Source: https://www.paworkerscomphelp.com/pennsylvania-workers-compensation-case-studies/pa-workers-compensation-impairment-rating-evaluation-case-village-at-palmerton-assisted-living-petitioner-v-wcab
Timestamp: 2019-04-18 16:19:30+00:00

Document:
Village At Palmerton Assisted Living, Petitioner v.
The Village at Palmerton Assisted Living (Employer) petitions for review of an Order of the Workers' Compensation Appeal Board (Board) affirming the Decision of the Workers' Compensation Judge (WCJ) which: (1) granted the reinstatement and review petitions filed by Donna Kilgallon (Claimant); (2) denied Claimant's penalty petition; and (3) denied Employer's modification and review petitions. On appeal, Employer argues that the Board erroneously interpreted the statutory requirements set forth in Section 306(a.2)(1) of the Workers' Compensation Act2 (Act) for obtaining an automatic change in a claimant's disability status based on an Impairment Rating Evaluation (IRE). Because we conclude that the Board [*2] erred, we reverse.
With respect to your concerns regarding the Request for Designation having been filed prematurely, please note that the Request for Designation does not "request the employee's attendance at the IRE." Instead, the regulations require the insurer to request the employee's attendance by completing form LIBC-765 (Impairment Rating Evaluation Appointment). (See 34 Pa. Code § 123.102(e).) In fact, unlike the Impairment Rating Evaluation Appointment form, the filing of a Request for Designation is not a necessary pre-requisite to obtaining an IRE determination and would not be filed where, for example, the parties agree on a physician to perform the examination. Thus, the date upon which the Request for Designation is filed may not be relevant to determining whether the actual IRE was timely or premature.
With regard to your request that the Bureau issue a new Notice of Designation of IRE Physician, please note [*8] that you may consider the Bureau's assignment of Brent M. Nickischer, D.O., to be effective as of the date of your most recent request.
Claimant filed reinstatement and review petitions alleging that Employer was not entitled to an automatic change in her disability status because the IRE request and resulting IRE were untimely. (2012 FOF ¶ 2.) Claimant also filed a penalty petition alleging that Employer violated the Act by improperly filing the Notice of Change. (2012 FOF ¶ 2.) Employer filed timely answers to Claimant's petitions. (2012 FOF ¶ 2.) Thereafter, Employer filed modification and review petitions "seeking review and/or modification of IRE change in status date to November 28, 2009." (2012 FOF ¶ 3.) The petitions were consolidated and proceedings before WCJ Pletcher ensued.
In order to secure an automatic change to Claimant's benefits, [Employer] was required to request Claimant's attendance at an IRE within sixty days of November 28, 2009. Dowhower. In order to effectively request Claimant's attendance, [Employer] was required to utilize Form LIBC-765 "Impairment Rating Evaluation Appointment." 34 Pa. Code § 123.102(e). [Employer] did not submit Form LIBC-765 until April 13, 2010, after the expiration of the sixty[-]day window under Section 306(a.2)(1). Because [Employer] did not request Claimant's attendance at an IRE until after the expiration of the sixty[-]day window, it was not entitled to an automatic change in Claimant's benefits and was required to proceed under the traditional administrative process. Diehl [v. Workers' Compensation Appeal Board (I.A. Construction), 607 Pa. 254, 5 A.3d 230 (Pa. 2010)]. [Employer] did not submit any evidence establishing Claimant's impairment rating before the WCJ so as to satisfy the traditional administrative process. Therefore, the WCJ did not err in denying [Employer's] Petitions [*14] and declining to automatically change Claimant's benefits to partial.
[Employer] nevertheless argues that it should be entitled to an automatic change in Claimant's benefits because it requested the designation of an IRE physician within the sixty[-]day window or alternatively that it should not be penalized for the Bureau's error in not designating an IRE physician sooner. We disagree. [Employer] was required to "request the employee's attendance at an IRE" within the sixty[-]day window. Dowhower, 919 A.2d at 917. In order to request Claimant's attendance, [Employer] was required to utilize Form LIBC-765. 34 Pa. Code § 123.102(e). Although the IRE was untimely in Dowhower where the request for designation was premature, it is clear that [Employer's] request for Claimant's attendance, in addition to its Request for Designation, must be timely in order to affect an automatic change in benefits. Gardner v. [Workers' Compensation Appeal Board] (Genesis Health Ventures), 585 Pa. 366, 888 A.2d 758 (Pa. 2005). Moreover, any delay in designation stemmed from [Employer's] original untimely Request for Designation and request for attendance. Despite this delay, the Bureau attempted to re-designate an IRE Physician effective as of December 16, 2009 pursuant to the Bureau letter dated December 24, 2009. [*15] The designation by letter afforded [Employer] a month between the designation and the close of the sixty[-]day window. Therefore, we determine no error in the WCJ's refusal to automatically adjust Claimant's benefits.
Here, Employer first argues that the Board erred by concluding that, pursuant to Section 306(a.2)(1) of the Act, an employer's timely request that a claimant submit to an IRE requires: (a) the filing of Form LIBC-766, "Request for Designation of a Physician to Perform an [IRE]", (b) subsequent receipt of the Bureau's designation of an IRE physician, and (c) the filing of Form LIBC-765, "[IRE] Appointment", all of which must occur within the sixty-day window following a claimant's receipt of 104 weeks of [*16] temporary total disability in order for an employer to obtain an automatic change in the claimant's disability status.
HN5 When an employe has received total disability compensation . . . for a period of one hundred four weeks, unless otherwise agreed to, the employe shall be required to submit to a medical examination which shall be requested by the insurer within sixty days upon the expiration of the one hundred four weeks to determine the degree of impairment due to the compensable injury, if any. The degree of impairment shall be determined based upon an evaluation by a physician who is licensed in this Commonwealth, who is certified by an American Board of Medical Specialties approved board or its osteopathic equivalent and who is active in clinical practice for at least twenty hours per week, chosen by agreement of the parties, or as designated [*17] by the department, pursuant to the most recent edition of the American Medical Association "Guides to the Evaluation of Permanent Impairment."
77 P.S. § 511.2(1). HN6 If the IRE conducted on the claimant produces an impairment rating of less than fifty percent, the claimant's total disability benefits are automatically reduced, upon sixty days' notice, to partial disability benefits. Section 306(a.2)(2), 77 P.S. § 511.2(2); Gardner, 888 A.2d at 762.
has sixty days from that date during which it must request that the claimant submit to an IRE for the purposes of obtaining the automatic relief set forth in [Section 306(a.2)(1)]." Gardner, 888 A.2d at 767-68 (emphasis added). Thus, under Section 306(a.2)(1) and the Supreme Court's holding in Gardner, it is the date of the request to submit to the medical examination to determine the degree of impairment, not the date that the claimant actually attends the IRE, that is determinative as to the timeliness of the IRE request. As such, we must determine what constitutes the "request that the claimant submit to an IRE," which must occur within the required sixty days in order for the request to be considered timely for purposes of obtaining the automatic relief under [*18] Section 306(a.2)(2). As stated previously, the Board held in this matter that both the request for the designation of an IRE physician (Form LIBC-766) and, after designation of the IRE physician is received, the request for a claimant's attendance at the IRE (Form LIBC-765) must be filed within sixty days upon the expiration of the claimant's receipt of 104 weeks of temporary total disability benefits in order to affect an automatic change in benefits. (Board Op. at 5-6.) Pursuant to the following discussion, we conclude that the Board's holding is incorrect.
In Dowhower the IRE process began on May 20, 1999, with the employer's insurer requesting the designation of a physician to perform an IRE on the claimant pursuant to Section 306(a.2)(1). Dowhower, 919 A.2d at 914. The Bureau complied and the IRE was conducted approximately four months later on September 1, 1999. Id. at 915. The claimant received 104 weeks of temporary total disability benefits as of July 23, 1999. Id. The issue before our Supreme Court was whether the insurer's request that the claimant submit to an IRE was premature because it was filed before the claimant had received 104 weeks of temporary total disability benefits. Id. at 917. In addressing this issue, the Supreme Court treated the [*19] date that the insurer filed its request for a designation of a physician to perform the IRE on the claimant as the date of the insurer's request that the claimant submit to an IRE. Id. The Supreme Court ultimately held that the insurer's request for a designation of an IRE physician, filed before the claimant had received 104 weeks of temporary total disability benefits, was premature and "because the IRE request did not comply with the requirements of section [306(a.2)(1)], the IRE itself [was] void." Id. at 918.
Although the Supreme Court, in Dowhower, did not specifically explain why HN8 the date that the request for the designation of an IRE physician is filed is determinative as to timeliness, use of this date is consistent with the mandatory requirement set forth in Section 306(a.2)(1) that "[t]he degree of impairment shall be determined based upon an evaluation by a physician who is licensed in this Commonwealth, who is certified by an American Board of Medical Specialties approved board or its osteopathic equivalent and who is active in clinical practice for at least twenty hours per week, chosen by agreement of the parties, or as designated by the department. . . ." 77 P.S. § 511.2(1) (emphasis added). HN9 As reflected in this language, if the parties [*20] do not choose a qualified physician by agreement, the first step in requesting that an employee submit to an IRE is securing, from the Bureau, the designation of a qualified physician to perform the IRE. The Bureau's regulations recognize its statutory duty to designate an IRE physician in an efficient manner by directing that such requests be filed on Form LIBC-766 and that a physician will be designated by the Bureau within twenty days of the receipt of an insurer's request. 34 Pa. Code § 123.104.
HN10 The regulations also require that an "insurer shall request the employee's attendance at the IRE in writing on Form LIBC-765, 'Impairment Rating Evaluation Appointment,' and specify therein the date, time and location of the evaluation and the name of the physician performing the evaluation, . . . designated by the [Bureau]." 34 Pa. Code § 123.102(e) (emphasis added). As such, Form LIBC-765, requesting attendance at the IRE, cannot be filed until the Bureau has designated an IRE physician and an IRE has been scheduled; these are necessary prerequisites to filing Form LIBC-765 requesting the employee's attendance at an IRE. The insurer or employer do not have total control over the timing of fulfilling these requirements because the [*21] designation of the physician is dependent on the Bureau and the date and time of the IRE is dependent on the physician's schedule.
The Board held that, in order for the IRE request to be timely under Section 306(a.2)(1), the insurer must file both forms, Form LIBC-766 requesting designation of a physician, and also Form LIBC-765 requesting the employee's attendance at the IRE, within the sixty-day window (within sixty days upon the expiration of the claimant's receipt of 104 weeks of temporary total disability benefits). However, the Supreme Court did not require this in Dowhower; the statute does not specifically require this; and even the Bureau's own regulations, given the timing requirements, do not support this requirement.
Accordingly, we conclude that, HN11 when the parties cannot agree on an IRE physician, the date the insurer requests that a physician be designated to perform an IRE is the determinative date as to whether the IRE request is timely under Section 306(a.2)(1) of the Act. Therefore, the Board erred by holding that, in order to secure an automatic change to Claimant's benefits, Employer was required to request the designation of an IRE physician by filing both Form LIBC-766 and request Claimant's attendance [*22] at an IRE by filing Form LIBC-765, within sixty days of when Claimant had received 104 weeks of temporary total disability, or November 28, 2009.
acknowledged that a request for the designation of an IRE physician had been made when it advised Employer, by letter dated December 24, 2009, that it could consider the previous assignment of Dr. Nickischer to be effective as of the date of Employer's most recent request. Finally, Employer argues that when it did file a second Form LIBC-766 on February 11, 2010, the Bureau rejected Employer's request.
The Bureau responded to Employer's December 16, 2009 Letter on December 24, 2009. (December 24, 2009 Letter, R.R. at 95a.) Therein, the Bureau acknowledged Employer's December 16, 2009 request that the Bureau issue a new notice of designation of IRE physician and advised Employer that it could "consider the [*25] Bureau's assignment of [Dr. Nickischer] to be effective as of the date of [Employer's] most recent request." (December 24, 2009 Letter, R.R. at 95a.) Notably, in its December 24, 2009 Letter, the Bureau did not specify that Employer had to refile a new LIBC Form-766 in order to request the designation of an IRE physician.
For the foregoing reasons, the Board's Order is reversed.

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