Opinion ID: 1990239
Heading Depth: 2
Heading Rank: 1

Heading: Whether the Van is an Orthopedic Appliance

Text: The parties maintain the positions they have taken throughout the litigation. Appellant argues that the cost of the van itself, no less than the cost of conversion, is encompassed by the Act's reference to orthopedic appliances and that the contrary conclusion reached by the en banc majority below, and the panel majority in Petrilla, should be disapproved. Appellant also contends that a contrary construction is unduly restrictive, resulting in a gross inequity that frustrates the humanitarian and remedial purpose underlying the Act. Appellant emphasizes that, in his case at least, the van is an indispensable part of the wheelchair lift that is necessary to accommodate the severely limited mobility brought about by his work-related quadriplegia. If he is to be mobile, appellant stresses, he has no choice but to secure a van, since a standard-sized automobile cannot accommodate his wheelchair and lift. Absent the van, the wheelchair lift (a conceded orthopedic device here) is useless to him. Appellant asserts that the Commonwealth Court's interpretation of the term orthopedic appliance leads to an arbitrary result, as only those quadriplegic claimants wealthy enough to afford a van on their own will be able to avail themselves of the Act's provision for reimbursement for the cost of a wheelchair lift and the cost of converting a van to make it wheelchair accessible. Appellant does not dispute that, viewed in isolation, a van ordinarily would not satisfy the common definition of an orthopedic appliance. However, appellant submits that, when a van becomes necessary as a result of a work injury which renders a person quadriplegic, it is indeed an orthopedic appliance. Like the dissent below, appellant relies upon the Rieger case, where the Commonwealth Court concluded that the cost of hand controls installed in a disabled claimant's automobile to enable him to drive, and the cost of remodeling his home to accommodate his wheelchair, were compensable as payment for orthopedic appliances. Although the cost of the vehicle itself was not an issue in Rieger, appellant invokes the broad assertion in Judge Colins' opinion that, a device specifically designed for the particular use of allowing the handicapped to travel as necessary without aid, qualifies the van as an orthopedic appliance. Rieger, 521 A.2d at 86. Appellant maintains that the van, which he did not need until he was rendered quadriplegic and confined to a wheelchair, is necessary for him to travel and, as such, it is an orthopedic appliance under the Act. Appellant also disputes the relevance of the en banc majority's claim that his inability to afford the van is a product of his financial circumstances, and not his work injury. Appellant notes that his need for the van is a direct result of the work injury, and his financial circumstances are not at issue in determining whether the van, in a circumstance such as this, is an orthopedic appliance. Finally, appellant posits that the decision below restricts his rightful access to medical benefits by denying him necessary transportation. Citing Bonitz Brothers, Inc. v. Workmen's Compensation Appeal Board (Wymes), 81 Pa.Cmwlth. 594, 474 A.2d 393, 394-95 (1984) and Roadway Express v. Workmen's Compensation Appeal Board (Ostir), 104 Pa.Cmwlth. 7, 520 A.2d 1261 (1987), appellant contends that Section 306(f.1)(1)(i) also contemplates reimbursement for travel for medical care as and when needed, because that travel falls within the definition of medical services. Employer counters appellant's suggestion that Petrilla should be disapproved by suggesting that appellant seeks to expand the definition of orthopedic appliances merely because of the humanitarian and remedial nature of the Act. Employer notes that it is already liable for lost wages, medical expenses, and the cost of retrofitting a van. In Employer's view, appellant's argument for the purchase price of the van is better addressed to the General Assembly, which can amend the Act to add such a provision explicitly, rather than to this Court, which is responsible for interpreting the statute as presently written. Employer also contends that appellant's reliance on Rieger is misplaced because that decision merely held that remodeling a claimant's home and installing hand controls on his vehicle were compensable as orthopedic appliances. Employer argues that, under appellant's reading of the decision, the employer in Petrilla would have been obliged to buy the claimant the house which was to be remodeled. Employer also disputes appellant's reliance upon the Bonitz and Roadway Express cases for the proposition that transportation for medical treatment is compensable as a medical service under Section 306(f.1)(1)(i) of the Act. Employer contends that these cases merely held that long distance travel to obtain medical treatment that was not available locally was compensable as a medical service; but, nothing in the cases held employers responsible for buying a claimant a car, bus, train or other means of transportation to travel for medical treatment, which is what appellant now seeks. Employer further argues that local travel is simply not compensable under the Act. See Helen Mining Co. v. Workmen's Comp. Appeal Bd. (Tantlinger), 151 Pa.Cmwlth. 242, 616 A.2d 759 (1992). [2] Although this issue is one of first impression for this Court, it has been considered by courts in several other jurisdictions construing similar statutes. A review of the approaches by our sister states is a helpful introduction to our consideration here. In Manpower Temporary Services v. Sioson, 529 N.W.2d 259 (Iowa 1995), the Supreme Court of Iowa considered a workers' compensation statute which obliged the employer/insurance carrier to provide work-injured claimants with reasonably necessary medical services and supplies, transportation expenses related to those services, and reasonable and necessary . . . artificial members and appliances. IOWA CODE § 85.27. The Manpower court held that a specially-equipped van qualified as an appliance. In so holding, the court noted that the claimant was confined to an electric wheelchair weighing in excess of 300 pounds, which could not practically be transported by ordinary automobile. The court further noted that [t]he point is that a van is necessary in order to make [the claimant's] wheelchair fully useful and that [w]ithout a van [the claimant] is, more than need be, a prisoner of her severe paralysis. Manpower, 529 N.W.2d at 264. The court also emphasized the fact that the claimant had never owned an automobile, preferring to travel by foot, bicycle, or public transportation, before her work-related accident. Id. at 262. In Terry Grantham Co. v. Industrial Commission of Arizona, 154 Ariz. 180, 741 P.2d 313 (Ariz.Ct.App.1987), the Court of Appeals of Arizona considered a workers' compensation statute that obliged the employer/insurance carrier to provide work-injured claimants with medical, surgical and hospital benefits or other treatment, nursing, medicine, surgical supplies, crutches and other apparatus, including artificial members. ARIZ.REV.STAT. ANN. § 23-1062(A). The court affirmed an award requiring the employer to pay for the quadriplegic claimant's van in addition to modifications to the van. The Grantham court suggested that the question was fact-intensive, however, agreeing with the employer that, in some instances, only the modification to the vehicle would qualify as an apparatus. On the facts in Grantham, however, the court reasoned as follows: [A] wheelchair is simply inappropriate for travel beyond limited distances. There was no evidence that the vehicle [the claimant] owned at the time of the accident could be satisfactorily modified to replace his lost bodily functions. There was evidence that the modified van was essential to restore virtually any mobility. The administrative law judge was correct in his conclusion that the van is a reasonably required other apparatus. Grantham, 741 P.2d at 316. In so holding, the court adopted the reasoning of the Florida District Court of Appeal to the effect that, [w]here an industrial injury necessitates the modification or substitution of an automobile in order to accommodate a wheelchair or artificial member and to restore in part a claimant's former ambulatory ability, such costs may be awarded as `other apparatus.' Id. (quoting Fidelity Cas. Co. v. Cooper, 382 So.2d 1331, 1332 (Fla.Dist.Ct.App.1980) (emphasis added by Grantham court)). In Brawn v. Gloria's Country Inn, 698 A.2d 1067 (Me.1997), the Supreme Judicial Court of Maine examined a workers' compensation statute which obliged the employer to provide work-injured claimants with reasonable and proper medical, surgical and hospital services, nursing, medicines, and mechanical, surgical aids, as needed. ME.REV.STAT. ANN. tit. 39-A, § 206. The obligation was further defined to include artificial limbs, eyes, teeth, eyeglasses, hearing aids, orthopedic devices and other physical aids made necessary by the injury. ME.REV.STAT. ANN. tit. 39-A, § 206(8). The Brawn claimant used a specially adapted wheelchair weighing 300 pounds, which was not transportable in an ordinary vehicle. The employer had voluntarily purchased a specially adapted van for the claimant in 1989. However, in 1994, when the claimant sought payment for a replacement van, the employer agreed only to pay to adapt the van, but not to purchase it. The Brawn court concluded that, in these circumstances, a van was a reasonable and proper mechanical or physical aid as it was reasonably necessary to facilitate the use of the claimant's wheelchair. The court noted that the practical benefit of a 300-pound wheelchair is greatly diminished if the claimant is effectively precluded from traveling beyond the boundaries of her own home. The court thus reasoned that the van, like the wheelchair, was reasonably necessary to provide basic mobility. The court stressed, however, that the statute would not always require that conclusion, because the employee might have access to other methods of transportation, or the employer might offer a reasonable alternative to the purchase of a van. In the court's view, each case must be decided according to its own particular facts and according to the statute's ultimate purpose to provide reasonable relief from the effects of a work-related injury. [3] [4] Other jurisdictions have deemed the cost of a specially adapted vehicle compensable but have looked to offsetting that cost premised upon the particulars of a given case. For example, in Crouch v. West Virginia Workers' Compensation Commissioner, 184 W.Va. 730, 403 S.E.2d 747 (1991), the quadriplegic claimant requested that the employer either buy him a van or pay the difference between the cost of a van and the cost of the claimant's normal mode of transportation prior to his work-related injury. The West Virginia workers' compensation statute provided, in relevant part, an entitlement to approved mechanical appliances and devices, as may be reasonably required. W. VA.CODE § 23-4-3. The court found that the cost of a customized van was compensable under the statute, stating that: We believe that an automobile, which is a machine, can be interpreted as a mechanical appliance under the statute. Moreover, implicit in this statute is the fact that, for a quadriplegic, an automobile capable of transporting the petitioner and the accompanying equipment is more than reasonably required to be active in our society. Without adequate transportation, the existence of a claimant handicapped like the petitioner is limited at best. Crouch, 403 S.E.2d at 750. The Crouch court went on to hold that the term mechanical appliances may be interpreted to extend to a specially converted van for claimants who are quadriplegic as the result of a compensable injury. Id. at 751. In support of its decision, the Crouch court cited to, inter alia, the Florida intermediate appellate decision in Fidelity and Casualty Co., supra, the Arizona decision in Grantham, supra, and the Commonwealth Court's decision in Rieger, supra . Furthermore, the court specifically noted the similarity of Pennsylvania's statutory term orthopedic appliances and the West Virginia statutory term mechanical appliances. Crouch, 403 S.E.2d at 751. Nevertheless, the Crouch court did not require the employer to pay for the entire cost of the van. Noting the claimant's testimony that he would have owned an automobile regardless of his injury, the court concluded that he was not entitled to the full cost of the van. Rather, the court held that, where a claimant owned or would have owned an automobile in any event, the employer was required to pay only the difference between the specially equipped van and the cost of an average mid-priced automobile of the same model year as the van. To similar effect is Meyer v. North Dakota Workers Compensation Bureau, 512 N.W.2d 680 (N.D.1994). In Meyer, the North Dakota Supreme Court held that the cost of adaptive equipment and the necessary additional vehicle cost associated with purchasing a van for the claimant, who was paralyzed from the chest down as the result of a work injury, was compensable under North Dakota's workers' compensation statute. Under that statute, the employer was obliged to provide artificial replacements, N.D. CENT.CODE § 65-05-07, a term including mechanical aids including braces, belts, casts, or crutches as may be reasonable and necessary due to compensable injury, N.D. CENT.CODE § 65-01-02(2). The Meyer court reasoned that, [i]f as part of his rehabilitation and return to employment, [the claimant] must use adaptive equipment, and if the adaptive equipment can only be used with a van, then the bureau is responsible for the cost of the adaptive equipment and the necessary additional vehicle cost associated with purchasing a van. Meyer, 512 N.W.2d at 684 (citing Crouch, supra ; Grantham, supra; and Fidelity Cas. Co., supra ). However, the court noted that, if the claimant had not been injured he still would have needed a vehicle, and therefore, he was entitled only to the added expense associated with buying a van compared to a regular automobile, and the cost of the adaptive equipment. The claimant was deemed responsible for the cost of the van's luxury conversion, and for an amount equivalent to the cost of an average vehicle, which he might have otherwise owned, of the same year as the van. Accord Negri v. Cont'l Sales & Serv., 139 S.W.3d 565, 571 (Mo.Ct.App.2004) (employer liable only for difference in cost between modified van and average, mid-priced automobile of same year as purchased van). Other states seem to be less flexible in their interpretation and response. For example, in Ex parte City of Guntersville, 728 So.2d 611 (Ala.1998), the claimant, a city police officer, suffered a bullet wound to his back in the line of duty rendering him a paraplegic and confined to a wheelchair. The state's workers' compensation statute required employers to provide reasonably necessary medical and surgical treatment and attention, physical rehabilitation, medicine, medical and surgical supplies, crutches, artificial members, and other apparatus as the result of an accident arising out of and in the course of the employment. ALA.CODE § 25-5-77(a). The city argued that it was not obligated to pay for a motor vehicle equipped with a wheelchair lift. The Supreme Court of Alabama held that, because a motor vehicle is not a device that serves to improve a disabled claimant's condition, but rather operates to improve the claimant's functioning, allowing reimbursement for such costs would stretch the workers' compensation statute beyond its intended meaning. To similar effect is Weakland v. Toledo Engineering Co., Inc., 467 Mich. 344, 656 N.W.2d 175 (2003), where the work-injured claimant's condition worsened to the point where he needed a motorized cart and a customized van to transport that cart. The claimant sought reimbursement for both the cost and customization of the van pursuant to Michigan's workers' compensation statute, which obligated employers to supply appliances necessary to cure, so far as reasonably possible, and relieve from the effects of the injury. MICH. COMP. LAWS § 418.315(1). The Supreme Court of Michigan held that the employer was not obligated to provide the van because it was not an appliance. In the court's view, the term appliance encompassed only the necessary modifications made to the van so that it could be operated by the claimant. Accord R & T Constr. Co. v. Judge, 323 Md. 514, 594 A.2d 99, 108 (1991) (claimant rendered quadriplegic by work injury denied reimbursement for specially equipped van because van deemed not to be prosthetic appliance, medical apparatus or device under governing statute). Two intermediate appellate decisions from New York likewise have held that the cost of an automobile was not covered by a workers' compensation statute that obligated the employer to make payments for `medicine, crutches and apparatus . . . or other devices . . . necessary . . . to replace, support or relieve a portion or part of the body.' N.Y. WORKERS' COMP. LAW § 13. See Kranis v. Trunz, Inc., 91 A.D.2d 765, 458 N.Y.S.2d 10 (N.Y.App.Div.1982); Nallan v. Motion Picture Studio Mechs. Union, Local No. 52, 49 A.D.2d 365, 375 N.Y.S.2d 164, 168 (N.Y.A.D.1975), rev'd on other grounds, 40 N.Y.2d 1042, 391 N.Y.S.2d 853, 360 N.E.2d 353 (1976); accord Bouge v. SDI Corp., 931 P.2d 477 (Colo.Ct.App.1996) (medical apparatus, as contemplated by workers' compensation statute, COLO.REV.STAT. § 8-42-101(1)(a), must be reasonably necessary for treatment of injury or to provide therapeutic relief from effects of work injury; because van does nothing to care for or remedy quadriplegia and also provides no therapeutic medical relief from symptoms of injury, van is not a compensable medical apparatus). While these decisions of other jurisdictions construing similar terms in their own workers' compensation statutes are illuminating, we are mindful that this is not a uniform act and the dispute therefore primarily involves a question of Pennsylvania statutory construction. Section 306(f.1)(1) of the Pennsylvania Workers' Compensation Act provides, in pertinent part, as follows: (1)(i) The employer shall provide payment in accordance with this section for reasonable surgical and medical services, services rendered by physicians or other health care providers, including an additional opinion when invasive surgery may be necessary, medicines and supplies, as and when needed. . . . (ii) In addition to the above service, the employer shall provide payment for medicines and supplies, hospital treatment, services and supplies and orthopedic appliances, and prostheses in accordance with this section. . . . 77 P.S. § 531(1)(i)-(ii). The operative disputed term here is orthopedic appliances and our task is to determine whether a modified van qualifies as such an appliance in circumstances like those presented sub judice. The polestar of statutory construction is to determine the intent of the General Assembly. 1 Pa.C.S. § 1921(a); see also Hannaberry HVAC v. Workers' Comp. Appeal Bd. (Snyder), 575 Pa. 66, 834 A.2d 524, 531 (2003). It is settled that, [w]hen the words of a statute are clear and free from all ambiguity, they are presumed to be the best indication of legislative intent. Hannaberry, 834 A.2d at 531. However, if the words of the statute are not explicit on the point at issue: the intention of the General Assembly may be ascertained by considering, among other matters: (1) The occasion and necessity for the statute. (2) The circumstances under which it was enacted. (3) The mischief to be remedied. (4) The object to be attained. (5) The former law, if any, including other statutes upon the same or similar subjects. (6) The consequences of a particular interpretation. (7) The contemporaneous legislative history. (8) Legislative and administrative interpretations of such statute. 1 Pa.C.S. § 1921(c). Many of these statutory construction concerns are subsumed in this Court's recognition that our basic premise in workmen's compensation matters is that the Workmen's Compensation Act is remedial in nature and intended to benefit the worker, and, therefore, the Act must be liberally construed to effectuate its humanitarian objectives. Hannaberry, 834 A.2d at 528 (quoting Peterson v. Workmen's Comp. Appeal Bd. (PRN Nursing Agency), 528 Pa. 279, 597 A.2d 1116, 1120 (1991) (collecting cases)). Accordingly, borderline interpretations of the Act are to be construed in the injured party's favor. Id. (quoting Harper & Collins v. Workmen's Comp. Appeal Bd. (Brown), 543 Pa. 484, 672 A.2d 1319, 1321 (1996)). Finally, we note that, in ascertaining legislative intent, there is a presumption that the General Assembly does not intend a result that is absurd, impossible of execution, or unreasonable. 1 Pa. C.S. § 1922(1). WEBSTER'S NEW WORLD Dictionary 1005 (2d college ed.1986) defines orthopedics as the branch of surgery dealing with the treatment of deformities, diseases, and injuries of the bones, joints, muscles, etc. Appliance, a commonly understood word, is defined in the same source as a device or machine for performing a specific task, esp. one that is worked mechanically or by electricity. Id. at 67, 834 A.2d 524. The term orthopedic appliance obviously is a broad one; indeed, it is one that no doubt was made deliberately general to account for innovations in the treatment, rehabilitation, and support of work injuries. Considering the remedial nature of the Act, and its humanitarian purpose, we conclude that, in proper circumstances, a van modified to make it operable by a person who has suffered a devastating work injury, and who otherwise would not be able to operate a motor vehicle, qualifies as an orthopedic appliance. Depending upon the circumstances of the individual, a van (indeed any vehicle) could be viewed as a necessity, a luxury, or something in between. What matters here is that appellant does not seek the modified van at issue as a lifestyle choice, or for the reasons other people might purchase a van or a sport utility vehicle. For appellant, the need for the modified van is a direct result of his work injury and, in his circumstances at least, it directly addresses the lack of mobility caused by that work injury. Without his wheelchair, appellant would be confined to a bed or a room; without a van equipped to handle his wheelchair, appellant would be confined to the limited area he could travel in that wheelchair. Whatever a van may represent to others fortunate to have unrestricted powers of ambulation, in circumstances such as these, the van indeed is an appliance that addresses and is directly responsive to the permanent orthopedic issue brought on by appellant's work injury. Moreover, there is some force in appellant's argument that a modified van is critical to his ongoing care and health, as he must travel for the follow-up medical care that has become a permanent necessity in his condition. Just as importantly, there is force in appellant's argument that the remedial purposes of the Act are not satisfied by the narrowest approach to what it is that will make an injured person nearer to whole. The wheelchair and the modified van appellant has sought from Employer do not begin to compensate appellant for the quadriplegia that resulted from his work injury. Appellant has lost the ability to stand, to walk, to run, to operate an ordinary vehicle, to ride in a friend's car, to hail a cab. He has lost the free mobility he had, and that others take for granted. To a person in appellant's condition, the van is crucial to restore some small measure of the independence and quality of life that existed before the work injury. Because the present restrictions on appellant's life and mobility were caused by his service to his employer, and a modified van directly addresses and helps to remediate that very harm, we conclude that a wheelchair accessible van qualifies under the broad definition of orthopedic appliances employed in the Act. [5] We find further support for our conclusion in the unreasonable situation that would result if we were to accept the Commonwealth Court majority's absolutist view that a van can never be deemed an orthopedic appliance. The parties agreed that the cost of retrofitting a van to be wheelchair accessible must be borne by the employer as a compensable orthopedic appliance. Therefore, as the dissenting opinion below recognized, a holding that the employer is never responsible for the cost of the van that would be retrofitted would result in two classes of claimants: those claimants who can afford to purchase a van will receive the retrofitting benefits that allow them to become mobile, while those less financially fortunate, who lack the funds to purchase a van, cannot avail themselves of the retrofitting benefit. The suggestion in the majority opinion below that this disparity is a product of [the claimant's] own financial circumstances, and not the injury, ignores that the very nature of the claimant's work injury severely restricts the type of vehicle he can operate. A person such as appellant cannot simply purchase the smallest and most economical vehicle, much less the vehicle of his choice. Instead, as a direct result of his work-caused quadriplegia, appellant is constrained to driving only a large, specially modified van that allows him to enter while seated in his wheelchair and to remain seated in the wheelchair while driving. Put another way, appellant may only avail himself of a vehicle specifically chosen for its capacity to be retrofitted to accommodate his other indispensable prosthetic device  his wheelchair. A claimant such as appellant therefore faces an unavoidable cost which is not a product of his economic circumstances, but of his work injury. We agree with the dissent below that the disparity that the Commonwealth Court majority deemed tolerable requires an unreasonable reading of the Act, one that is at odds with the Act's remedial purpose. Our conclusion that a modified van may qualify as an orthopedic appliance, however, does not end the inquiry. The Act is remedial, but it does not authorize windfalls. As some of our sister states have recognized, the extent of an employer's liability may and should vary depending on the particular circumstances affecting the claimant. Nothing in the Act, for example, requires that an orthopedic appliance  the van here  be brand new. In addition, the claimant's prior lifestyle and resources may be relevant in fixing the appropriate expense owed by the employer to secure an appropriate vehicle. Thus, the circumstances of a claimant who already owned a van prior to his injury will be different from the circumstances of a claimant who owned a smaller vehicle not suitable for wheelchair-accessible modification (but perhaps suitable for trading-in to offset the cost of a van), or a claimant who owned no car at all, but relied upon walking, public transportation or other means of travel. We agree with those courts that, while recognizing that a modified van is a necessary appliance or apparatus for some claimants, concomitantly recognized that the particular circumstances of the claimant must be considered in determining the precise obligation of the employer. Our review of the record before the WCJ reveals that appellant did not have access to a vehicle that was adequate to transport him and his wheelchair. See WCJ Decision at 4 (Other than the rental vans and the van finally purchased, [appellant] had no other vehicles which would enable [appellant] to get to his medical appointments; transportation for this purpose had not been provided by the Carrier.). However, it appears that the parties did not focus on appellant's circumstances prior to his injury  i.e., whether he owned and regularly operated a vehicle, the age and type of the vehicle, its value, etc. In these circumstances, we will remand to the WCJ for a determination of Employer's liability toward the purchase of the van, consistently with the principles set forth in this Opinion.