Source: https://www.paworkerscomphelp.com/pennsylvania-workers-compensation-case-studies/pa-workers-compensation-reinstatement-of-wage-loss-benefits-sloane-v-wcab
Timestamp: 2019-04-18 16:59:56+00:00

Document:
HOLDINGS: -The Workers' Compensation Appeal Board properly upheld a portion of a workers' compensation judge's (WCJ) determination that a claimant's right-knee replacement surgery and related treatment were compensable medical expenses that were related to her second work injury, based on substantial and competent medical testimony from her treating physician, as the weight and credibility of the physician's testimony was within the WCJ's determination; -The Board properly reversed the WCJ's reinstatement of total disability benefits that arose from the second work injury because the claimant did not comply with the limitations periods pursuant to 77 Pa. Stat. Ann. §§ 771, 772, and 602, based on the employer's having issued a medical-only notice of compensation payable, such that the 500-week limitation for reinstatement of benefits was inapplicable.
Before this Court are cross-petitions for review filed by Sandra Sloane (Claimant) and her employer, Children's Hospital of Philadelphia1 (Employer), of an order of the Workers' Compensation Appeal Board (Board) that affirmed in part and reversed in part the decision and order of a Workers' Compensation Judge (WCJ) granting a petition for reinstatement of benefits (Petition) filed by Claimant. Claimant seeks review of the portion of the Board's order that reversed the WCJ's reinstatement of total disability benefits arising from work injuries sustained in 2004 and 2006. Employer seeks review of the Board's order to the extent it upheld the WCJ's determination that Claimant's 2007 right-knee replacement surgery and related treatment were compensable medical expenses related to the 2006 work injury. For the [*2] reasons that follow, we affirm the order of the Board.
Claimant filed the Petition on May 31, 2011 seeking the reinstatement of total disability benefits as of November 1, 2007. (Petition, R.R. at 1a-3a.) Employer filed an answer to the petition denying Claimant's entitlement to a reinstatement of benefits, and the matter was assigned to a WCJ. (Answer, R.R. at 4a-5a.) Claimant testified by deposition and at a hearing before the WCJ, and Claimant also submitted the deposition of her physician, Thomas J. Mercora, D.O. The evidence presented by Employer included [*4] the deposition testimony of Barry Ruht, M.D., who performed an independent medical examination of Claimant on December 22, 2011.
Claimant and Employer each petitioned this Court for review of the Board's order.3 Claimant argues on appeal that the Board erred in holding that her request for disability benefits for the 2006 injury was barred by the three-year limitations period of Section 413(a) and that the issuance of the medical-only 2006 NCP put her disability in suspended status which could be reinstated within 500 weeks of the 2006 NCP. Claimant further argues that the Board erroneously reversed the WCJ's determination that Claimant was rendered totally disabled on November 17, 2007 as a result of her 2004 work injury to her right elbow, upsetting the WCJ's credibility determinations. In its appeal, Employer challenges the Board's determination that Employer was liable for Claimant's 2007 right-knee replacement surgery and other medical expenses relating to the 2006 injury, arguing that Dr. Mercora's testimony was not sufficient to support this conclusion and that the Board erred in crediting him as her treating physician.
We first address whether the Petition was timely filed with respect to the request for total disability benefits based on the 2006 work injury. Section 413(a) of the Act provides a WCJ with broad discretion to amend an award of benefits, an NCP or an agreement of the parties. 77 P.S. §§ 771, 772, 773. Under the first paragraph of Section 413(a), the WCJ may "review and modify or set aside" an NCP, agreement or award that "was in any material respect incorrect." 77 P.S. § 771. Pursuant to the second paragraph of Section 413(a), the WCJ may "modify, reinstate, suspend, or terminate" an NCP, agreement or award "upon proof that the disability of an injured employe has increased, decreased, recurred, or has temporarily or finally ceased." 77 P.S. § 772.
where compensation has been suspended because the employe's earnings are equal to or in excess of his wages prior to the injury that payments under [*8] the agreement or award may be resumed at any time during the period for which compensation for partial disability is payable, unless it be shown that the loss in earnings does not result from the disability due to the injury.
77 P.S. § 772. As our Supreme Court has explained, this provision acts as a statute of repose, cutting off any entitlement to the reinstatement of disability benefits that have been partially or totally suspended at the expiration of the 500 weeks under which partial disability benefits are payable pursuant to Section 306(b)(1) of the Act, 77 P.S. § 512(1). Cozzone v. Workers' Compensation Appeal Board (PA Municipal/East Goshen Township), 621 Pa. 23, 73 A.3d 526, 535-36 (Pa. 2013). Furthermore, the 500-week and three-year limitations periods of Section 413(a) must be construed together and both be given effect, allowing a claimant whose benefits were suspended or reduced prior to the expiration of the 500-week period to seek reinstatement of total disability payments within three years of the last payment of benefits or the maximum 500 weeks allowed for partial disability, whichever is later. Id. at 535-40.
Claimant argues that the 2006 NCP has the same effect as the prior practice before the Board of granting a claim petition with [*9] the immediate suspension of disability benefits in cases where medical treatment is required but there is no immediate wage loss. See, e.g., Ruth Family Medical Center v. Workers' Compensation Appeal Board (Steinhouse), 718 A.2d 397, 403 (Pa. Cmwlth. 1998) (recognizing that the Board acted properly in granting a claim petition and immediately suspending benefits where the injury had not manifested itself in a loss of earning power); Shaffer v. Workmen's Compensation Appeal Board (Hollenback Township), 153 Pa. Commw. 430, 621 A.2d 1125, 1129 (Pa. Cmwlth. 1993) (same). Therefore, Claimant contends that the appropriate form to seek disability benefits for the 2006 injury was by filing a petition to reinstate her suspended benefits and her Petition was timely filed within the 500-week period in which an injured employee is eligible to receive partial disability benefits.
However, as the Board explained in its opinion, the effect of issuing a medical-only NCP is distinct from the effect of a WCJ ruling that a claimant has suffered a loss of earning power and granting a claim petition but immediately suspending benefits. As this Court has explained, the Board created the medical-only option for NCPs in 2004 to allow an employer to accept liability for an injury but not any loss of earning power. City of Philadelphia v. Workers' Compensation Appeal Board (Butler), 24 A.3d 1120, 1124 (Pa. Cmwlth. 2011) (en banc); Forbes Road CTC v. Workers' Compensation Appeal Board (Consla), 999 A.2d 627, 629 (Pa. Cmwlth. 2010); Armstrong v. Workers' Compensation Appeal Board (Haines & Kibblehouse, Inc.), 931 A.2d 827, 831 & n.5 (Pa. Cmwlth. 2007). This understanding of the effect of a medical-only NCP is evident in this case where Employer checked the portion of [*10] the NCP form which states "[c]heck only if compensation for medical treatment (medical only, no loss of wages) will be paid subject to the Workers' Compensation Act" and did not complete the portions of the form related to wage-loss benefits, including the weekly compensation rate. (2006 NCP, R.R. at 8a (emphasis in original).) Accordingly, because no disability had ever been recognized by Employer or established by a WCJ for the 2006 injury, disability had not been suspended when the 2006 NCP was issued. Claimant therefore could not seek to have disability benefits reinstated, and the 500-week period for reinstatement of benefits does not govern this case.
5 Section 315 provides that "all claims for compensation shall be forever barred, unless, within three years after the injury, the parties shall have agreed upon the compensation payable...or unless within three years after the injury, one of the parties shall have filed a [claim] petition...." 77 P.S. § 602.
6 Penn Beverage, 901 A.2d at 1102 (concluding that the claimant's specific loss petition for facial disfigurement arose from a previously established automobile accident work injury and therefore should be analyzed pursuant to Section 413(a)); see also Westinghouse Electric Corp./CBS v. Workers' Compensation Appeal Board (Korach), 584 Pa. 411, 883 A.2d 579, 587-92 (Pa. 2005) (holding that a petition seeking [*12] to add a psychiatric condition to a previously accepted back injury from over ten years prior was governed by the limitations period of Section 413(a) because the later injury "arose as a direct result of" the earlier injury); Guthrie v. Workers' Compensation Appeal Board (Keystone Coal Co.), 767 A.2d 634, 636-37 (Pa. Cmwlth. 2001) (concluding that Section 413(a) was applicable to a claim seeking benefits for a permanent scar related to a previously recognized facial injury because the case had a "history" of litigation).
7 Furthermore, it is not clear that a review petition here would be in accordance with the text of Section 413(a). A review petition is appropriate under the first paragraph of Section 413(a) where an NCP is "in any material respect incorrect" and under the second paragraph of Section 413(a) where "the disability of an injured employe has increased, decreased, recurred, or has temporarily or finally ceased." 77 P.S. §§ 771, 772; see also Cinram Manufacturing, Inc. v. Workers' Compensation Appeal Board (Hill), 601 Pa. 524, 975 A.2d 577, 580-81 (Pa. 2009) (explaining that petitions under the first paragraph of Section 413(a) deal with "[c]orrective amendments" that address "an inaccuracy in the identification of an existing injury," while petitions under the second paragraph deal with amendments "addressing subsequently-arising medical or psychiatric conditions related to the original injury (or consequential conditions)"). Claimant has not alleged an inaccuracy in the medical-only NCP for the 2006 [*13] injury or an increase or recurrence of her disability; instead, Claimant now seeks an award of disability benefits that had not previously been recognized.
Despite the apparent ambiguity relating to the proper form of the Petition, we need not resolve this issue because Claimant's request for disability benefits for the 2006 injury would be untimely under the limitations periods of Section 413(a) or Section 315. Under Section 413(a), a reinstatement petition must be filed "within three years after the date of the most recent payment of compensation made prior to the filing of such petition." 77 P.S. § 772. The payment of medical benefits by an employer does not constitute "compensation" for the purposes of Section 413(a) that would act to toll the liability period. Westinghouse Electric Corp./CBS v. Workers' Compensation Appeal Board (Korach), 584 Pa. 411, 883 A.2d 579, 591 (Pa. 2005); Riggle v. Workers' Compensation Appeal Board (Precision Marshall Steel Co.), 890 A.2d 50, 56 (Pa. Cmwlth. 2006); O'Brien v. Workers' Compensation Appeal Board (Montefiore Hospital), 690 A.2d 1262, 1264-65 (Pa. Cmwlth. 1997). Since no disability compensation had been paid for the 2006 injury, Claimant was required to establish an entitlement within 3 years of the date of the injury. The Petition filed on December 31, 2011 was therefore untimely under Section 413(a).
Section 315 also imposes a three-year limitations period, measured from the date of injury. 77 P.S. § 602. Unlike Section 413(a), payments of medical expenses may toll the Section 315 limitations period where those payments were made "in lieu of" workers' compensation benefits. Korach, 883 A.2d at 591; Schreffler v. Workers' Compensation Appeal Board (Kocher Coal Co.), 567 Pa. 512, 567 Pa. 527, 788 A.2d 963, 971 (Pa. 2002) (plurality opinion); Harley Davidson, Inc. v. Workers' Compensation Appeal Board (Emig), 829 A.2d 1247, 1252 (Pa. Cmwlth. 2003) [*14] . The controlling question in this analysis is the intent of the employer, i.e. whether the employer intended the payments for medical services to replace disability benefits. Schreffler, 788 A.2d at 969-70; Harley Davidson, 829 A.2d at 1252-53; Golley v. Workers' Compensation Appeal Board (AAA Mid-Atlantic, Inc.), 747 A.2d 1253, 1256 (Pa. Cmwlth. 2000). Here, by issuing the medical-only NCP, Employer made its intent expressly clear that it would pay Claimant's medical expenses but accepted no liability for wage-loss benefits. Thus, the Petition would also be untimely under Section 315.
Petition and the parties expressly agreed that the matter before the WCJ was confined to the 2006 injury.
[Employer's counsel:] I do want you to focus your medical opinions on the claimant's right knee. Prior to your deposition today we had an off-the-record discussion between Counsel, and in light of the medical opinions rendered by Dr. Mercora during his deposition it's been agreed between the parties that the issue pertinent to the review petition currently pending before [the WCJ] is whether or not the claimant's right knee replacement was necessitated by her [*16] work-related injury of 2006.
...And, Counsel, if you could just please state for the record whether I accurately represented our stipulation prior to the dep?
[Claimant's counsel:] Yes, you did.
(Deposition of Dr. Ruht at 14-15, R.R. at 117a-118a.) Importantly, this stipulation excluding the 2004 injury occurred after the statement by Claimant's counsel during Claimant's deposition, which the Board had held expanded the issues in the Petition. Furthermore, in accordance with the parties' understanding that only the 2006 right knee injury was at issue, Employer did not elicit testimony from Dr. Ruht concerning Claimant's 2004 injury and whether that contributed to Claimant's total disability.
We recognize, as the Board did, that [*17] liberal pleading rules apply in workers' compensation matters. Krushauskas v. Workers' Compensation Appeal Board (General Motors), 56 A.3d 64, 69 (Pa. Cmwlth. 2012) (en banc); Brehm v. Workers' Compensation Appeal Board (Hygienic Sanitation Co.), 782 A.2d 1077, 1081-82 (Pa. Cmwlth. 2001) (en banc). Nevertheless, principles of fairness and due process require that the party against whom relief is awarded must have been on notice of the theory of relief and had an opportunity to respond. Krushauskas, 56 A.3d at 69; Brehm, 782 A.2d at 1081-82 & n.16. Thus, where the parties expressly stipulated that the 2004 injury was excluded from the current proceedings and Employer relied on that agreement to not present medical evidence related to that injury, the WCJ acted outside his authority by ordering benefits related to the 2004 injury.
Employer also appeals from the Board's order affirming the WCJ's determination that Employer was responsible to pay Claimant's medical expenses related to the December 3, 2006 knee injury, including Claimant's right-knee replacement surgery.10 Employer specifically challenges the competency of Dr. Mercora, Claimant's medical expert, arguing that the WCJ erred in crediting Dr. Mercora as Claimant's treating physician because Dr. Mercora was hired only for litigation purposes and he did not have personal knowledge of Claimant's treatment.
10 We note that the WCJ determined that Employer was liable for payment for all medical [*18] services in connection with both the 2004 and 2006 injuries; the Board affirmed the WCJ to the extent the WCJ required Employer to reimburse Claimant for medical expenses but did not address Employer's responsibility for medical expenses related to the 2004 injury in its opinion. (WCJ Decision and Order, F.F. ¶17, C.L. ¶¶7-8, Order; Board Op. at 10-11, Order.) Because Employer only appealed from the decision that the right-knee replacement surgery and other treatment related to the 2006 injury were medically compensable, we need not address whether Employer is responsible for payments related to the 2004 injury.
Upon review of the record, we conclude that the WCJ's determination that Dr. Mercora credibly supported Employer's liability for medical expenses related to the 2006 right-knee injury was not in error. Employer contends that Dr. Mercora's testimony was not competent because Dr. Mercora did not examine Claimant in July 2011 and based his diagnosis and opinion on causation on the notes of Dr. Booth and Claimant's other doctors. However, an expert may base his opinion in part on the notes of others on which he customarily relies in his professional practice. Westinghouse Electric Corp./CBS v. Workers' Compensation Appeal Board (Burger), 838 A.2d 831, 838 (Pa. Cmwlth. 2003); Empire Steel Castings, Inc. v. Workers' Compensation Appeal Board (Cruceta), 749 A.2d 1021, 1026 (Pa. Cmwlth. 2000). To the extent Employer seeks to have us second guess Dr. Mercora because he did not treat Claimant at the time [*21] of her right knee replacement surgery, Employer's arguments must be rejected because they go to the weight and credibility of the evidence rather than Dr. Mercora's competency. Burger, 838 A.2d at 838. The WCJ has exclusive province over questions of credibility and evidentiary weight, including whether to accept or reject the testimony of any witness, including a medical witness, in whole or in part. University of Pennsylvania v. Workers' Compensation Appeal Board (Hicks), 16 A.3d 1225, 1229 n.8 (Pa. Cmwlth. 2011); Anderson v. Workers' Compensation Appeal Board (Penn Center for Rehab), 15 A.3d 944, 949 (Pa. Cmwlth. 2010). As an appellate court we may not reweigh the evidence or review the credibility of witnesses, but rather our role is confined to determining whether the WCJ's findings are supported by substantial evidence. Sell v. Workers' Compensation Appeal Board (LNP Engineering), 565 Pa. 114, 771 A.2d 1246, 1250-51 (Pa. 2001).
Employer also argues that the WCJ erred by affording Dr. Mercora greater deference than Employer's expert, Dr. Ruht, as Claimant's treating physician when Dr. Mercora first saw her in connection with this litigation and he admitted that he was only "monitoring" Claimant's condition. (Mercora Dep. at 27, R.R. at 98a.) It is well established that "greater credence may be given to the testimony of a treating physician than to a physician who examines simply to testify for litigation purposes." School District of Philadelphia v. Workers' Compensation Appeal Board (Hilton), 84 A.3d 372, 375 (Pa. Cmwlth. 2014) aff'd, 117 A.3d 232 (Pa. 2015) (quoting D.P. "Herk" Zimmerman, Jr., Inc. v. Workmen's Compensation Appeal Board (Himes), 103 Pa. Commw. 68, 519 A.2d 1077, 1080 (Pa. Cmwlth. 1987)). Here, while Claimant was first referred to Dr. Mercora by Claimant's counsel, Dr. Mercora [*22] testified that he had seen Claimant once a month since the initial visit with the intention of eventually scheduling to see her every six months and that Claimant had requested he become her primary care physician. (Mercora Dep. at 26-29, 33, R.R. at 98a-99a.) Furthermore, while Dr. Mercora testified that he was only "monitoring" Claimant's right knee and right elbow conditions at the moment, he also testified that he had recommended to Claimant that she continue seeking treatment for those conditions with her other doctors, provided treatment related to her lower back, and had discussed potential future treatment for her right knee and elbow including the use of medication and possible surgery. (Id. at 26-31, R.R. at 98a-99a.) Thus, there was substantial evidence to support the finding that Dr. Mercora had assumed a greater responsibility in Claimant's medical care than simply as a litigation expert and, as Claimant's treating physician, was entitled to greater deference.
Finally, Employer argues that Dr. Mercora's testimony was not competent because his opinion was in conflict with the notes of Dr. Booth and his associates who had previously provided treatment to Claimant's for her knees. Employer cites specifically [*23] Dr. Booth's failure to reference any trauma to Claimant's knee in his notes for her first appointment after the December 3, 2006 incident, a pre-2006 note indicating that at some point in the future Claimant might need right knee replacement surgery and notes indicating that Claimant had some pain in her right knee as far back as 2001. (Id. at 19, 22, 39-40, R.R. at 96a, 97a, 101a.) However, Dr. Mercora did not deny that Claimant had degenerative joint disease and pain in her right knee prior to 2006, but instead stated that her left knee was the predominant issue prior to the 2006 work injury and she had responded well to the injections in her right knee that she began receiving in November 2005. (Id. at 19-21, 40-41, R.R. at 96a, 101a.) Dr. Mercora further testified that it was only in July 2007 that Claimant presented to Dr. Booth with persistent right knee pain which indicated that she had suffered an injury to her right knee in the December 3, 2006 work incident. (Id. at 21, 40-41, R.R. at 96a, 101a.) Dr. Mercora's testimony was thus not inconsistent with the notes of Dr. Booth. Moreover, even if we were to accept Employer's arguments that the testimony of Dr. Mercora is inconsistent with the notes of Claimant's other doctors, the WCJ's determination to accept [*24] Dr. Mercora's opinion on the causation of Claimant's injury is within the WCJ's role as sole arbiter of evidentiary weight and credibility and subject to our review.
Accordingly, we conclude that the Board did not err in determining that Claimant's medical treatment for the 2006 work injury was compensable under the Act but was not entitled to an award of total disability benefits for the 2004 or 2006 work injuries. The order of the Board is affirmed.
AND NOW, this 1st day of October, 2015, the order of the Workers' Compensation Appeal Board in the above matters is affirmed.
Anytime that I needed anything from Joe, he was right there by my side to help me and answer any questions that I had.

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