Source: http://www.pawcj.com/2003/09/
Timestamp: 2019-04-20 00:43:45+00:00

Document:
Jeanes Hospital v. WCAB (Hass) is the case that holds a Claimant must file a timely Claim Petition to add to the description of injury. The Supreme Court granted Allocatur to rule on whether, consistent with Commercial Credit, "...filing a review petition is an appropriate procedure by which to seek amendment of a Notice of Compensation Payable, even if filed more than three years from the date of the workplace injury, in order to add to the description of the covered injury(ies) such consequential medical and psychiatric conditions which are alleged and found to have resulted from the workplace incident or injury identified in the Notice of Compensation Payable, but were not in existence at the time the Notice of Compensation Payable was executed."
In P. Gallie v. WCAB (Fichtel & Sachs Industries) The Commonwealth Court affirmed the WCJ, who determined that Section 306(f.1)(6)(iv) of the Act can be read to allow a party to file a Petition to Review Utilization Review Determination within thirty days of the Bureau's receipt of the underlying Determination, even where this date was after the date the party actually received it.
Accordingly, if there is an issue about timely filing, the parties will have to check with the WCJ's office to determine the date of the Bureau's receipt of the Utilization Review Determination. This would be the date stamped by the Bureau on the Utilization Review: Determination Face Sheet. Pray that it is legible, because the receipt of this document was not recorded in the Bureau's Comprehensive Information Management System (CIMS) in the case I looked at.
John W. Smithson, President and Chief Executive Officer of PMA Capital Corporation, will make a presentation at Sandler O'Neill & Partner's 2003 Insurance Conference. The presentation will provide an overview of PMA Capital's operations and discuss the current market for the Company's specialty insurance and reinsurance products. The live audio webcast of Mr. Smithson's presentation, along with slides related to the presentation, can be accessed at www.pmacapital.com by going to the Investor Information page, clicking on News Releases to find this announcement and then clicking on the microphone icon next to this release.
By clicking on this link to the United States Department of Health and Human Services Q&A Site, you can review the position of HHS that HIPAA does not affect the disclosure of health information necessary for the processing or adjudication of a workers' compensation case, or to coordinate care in a workers' compensation case. The Q&As generally indicate all procedures for gathering records pursuant to state law require no further authorization of the Claimant.
In Faulkner Cadillac v. WCAB (Tinari) the Claimant's specific loss was unrelated to a later injury for which he was receiving workers' compensation benefits. The WCJ awarded TTD benefits and specific loss benefits concurrently. The Employer argued the benefits should be limited by either the Claimant's pre-injury earning power or by the statutory maximum. The convention since Moran v. Glen Alden Coal Co., 36 A.2d 845 (Pa. Super. 1944) has been that the specific loss benefits would be paid at the end of the period of temporary total disability. The Commonwealth Court held, however, that since specific loss benefits are paid without regard to loss of earning power, they can be paid concurrently.
C. O'Donnell v. WCAB (United Parcel Service) is the first case to apply the Supreme Court's decision in Daniels to find a WCJ's decision to be not a reasoned decision in accordance with Section 422(a) of the Act. The Claimant had cervical injuries from lifting a 115 lb. box. The issues in the case were whether psychiatric treatment was related to the work injury, whether the description of injury should be expanded and whether recommended breast reduction surgery was compensable.
Five doctors testified: the family doctor, the Claimant's psychiatrist and orthopedist and the Employer's psychiatrist and orthopedist. The WCJ rejected opinions that psychiatric treatment was related and opinions that breast reduction surgery was related. The WCJ rejected opinions that the description of injury should be expanded. In the credibility findings the WCJ gave no reasons or nonspecific reasons why the doctors' opinions were credible or not credible.
The Board affirmed based on the Commonwealth Court's ruling in Daniels which held a WCJ issues a reasoned decision when he or she outlines all of the evidence considered, merely states the credible evidence upon which he or she relied, and sets forth the reasons for the ultimate disposition of the petition at issue.
The rub with applying this standard, according to the Supreme Court, was that a reviewing court would be charged with "imagining" the reasons why the WCJ was more convinced by the opinions the WCJ found to be credible. In O'Donnell, the Commonwealth Court gave just a taste of what it could imagine based on bits of five doctors' testimony, then remanded, holding that under the Supreme Court's Opinion in Daniels, the WCJ has to show his or her reasoning. The Commonwealth Court highlighted the quote from footnote 8 in Daniels: "One of the virtues of the legal profession -- and it is a virtue that certainly applies to the judicial decision-making process -- is that it depends upon reasoned articulation. Views are oftentimes shaped, molded, and changed in the very process of articulation."
The Commonwealth Court indicated in the Opinion that with articulated reasoning to support a credibility finding, the Court will: 1) review the record to be sure substantial competent evidence exists to support the elements of the WCJ's logical process; 2) assure that the WCJ's reasoning with respect to uncontroverted evidence is rational as required by Section 422(a); and 3) apply Wintermeyer review to determine whether the WCJ's "conclusions are based on capricious disregard of other evidence." In the case where this is "clear beyond doubt" the Court may engage in appellate review of the resulting credibility finding.
The Commonwealth Court published the Opinion in M. Koken v. Legion Insurance Company concluding Legion should be liquidated.
An August 29, 2003 Department News post advises the Bureau is accepting various documents that purport to be a medical only Notice of Compensation Payable. The post further advises the Revised Notice of Compensation Payable form with a medical only check box is expected to be published in November.
In W. Bensing v. WCAB (James D. Morrissey, Inc.), even though the Employer did not file an answer or appear at the first hearing, the Commonwealth Court upheld the decision of the WCJ and the Board that the Claimant was not in the course and scope of his employment when he was injured.
The Claimant, a construction worker, car pooled with his co-workers, and the Employer coordinated calls to the Employees to facilitate the car pool. However, the travel was not done in a company vehicle and the costs were paid by the Employees. They were traveling to a fixed place of employment.
The Court first held the Employer's non-response did not relieve the Claimant from proving he was in the course and scope of employment at the time of the injury, it only prevented the Employer from introducing contrary factual evidence. The Court then held the Claimant was not in the course and scope of his employment both under Foster v. WCAB 639 A.2d 935 (Pa. Cmwlth 1994) and the Ridesharing Act.
City of Phila. v. WCAB (Szparagowski) & Milici v. WCAB (City of Phila.) are cases of injured Philadelphia firefighters that took disability pensions. The issue before the Supreme Court was whether light duty dispatcher jobs were unavailable because the Claimants' disability pensions would be suspended if they took the jobs. The Supreme Court held the light duty positions were available.
The Court looked at the pension plans for firefighters and dispatchers and observed that the Claimants could not suffer a diminution of pension benefits by returning to the light duty positions. The Claimants argued they would be losing the qualitative benefit of the payments of pension benefits in part because they would continue to receive the benefits if they took a job with another employer. The Supreme Court rejected this argument. The Court stated St. Joe Container Co. v. WCAB (Staroschuck) 633 A.2d 128 (Pa. 1993) only makes jobs unavailable when the Claimant would be made less than whole. The Court stated the Claimants' argument in this case asked that they be made more than whole.
Mr. Milici had been awarded benefits for an irreversible lung disease. He argued his benefits could not be modified because the Employer could not show a change in condition, the first prong of the Kachinski standard. The Supreme Court clarified that "change in condition" equates with "change in earning power" and medical evidence can establish this even in the case of an irreversible disease.
City of Philadelphia v. WCAB (Brown) is a case in which the Claimant, a corrections officer, fell on 9/17/94. The Employer's injury report included the description of injury to the left knee. The Claimant alleged other times her knee pain flared up while she was on duty, and the Employer apparently paid medical expenses and paid IOD benefits. In 1997 the Employer had an opinion from its panel physician that the Claimant's left knee condition was all degenerative.
The Claimant went off for her knee condition on 3/6/98. The Employer stopped paying meds as of 3/2/98 and on 4/21/98 issued an NCP for the 9/17/94 injury with a description of "contusions left hand and left leg, left wrist." The NCP presumably provided the Claimant was not disabled. On 6/5/98 the Claimant filed a Penalty Petition alleging the 4/21/98 NCP was issued late. On 7/13/98 the Employer filed a Termination/Suspension Petition alleging the Claimant returned to light duty on 7/4/96 and full duty on 1/14/97 without further disability.
The WCJ credited Claimant's physician's testimony that the 9/17/94 injury aggravated her underlying degenerative knee condition and dismissed the Employer's Petition. The WCJ found no violation of the Act but awarded TTD benefits beginning 3/6/98. The Board affirmed. The Commonwealth Court indicated the Employer should have issued a medical only NCP 21 days from the 9/17/94 date of injury. Since the authority for this is the 2003 case of Waldameer Park, no penalty was awarded.
The Employer also argued on appeal that under Commercial Credit, the Claimant's Claim set forth in her 6/5/98 Penalty Petition was barred by the statute of limitations. The Court stated the Employer could not use Commercial Credit as a sword. More to the point, the Commonwealth Court noted the Employer paid medical expenses up to 3/2/98 and the 6/5/98 Petition was therefore timely.

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