntarily removed himself or herself from the workforce.
This petition was filed in the Hepler case. The WCJ found the claimant was forced into retirement by the work injury and denied suspension, but the Board reversed based on the Weis case. The Commonwealth Court affirmed, finding the Weis case controls. The Commonwealth Court stated it is the claimant's burden in this case to show the claimant has not voluntarily withdrawn from the entire labor market and is open to employment within the claimant's physical capabilities.
Legal Intelligencer Article on Gardner.
In D. Zuback v. WCAB (Paradise Valley Enterprise Lumber Co.) , the Claimant had stair glides installed after his injury, which invloved the loss of an arm and a leg. When the stair glides became worn out, the Employer and Insurnce Carrier denied repair or replacement of the equipment under Bombay v. Workmen’s Compensation Appeal Board (South Erie Heating Co.), 572 A.2d 248 (Pa. Cmwlth. 1990). In that case, reasonable home modifications were made and additional home modifications were denied.
The stair guides were working, although wear and tear was evident in all parts of the mechanical operation. It was perhaps on this basis that the WCJ and Board denied the Claimant's request for repair or replacement. The Court, however, reversed and held the Employer and Insurer are responsible to (in this case) replace the stair glides before they fail as a reasonable home modification.
In Acme Markets, Inc. v. WCAB (Brown), the Commonwealth Court reviewed a WCJ's decision wherein the WCJ accepted the Claimant's statement of his self-employment income as reflected on his tax return, after deductions. The Employer argued the Claimant's gross income was a more accurate measure of his earning power. The Claimant had taken deductions for business expenses and a salary for his wife for secretarial and bookkeeping services.
The WCJ rejected the testimony of the Employer's vocational consultant as to average earnings of appraisers (the Claimant's self-employed occupation) secretaries and bookkeepers. The Court highlighted the reasons given by the WCJ for rejecting this testimony and found the WCJ's decision was reasoned. The Court affirmed.
The Pennsylvania Compensation Rating Bureau requested an average 8.5% reduction in loss cost level. The reduction is attributed to a decreasing number of claims and a moderation of the rate of increasing severity of the claims that are filed. The Pittsburgh Business Times published an in depth article, which also mentions there are more insurers writing policies in Pennsylvania and more competition over rates.

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