Source: http://www.pawcj.com/2004/
Timestamp: 2019-04-24 18:10:25+00:00

Document:
Secretary of Labor and Industry Stephen Schmerin announced the 2005 maximum rates for workers' compensation and unemployment compensation in a press release today.
Life tables for the year 2002 were published recently and are available. United States Life Tables, 2002 .pdf The most updated life table yields the most advantageous Sciarotta calculation.
There is a link on the left side of the page to annual life table updates from the National Center on Health Statistics.
The suggested citation is: Arias E. United States life tables, 2002. National vital statistics reports; vol 53 no 6. Hyattsville, Maryland: National Center for Health Statistics. 2004.
In a very well organized opinion in Verizon Pennsylvania, Inc. v. WCAB (Baun), the Commonwealth Court provided guidance on the modification of benefits under §306(b)(1) which provides an employe shall not receive more in compensation and wages combined than the current wages of a fellow employe in employment similar to that in which the injured employe was engaged at the time of injury. Although the Court held the Employer did not meet its threshold burden to demonstrate what similarly situated employees were making at the time of injury, the Court went on to clarify its interpretation of the remainder of any §306(b)(1) analysis.
The Court held the threshold burden is to establish the wages at the time of injury of the class of similarly situated employees. The Court stated a WCJ may elect to evaluate the wages of each employee in the class or rely on an average or median, as the WCJ's discretion directs.
The court further stated Maier's Bakery v. Workers' Comp. Appeal Bd. (Sandt), 751 A.2d 1208 (Pa. Cmwlth. 2000) does not require that the Employer must show economic distress caused wages to be reduced. The Court explained there is no such requirement in the statute.
Finally, the Court stated the only comparison to be made by the WCJ is whether the Claimant is currently receiving more in wages and compensation combined than the class of similarly situated employees. The Claimant had returned to work at modified duty, and there would be a figure that represents the Claimant's wages and compensation combined. Even if, as here, some employees in the class were currently making more than the Claimant's Average Weekly Wage, this fact does not necessarily enter into the comparison to be made between what the Claimant receives and the representative current wages of the class that the WCJ determines.
Pennsylvania AFL-CIO President William M. George issued a press release in response to news of a proposed rate decrease from the Pennsylvania Compensation Rating Bureau. The press release highlights positive trends in job safety.
The York Daily Record is running a series on workers' compensation. Four articles have been printed to date. They are linked at the bottom of this article from today.
The articles begin with a discusssion of a specific case, then broaden into a discussion of Pennsylvania's statutory system and proposed changes of injured workers, their families, employers and insurers.
The Workers' Compensation Research Institute will brief the newest results from the 5th Edition of the WCRI CompScope™ multistate benchmarks study, comparing workers' compensation system performance for Pennsylvania with 11 major states (California, Connecticut, Florida, Illinois, Indiana, Louisiana, Massachusetts, North Carolina, Tennessee, Texas and Wisconsin) in Harrisburg on January 19, 2005.
In Wellington Foods v. WCAB (Rice), the Claimant attended an IRE requested more than 60 days after payment of 104 weeks of total disability benefits. The Commonwealth Court rejected the Employer's argument the Claimant waived his objection to the timeliness of the IRE by attending the IRE.
In S. Ramseur v. WCAB (Wachovia Corp.), the Commonwealth Court held that where the Claimant was entitled to benefits on March 3, 2000, but didn't receive the first payment until August 3, 2000 (presumably a payment including back benefits), the 104 weeks provided for in Section 306(a.2) of the Act expires on August 3, 2002. This made the August 27, 2002 IRE request timely.
In Panyko v. WCAB (U.S. Airways), the Commonwealth Court reversed the grant of a heart attack claim based on Davis v. Workers' Compensation Appeal Board (Swarthmore Borough), 561 Pa. 462, 751 A.2d 168 (2000). The Commonwealth Court recognized the Claimant's argument that abnormal working conditions do not need to be shown in a heart attack case, but the Court noted the Supreme Court applied Davis to a heart attack case without further explanation in Erie Bolt Corporation v. Workers' Compensation Appeal Board (Elderkin), 777 A.2d 1169, 1998 Pa. Commw. LEXIS 1004 (Pa. Cmwlth., No. 1698 C.D. 1997, filed February 5, 1998), reversed, 562 Pa. 175, 753 A.2d 1289 (2000). The Supreme Court has now granted the Claimant's petition for appeal in the Panyko case.
In the case, the witness admitted he had no personal knowledge the material was asbestos. Although the Court would allow the witness to have obtained this knowledge by either formal education or practical experience, there was no evidence the witness possessed either.
In E. Williams v. WCAB (USX Corp.-Fairless Works, et al.) the Claimant appealed the credibility findings of the WCJ. The Commonwealth Court made it clear that the Claimant could not cobble together bits and pieces of testimony to make an argument that the WCJ capriciously disregarded competent evidence. Rather, the WCJ's decision identified and explained the substantial, competent, and credible evidence on which the decision was based. The Court emphasized it will be a rare instance in which an appellate court would disturb an adjudication based upon the capricious disregard of material, competent evidence.
WTAE's web site has information on Fish Oil used in place of NSAIDs for neck and low back pain. The research was done by Dr. Joseph Maroon. The links to the right under the heading "All About Back Pain" are interesting also.
In T. Brenner v. WCAB (Drexel Industries) the Commonwealth Court reversed the Board and affirmed the WCJ's holding that the Employer/Insurer violated the Act when it unilaterally ended a prescription card program. The Claimant was able to get medications through the prescription card program. When the card was cancelled without prior notice to the Claimant, she went without medications for a period of time, then submitted prescription expenses she was able to pay, only to have them sent to utilization review.
The Commonwealth Court held the WCJ was correct to apply McLaughlin v. Workers' Compensation Appeal Board (St. Francis Country House), 808 A.2d 285 (Pa. Cmwlth. 2002), appeal denied, 573 Pa. 717, 828 A.2d 351 (2003) which held the Employer cannot plead failure to present bills properly when it acts to prevent the treatment at issue. Where the Employer/Insurer gave no notice to the Claimant of the revocation of the prescription card, a penalty was appropriate under McLaughlin.
In Leslie Fay Companies, et al. v. WCAB (Macaluso, et al.) the Commonwealth Court let stand a WCJ's decision finding the date of injury in a cumulative trauma case was the last day of work. The insurer appealed because the Claimant had a long history of symptoms and the last insurer only covered the Employer for two an a half months.
As stated recently by the Supreme Court in City of Philadelphia v. WCAB (Williams) the analysis of the appropriate date of injury in a cumulative trauma case looks only to whether credited medical evidence establishes each day of work causes an "aggravation" or new injury.
In M. Stiles v. WCAB (Dept. of Public Welfare) the Commonwealth Court affirmed a summary dismissal of a Petition to Set Aside a Compromise and Release Agreement. The Claimant alleged she was not mentally competent when the C&R was approved. The dismissal was summary because Claimant's Counsel moved for a continuance for medical testimony at the first hearing and deferred the Claimant's testimony. The Employer thereafter moved for dismissal on the basis of collateral estoppel, and the WCJ granted the motion.
The Court distinguished the case from North Penn Sanitation Inc. v. Workers' Compensation Appeal Board (Dillard), ___ A.2d ___, (Pa. Cmwlth. No. 2115 C.D. 2003, filed, May 10, 2004) on the basis that Dillard's blindness was unknown to the WCJ. The Court stated the Claimant's mental competency was an issue before the WCJ, who made a finding the Claimant understood the Agreement.
Pennsylvania Workers' Compensation Practice and Procedure Reference 26.3 et. seq.
An article from the Philadelphia Business Journal reports that as personal injury lawyers have fewer and less lucrative cases, they are appearing more often before WCJs. "With the various changes with the law, the personal injury attorneys are seeing their business hit," [George] Martin said. "They're less inclined to refer [workers' compensation cases] out when their business is down."
Counsel instead applies the whole counsel fee to the net amount representing future indemnity. The fee then may exceed 20% of the indemnity amount, but the context clearly shows the fee has been reallocated in accordance with Medicare's directive.
The lifetime pro-ration calculation is performed on the net amount after Medicare set aside and attorney's fees. Recently, however, a counsel from the Pittsburgh area has been instructed by representatives of the Social Security Administration to allocate only a pro rata portion of the fee to the indemnity.
If SSA limits the fee reduction to 20% of the indemnity amount, the Claimant will have to be asked: "Do you understand a portion of the attorney's fee in this case amounting to (the attorney's fee on the Medicare set aside amount) will be included as your income from this settlement for the purpose of calculating your future entitlement to social security disability benefits?"
J. Burrell v. WCAB (Philadelphia Gas Works, et al.) is a case that has application in many areas. In the final analysis the Commonwealth Court affirmed the Order of the WCJ and Board that imputed income of $9.93 per hour for eight hours per week based on evidence the Claimant was working at least that much as a shoe shiner in his mother's shop.
The first issue was whether modification can be granted without a Notice of Ability to Return to Work when surveillance found the Claimant working. The Commonwealth Court noted receipt of medical information documenting a change in condition triggers the Employer's obligation to send the Notice of Ability to Return to Work. The purpose of the statute is to place the Claimant on notice of the medical information. Where the Claimant deems himself able to work, such notice is not required.
The next issue was whether the Employer had to demonstrate it had no job available to the Claimant within his restrictions before an award of modification. The Court held where the Claimant deems himself able to work, this can only be an affirmative defense of the Claimant.
Another issue was whether the WCJ's holding that the Claimant's imputed hourly wage should be $9.93 was supported by substantial evidence. The Employer's Vocational Expert opined this is the average wage for a shoe shiner in Philadelphia. The Claimant basically argued he's not that good. The Court held the accuracy of the VE's opinion is beyond challenge when the WCJ gives full weight to the VE's testimony, and this determination is within the sole province of the factfinder.
Finally, the Employer requested a credit. The Court recognized "Unjust enrichment occurs when a person has and retains money or benefits, which in justice and equity belong to another." and a credit may be granted to prevent unjust enrichment. However, the Employer could not prove the Claimant received wages or gratuities.
In T. Palmer v. WCAB (City of Philadelphia) The Employer took a unilateral suspension because the Claimant became entitled to a pension that offset her workers' compensation benefits. Even though the Claimant was due no workers' compensation benefits after the offset was applied, the WCJ's award of a penalty on the amount of workers' compensation due before the offset was affirmed by the Commonwealth Court.
This could apply in the case of return to work unilateral suspensions as well. The Court stated the rule that no penalty can be awarded when no compensation is awarded does not apply when compensation is payable, but offset, because the purpose of the statutory provision is to penalize conduct of the Employer/Insurer that is unlawful, in this case the unilateral suspension.
As noted in the recent Bureau of Workers' Compensation News and Notes, the Bureau issued a Statement of Policy providing the qualifications of vocational experts referred to in Act 53 of 2003 are as set forth in the "Qualifications (of vocational experts)" Regulation at 34 Pa. Code §123.202.
Later regulation is promised and may address the requirement that vocational experts comply with the code of professional ethics for rehabilitation counselors pertaining to the conduct of expert witnesses and other matters.
In an article in the Pennsylvania Bar Association Quarterly, James A. Tinnyo, Esquire analyzes Acme Markets, Inc. v. WCAB (Purcell) to hold that an employee must be engaged in the furtherance of business when he suffers an injury off the premises that arises out of employment.
In the case, the Claimant labored heavily for years for the employer, but when his lumbar disk herniated, he was at home. What distinguishes this case from others is that the WCJ credited Claimant's doctor who opined the substantial cause of the herniated disk was the years of employment, not getting up off the floor after assembling a file cabinet for personal use.
Perhaps in this pre Daniels, two months post Wintermeyer case the Commonwealth Court didn't feel it could review the credibility determination.
One has to ask what the Court would have done if the Claimant, due to his degenerative condition accumulated from years at work, simply couldn't get up in the morning due to pain. If the Court would still deny the Claimant because he was at home (which is contrary to the heart attack cases Mr. Tinnyo cites) then a new precedent has been created.
In S. Hilyer v. WCAB (Joseph T. Pastill, Jr. Logging), the Commonwealth Court endorsed the Bureau's Regulation at 34 Pa. Code §123.102(g) which provides an Employer can have an IME (Independent Medical Exam) that comments on the status of the Claimant's impairment under the AMA Guides within the twelve months following the IRE (Impairment Rating Evaluation) provided for in §306(a.2)(1) of the Act.
The Court danced around the fact the Act only allows an IME to be held after the Employer's one shot at an IRE which must be conducted within sixty (60) days after 104 weeks of temporary total disability is paid. §306(a.2)(6) The Court allowed to stand the obfuscation of the regulation that states an Employer can have two IRE's in a twelve month period, when the statute clearly says IMEs.
The bottom line, however, is the Court properly read §306(a.2) in pari materia to provide that in an IME that takes place after an IRE is properly conducted, the examiner can review the status of the Claimant's impairment under the AMA Guides. The Court further held no prefatory showing of a change in condition is required by §306(a.2)(6).
In Meenan Oil Co., L.P. v. WCAB (Pownall) the Commonwealth Court held that pursuant to Section 413(a) of the Act, a review petition can be filed "at any time" to correct material mistakes including the date of injury and the description of injury.
The key here is the facts that direct the relief requested existed at the time the NCP was issued. The WCJ considered these facts under a review petition. The WCJ's finding that the date of injury and the description of injury were incorrectly entered on the NCP was within the authority granted by Section 413(a).
Pittsburgh Board of Education v. WCAB (Schulz) answered the question left unanswered in Pittsburgh Board of Education v. WCAB (Dancho). For the pension offset, a school district can offset only what it contributes, not the Commonwealth's contribution.
A press release regarding the latest WCRI Study states that while costs per claim in Pennsylvania rose 8.5 per cent per year on average from 1999 to 2002, costs per claim remained 15 per cent lower than the median of other states surveyed. Attorney involvement was not identified as a cost driver as it has been in the past. Cost drivers were identified as double-digit increases in medical costs per claim and benefit delivery expenses. Also, Pennsylvania public officials, insurers and employers were commended on compliance with the 21 day rule.
The WCRI site also touts a study that found workers in Pennsylvania and Massachusetts are more likely to have satisfactory recoveries and a timely return to work, although this is consistent with findings that workers in these states have better access to satisfactory medical care.
In J. Weikel v. WCAB (PECO) The Employer provided "flex dollars" for benefits, and the Claimant could get them in cash if they were unused. The WCJ held amounts allocated by the Claimant to purchasing plan items are not includable in the average weekly wage. The Commonwealth Court affirmed, noting Section 309 excludes from the AWW calculation "employer payments for or contributions to a retirement, pension, health and welfare, life insurance, social security or any other plan for the benefit of the employe or his dependents."
In Karotka, et al. v. WCAB (Millcreek Community Hospital, et al.) the spouse of the Claimant who passed away from reasons unrelated to her work injury filed serial Penalty Petitions alleging vague misconduct by the Employer. The WCJ cut the Complainant off at the hearing and gave him an additional 30 days to state his case in writing. The WCJ then dismissed on the basis of res judicata.
The Commonwealth Court affirmed and further stated that nothing in Section 504 of the Administrative Agency Law requires an evidentiary hearing. Notice and the opportunity to be heard is satisfied if the WCJ reviews the pleadings and requests briefs. This can be on the WCJ's own motion, or on the motion of a party. The WCJ can dismiss a frivolous petition using this procedure.
In Coyne Textile v. WCAB (Voorhis) the WCJ dismissed the Employer's Termination Petition after a C&R holding the C&R resolved all the issues in the case. The Employer wanted a decision on the Termination Petition to get supersedeas reimbursement.
Upon approval of the Compromise and Release Agreement by [the WCJ], the [C]laimant will receive a total of $17,500 to fully and finally settle any entitlement for indemnity and medical benefits from August 16, 2000 into the future.
Specifically, the parties acknowledge that this Compromise and Release Agreement does not adjudicate the issues raised by [Claimant's Challenge Petition], filed in response to the [Suspension Petition] filed by the [E]mployer on June 23, 1999. Those issues will be decided by the [WCJ] based on the evidence of record already submitted by the parties.
With this language in the C&R Agreement, the Commonwealth Court held it was appropriate for a decision to be issued on the Employer's Petition for Termination. The Court remanded to the WCJ to render a decision.
When the WCJ receives the remand, the WCJ can either do a full opinion and order or follow the procedure set forth in Optimax, Inc. v, WCAB (Yacono). In Optimax, the parties entered into a stipulation that a Termination Petition should be granted. The WCJ entered a decision and order on the stipulation. The Employer proceeded to file a Petition for Supersedeas Reimbursement, and this petition was assigned to a WCJ. The WCJ who decided the Petition for Supersedeas Reimbursement dismissed the Petition because the termination was entered on a stipulation. The Commonwealth Court reversed and remanded to the WCJ that received assignment of the Petition for Supersedeas Reimbursement, with the direction that this WCJ review the record and determine whether the record supported the facts stipulated to, e.g. the facts supporting termination. The Court stated supersedeas reimbursement could be had if the record supported termination.
Therefore, the procedure according to these two cases is to provide in the C&R that the lump sum is in consideration of future benefits, and that the Employer's Petition will be decided on the record. There has to be a record, e.g. a supporting deposition or withdrawal of Claimant's objection to Employer's medical report under Section 422(c). To dispose of the Employer's Petition, the parties enter into a stipulation that the petition should be granted. The WCJ issues a decision on that stipulation. The Employer files a Petition For Supersedeas Reimbursement. The WCJ who receives assignment of the Petition For Supersedeas Reimbursement reviews the record and determines whether the record supports the stipulation. If so, supersedeas reimbursement may be granted.
In Rossa v. WCAB (City of Philadelphia) the issue before the WCJ was the paternity of a child prosecuting a fatal claim petition. The Supreme Court held: "Given the familial relationships that the WCJ must often disentangle, determining the eligibility of a child is not an extraordinary task. It is a responsibility that the WCJ is well able to assume."
The Court further held the standard of proof is preponderance of the evidence.
On December 23, Section 306(b) was amended to provide a vocational expert that meets qualifications established by the Department by regulation can conduct a vocational interview. On December 30, the Supreme Court in Caso v. WCAB (School District of Philadelphia) held that is what Section 306(b) meant all along. The Court held the Department's interpretation of the statute was entitled to great deference, and should not have been overturned unless such interpretation was clearly erroneous. Here, the interpretation that "approved" in Section 306(b) means "competent" was held by the Court to be reasonable.
The Court then reviewed the resulting application of the statute: an expert that meets the qualifications set forth in the regulations is deemed "approved" and the claimant may be compelled to attend a vocational examination with the expert. On a subsequent petition the WCJ determines competency of the vocational expert and may do so in light of the Bureau's (Department's) regulations. Finally, the Court noted defendant employers and insurers are subject to the imposition of penalties for bad faith selection of an unqualified interviewer.

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