Court Opinion

ID: 9964229
Source: CourtListenerOpinion
Date Created: 2024-04-29 14:13:30.192188+00
Date Added: 2024-06-11T08:25:14.609674
License: Public Domain

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

St. Luke’s Physician Group,             :
                                        :
                         Petitioner     :
                                        :
                v.                      : No. 955 C.D. 2022
                                        : Submitted: May 19, 2023
Sheila Kuzo (Workers’ Compensation      :
Appeal Board),                          :
                                        :
                         Respondent     :

BEFORE:     HONORABLE ANNE E. COVEY, Judge
            HONORABLE MICHAEL H. WOJCIK, Judge
            HONORABLE STACY WALLACE, Judge

OPINION NOT REPORTED

MEMORANDUM OPINION
BY JUDGE WOJCIK                                          FILED: April 29, 2024

            St. Luke’s Physician Group (Employer) petitions for review of the
August 16, 2022 order of the Workers’ Compensation (WC) Appeal Board (Board),
that affirmed the decision of the Workers’ Compensation Judge (WCJ) granting the
penalty petition (Penalty Petition) filed by Sheila Kuzo (Claimant). After careful
review, we affirm.
            Claimant was employed as a critical care nurse at Miners Memorial
Hospital (now St. Luke’s Miners Campus). Reproduced Record (R.R.) at 16a, 236a.
Claimant sustained a work-related injury on September 18, 1996, while lifting a
patient into bed in the course and scope of her employment. Id. at 16a. A notice of
compensation payable (NCP) was issued by Employer acknowledging a herniated
disc at C6-7.         Id.   The NCP was amended on June 4, 2003, to include
“swallowing/esophagus problems” as well as a diagnosis of “major depression.” Id.
at 13a. Both parties agreed to these amendments. Id. at 6a. The NCP was amended
again on June 24, 2008, to include a diagnosis of “sleep disorder.” Id. at 18a.
                On February 10, 2021, Claimant filed the Penalty Petition alleging that
Employer violated the Workers’ Compensation Act (Act)1 by failing to make timely
payment of Claimant’s reasonable, necessary, and causally-related medical
expenses. R.R. at 31a. The unpaid expenses in question are prescriptions for four
medications: Lamotrigine, Cymbalta/Duloxetine, Lexapro, and Hydroxyzine. Id. at
277a-78a. The WCJ conducted hearings and heard testimony from Claimant and
Dr. Kenneth Zemanek, who is board certified in psychiatry and neurology, and the
doctor who prescribed the disputed medications. Lisa Llewellyn, the collections
manager for Alliance Medication Services, also testified for Claimant on the billing
for the medications and the amount of unpaid expenses.2
                At a hearing on April 29, 2021, Claimant testified on her own behalf in
support of the Penalty Petition, where she described her work injury and medical
history. R.R. at 58a-78a. In addition to her family doctor and her pain management
doctor, Claimant treated with Dr. Zemanek roughly every 3-6 months for her
psychiatric issues. Id. Claimant testified that Dr. Zemanek managed her medication
and talked to her about how she feels and any issues she has. Id. On cross-
examination, Claimant stated that she had no prior mental health treatment before

       1
           Act of June 2, 1915, P.L. 736, as amended, 77 P.S. §§1-1041.4; 2501-2710.

       2
         Llewelyn verified billing documentation and testified that the outstanding payments for
the medications prescribed by Dr. Zemanek totaled $39,904.03. R.R. at 284a. Neither the
authenticity of the documents nor her testimony is disputed by Employer on appeal.
                                                2
her work injury. Id. Claimant also answered questions regarding other health issues
and potential sources of stress from her childhood and relationships with family
members. Id. She testified that her parents had an abusive relationship and alcohol
dependency, she had to care for her siblings at age 11 or 12, she had a younger sister
who was in a serious car accident and later died of melanoma, and her son and
daughter-in-law struggled with substance abuse issues. Id. She also testified to other
health issues beyond her work injury, including neuropathy in her hands and feet,
blood clotting, and lower back pain that required surgery. Id.
             The WCJ found Claimant’s testimony regarding her current symptoms,
side effects from medication (specifically from Lexapro), and treatment with Dr.
Zemanek to be generally credible. R.R. at 283a. The WCJ found Claimant’s
testimony to be largely uncontradicted and found her answers to questions about
other health issues and potential stressors in addition to her work injury were
“generally consistent with Dr. Zemanek’s understanding of those other stressors.”
Id.
             At a deposition on May 20, 2021, Dr. Zemanek testified as to his
treatment of Claimant’s work injury. R.R. at 81a-130a. Dr. Zemanek testified that
he began consistently treating Claimant starting May 16, 2018.           Id. at 276a.
Claimant was first seen for anxiety and depression and suffered several days of
impulsiveness and racing thoughts. Id. Claimant was already taking Cymbalta and
Lexapro, as well as Lyrica, before May 2018. Id. As noted by the WCJ,

             Dr. Zemanek diagnosed Bipolar II, major depressive type
             with seasonal affective component due to chronic pain,
             difficulty functioning and depression due to the work
             injury of September 18, 1996. Dr. Zemanek noted all the
             steroids she was prescribed in the past could have caused
             her mood to shift as well and should be considered. Dr.
             Zemanek was asked about the injury description of major
                                          3
            depression and his diagnosis of Bipolar II major
            depressive type and how the two work together. Dr.
            Zemanek replied, “well, major depressive disorder is one
            aspect of the mood syndrome and hypomanic is above the
            normal mood, but not severely above a normal mood to be
            a mania, but higher than a general good mood.” Dr.
            Zemanek was asked about the four medications he
            prescribed. The Lamotrigine is an anti-seizure medication
            but good for stabilizing mood in a depressive state and was
            prescribed for her depressive state.                     The
            Cymbalta/Duloxetine is related to [t]his diagnosis and is a
            good anti-depressant and useful for nerve pain. The
            Lexapro is also an anti-depressant used to help for the
            same reasons as Cymbalta. Finally, the Hydroxyzine is
            related to the work injury and used to deal with the anxiety.
            Dr. Zemanek was asked if a difference exists between
            major depression and major depressive disorder. Dr.
            Zemanek stated that major depression is feelings of
            depression and major depressive disorder is a couple of
            week period of depression with loss of interest, loss of
            sleep, guilty feelings, change in appetite, no energy,
            agitation, helplessness, and hopelessness.
R.R. at 277a-78a (emphasis added).
            On cross-examination, Dr. Zemanek answered questions about his
understanding of Claimant’s background and other potential sources of stress
beyond the work injury. R.R. at 278a. He agreed with Employer’s counsel that
individuals with adverse childhood experiences may be prone to certain ailments,
including depression. Id. He further testified that although he was aware Claimant’s
parents were alcoholics and there was emotional abuse present, he was not sure if
her parents were also physically abusive. Id. Dr. Zemanek was unaware that
Claimant took care of her siblings when she was a child, but he was aware of other
family matters related to Claimant’s siblings and husband. Id. Dr. Zemanek testified
that he was also aware of Claimant’s health issues beyond her work injury, including
pulmonary emboli, rhizotomy, bone fusion, carpal tunnel syndrome, gastric bypass,

                                         4
methicillin-resistant staphylococcus aureus (MRSA), menstrual difficulties, urinary
tract infection, degenerative joint disease, and headaches. Id.
             Dr. Zemanek’s letters of medical necessity for the four prescriptions
were attached to his deposition. R.R. at 278a. The letters for the Lamotrigine and
Cymbalta/Duloxetine were both accompanied by fax cover sheets with the word
“yes” circled to indicate that Dr. Zemanek was treating Claimant for a work injury
and billing Employer’s WC carrier. Id. The letter of medical necessity for Lexapro
was also marked as being for Claimant’s work injury but did not have a cover sheet
attached. Id. The final letter of medical necessity for Hydroxyzine noted that the
medication was prescribed for depression in conjunction with the work injury, but
the cover sheet had the word “no” circled, indicating that the prescription was not
for a work injury and that Employer’s WC carrier should not be billed. Id. at 278-
79a.
             The WCJ found Dr. Zemanek’s testimony credible, as follows.

             After careful review of all evidence and weighing same,
             the testimony of Dr. Zemanek is found to be competent
             and credible on the issues raised by this [P]enalty
             [P]etition. Dr. Zemanek has been treating Claimant for her
             mental health issues including major depression as part
             of his diagnosis of Bipolar II major depressive type since
             2018. Dr. Zemanek credibly testified that the major
             depression is an aspect of her mood syndrome. Dr.
             Zemanek has diagnosed major depressive disorder and
             has treated Claimant with medication. Dr. Zemanek’s
             testimony that the four medications at issue; Lamotrigine,
             Cymbalta/[D]uloxetine, Lexapro, and Hydroxyzine are all
             related to Claimant’s work injury is found to be credible.
             No medical evidence was submitted to contradict the
             opinions of Dr. Zemanek. Dr. Zemanek completed letters
             of medical necessity on all four medications spanning
             2018 to 2019 relating the medications to the work injury.
             Dr. Zemanek clearly relates these medications to the work

                                          5
             injury of September 18, 1996, that was expanded by
             agreement in 2003 to include “major depression[.”] The
             fax cover sheet dated March 11, 2019, for the prescription
             Hydroxyzine has the word “no” circled for the questions
             are you treating the patient for a work injury and are you
             billing [W]orkers[’] [C]ompensation. The letter of
             medical necessity bearing the same date contradicts this
             information, as does the testimony of Dr. Zemanek. The
             March 11, 2019[] fax cover sheet is not enough to shake
             the credibility of Dr. Zemanek or his opinions given
             during testimony based upon the totality of the evidence.
R.R. at 283a-84a (emphases added).
             Based on the evidence presented at the hearings, the WCJ concluded
that Claimant sustained her burden of proving that Employer violated the Act by
failing to pay for the medications prescribed by Dr. Zemanek in connection with her
work injury, totaling $39,904.03. R.R. at 284a. The WCJ further noted that “[a]n
employer that stops payment of medical treatment based solely on causation is
subject to penalties at the discretion of a workers[’] compensation [j]udge if the
[j]udge finds the bills to be related to the work injury,” citing in support Delarosa v.
Workers’ Compensation Appeal Board (Masonic Homes), 934 A.2d 165, 169-70
(Pa. Cmwlth. 2007). R.R. at 284a. The WCJ assessed a 20% penalty against
Employer for violating the Act by failing to pay for the medications. Id.
             Employer appealed to the Board, arguing that Dr. Zemanek’s testimony
regarding medical issues was legally incompetent, the WCJ capriciously disregarded
uncontroverted evidence of record, and the WCJ improperly expanded the nature of
Claimant’s adjudicated work injury and Employer’s liability. R.R. 287a-92a. The
Board affirmed the WCJ’s decision and concluded as follows.

             Under Section 306(f.1)(5) of the Act, [77 P.S. §531(5),]
             medical bills must be paid within 30 days of receipt unless
             the employer disputed the causal connection or the
             reasonableness and necessity of the treatment. [Employer]

                                           6
contends that the prescriptions were not causally related to
the work injury and that the WCJ misapprehended the
nature of its defense; specifically, that Claimant’s
evidence failed to meet her burden. We do not agree that
the WCJ’s observation that there were no defense
witnesses indicates any such grave misapprehension.

       [Employer] further argues that Dr. Zemanek’s
testimony was worthless, as he disregarded the
adjudicated work injury and did not establish the required
causal connection between the injury and his treatment.
Claimant’s work-related diagnoses include major
depression and a sleep disorder. The WCJ concluded that
Dr. Zemanek’s diagnosis of [B]ipolar II, major depressive
type[,] encompassed the adjudicated major depression,
and that the medications at issue were prescribed to treat
Claimant’s work-related major depression and sleep
disorder.

        [Employer] contends that Dr. Zemanek was, in fact,
treating a plethora of non-work-related conditions and
admitted that he did not attempt to determine the cause of
Claimant’s emotional condition. In context, Dr. Zemanek
testified that he did not delve deeply into Claimant’s
childhood and family issues; rather, he treated her then-
existing condition. Dr. Zemanek related the depression to
chronic pain, difficulty with functioning, loss of work, and
the stress of chronic pain resulting from the work injury[]
and noted the possibility of mood shifts due to the use of
steroids in the past. His testimony explaining major
depression and major depressive disorder is reminiscent of
testimony concerning disc herniations and disc
protrusions, where different clinicians read imaging
studies accurately but use slightly different descriptions.
Medical testimony is not evaluated on the basis of a few
words taken out of context. Lewis [v. Workmen’s
Compensation Appeal Board (Pittsburgh Board of
Education), 498 A.2d 800 (Pa. 1985)]. We determine no
error.

                             7
R.R. at 306a-07a. Employer then appealed the Board’s order to this Court.3
              Employer presents three issues for our review. First, Employer argues
that the WCJ erred by capriciously disregarding uncontroverted evidence of record
that established Dr. Zemanek treated conditions unrelated to Claimant’s work injury,
and, as such, Employer had no legal obligation to pay for expenses beyond the
adjudicated work injury. Second, Employer asserts that the WCJ erred by finding
that Dr. Zemanek’s testimony regarding medical issues was legally competent.
Lastly, Employer argues that the WCJ’s decision expanded the adjudicated work
injury in violation of res judicata and collateral estoppel principles.
              Employer first argues that the WCJ capriciously disregarded case law
and uncontroverted evidence establishing that the prescriptions issued by Dr.
Zemanek were not related to the adjudicated work injury. Employer asserts that the
WCJ discounted evidence that Dr. Zemanek had been treating physical and
emotional conditions with no causal connection to Claimant’s work injury.
Employer argues that certain statements made by Dr. Zemanek undermine his
testimony that the medications he prescribed were to treat Claimant’s work-related
depression. Employer points to the following exchange during cross-examination:

              Q: And part of your job I would think as a therapist is to
              assist the patient on occasion in trying to figure out what’s
              really bothering them. Would that be fair to say?

       3
          Our review in a workers’ compensation appeal is limited to determining whether an error
of law was committed, whether constitutional rights were violated, or whether necessary findings
of fact are supported by substantial evidence. Bloom v. Workmen’s Compensation Appeal Board
(Keystone Pretzel Bakery), 677 A.2d 1314, 1318 n.4 (Pa. Cmwlth. 1996). Substantial evidence
means such relevant evidence as a reasonable mind might accept as adequate to support a
conclusion. Bethenergy Mines, Inc. v. Workmen’s Compensation Appeal Board (Skirpan), 612
A.2d 434, 436 (Pa. 1992). Whether an expert’s opinion is incompetent is a question of law subject
to this Court’s plenary review. Casne v. Workers’ Compensation Appeal Board (Stat Couriers,
Inc.), 962 A.2d 14,16 (Pa. Cmwlth. 2008).
                                               8
               A: Yes, but my role I was the psychopharmocologist
               treating her just for medication management.

               Q: Okay. So[,] your role really wasn’t to try to get to the
               root of what might have been bothering her. Do I
               understand you correctly?

               A: Correct.
Petitioner’s Brief at 28; R.R. at 118a-19a. Employer argues that the WCJ erred by
not construing this exchange as an admission by Dr. Zemanek that he had no factual
basis to offer an opinion on causation. Petitioner’s Brief at 28. Claimant responds
that the WCJ’s decision was supported by substantial evidence and that the WCJ did
not capriciously disregard Dr. Zemanek’s testimony. Claimant further responds that
Employer failed to present a medical expert to challenge Dr. Zemanek’s opinions or
file a utilization review request to challenge the reasonableness or necessity of the
medications.
               When properly raised, as it was here, this Court may review for
“capricious disregard of material, competent evidence.” Leon E. Wintermyer, Inc.
v. Workers’ Compensation Appeal Board (Marlowe), 812 A.2d 478, 487 (Pa. 2002).
Capricious disregard occurs “only when the fact-finder deliberately ignores relevant,
competent evidence.” Williams v. Workers’ Compensation Appeal Board (USX
Corp.-Fairless Works), 862 A.2d 137, 144 (Pa. Cmwlth. 2004). Further, we are
mindful that in WC cases, “the WCJ is the ultimate fact-finder who must determine
credibility and evidentiary weight. In this role, the WCJ freely evaluates the
evidence offered and can accept or reject any witness’[s] testimony, in whole or in
part, including that of medical witnesses.” Davis v. Workers’ Compensation Appeal
Board (City of Philadelphia), 753 A.2d 905, 909 (Pa. Cmwlth. 2000). As this Court
further stated, “[w]hile this Court can and should consider the competency and
sufficiency of evidence presented before a WCJ, the WCJ’s assessment of witness
                                           9
credibility is not subject to our review on appeal.” Id. Finally, we must review the
evidence in the light most favorable to the prevailing party and give it the benefit of
all inferences reasonably deduced from the evidence. West Penn Allegheny Health
System, Inc. v. Workers’ Compensation Appeal Board (Cochenour), 251 A.3d 467,
475 (Pa. Cmwlth. 2021).
                In Williams, 862 A.2d 137, our Court considered whether the Board
erred in granting the employer’s petition to modify the claimant’s WC benefits
because the claimant failed to pursue an available position within his medical
restrictions.    The claimant argued that the WCJ capriciously disregarded the
testimony of the claimant’s medical experts, who opined that the claimant was
unable to perform the duties required by the available position. Id. at 140-41. The
Court emphasized that

                as fact[-]finder, the WCJ is not required to accept even
                uncontradicted testimony.         Capasso v. Workers’
                Compensation Appeal Board (RACS Associates, Inc.), 851
                A.2d 997 (Pa. Cmwlth. 2004). Capricious disregard
                occurs only when the fact-finder deliberately ignores
                relevant, competent evidence. Id. A capricious disregard
                of the evidence in a workers’ compensation case is a
                deliberate and baseless disregard of apparently
                trustworthy evidence.         Christopher v. Workers’
                Compensation Appeal Board (Consolidation Coal Co.),
                793 A.2d 991 (Pa. Cmwlth. 2002). We emphasize our
                Supreme Court’s pronouncement that, where there is
                substantial evidence to support an agency’s factual
                findings, and those findings in turn support conclusions, it
                should remain a rare instance in which an appellate court
                would disturb an adjudication based upon the capricious
                disregard of material, competent evidence. Wintermyer[,]
                [812 A.2d at 490].

                                            10
Williams, 862 A.2d at 144. The Court then analyzed and rejected the claimant’s
argument regarding the WCJ’s capricious disregard of the testimony of the
claimant’s medical expert.

               Counsel for [the c]laimant seems to misapprehend the
               crucial distinction between a rejection of a witness’s
               testimony, and the capricious disregard thereof. In this
               matter, the WCJ clearly and detailedly summarized the
               testimony of [the claimant’s medical expert], as evidenced
               primarily in the WCJ’s Finding []. Although the WCJ
               ultimately found that testimony to not be credible, such a
               credibility determination is the exclusive province of the
               WCJ, and such a rejection of testimony is not a disregard
               therefor, but simply a rejection. A capricious disregard of
               evidence occurs only when the fact-finder deliberately
               ignores relevant, competent evidence. Capasso.
Williams, 862 A.2d at 145. See also Grooms v. City of Philadelphia (Workers’
Compensation Appeal Board) (Pa. Cmwlth., No. 42 C.D. 2022, filed January 23,
2023), appeal denied, 302 A.3d 1193 (Pa. 2023).4
               Here, the WCJ carefully reviewed the testimony of both Claimant and
Dr. Zemanek. The WCJ determined that Claimant’s testimony was generally
credible regarding her current treatment, side effects, and treatment with Dr.
Zemanek. R.R. at 283. The WCJ carefully reviewed and weighed the testimony and
evidence presented by Dr. Zemanek and determined that his testimony was
“competent and credible on the issues raised by the [P]enalty [P]etition.” Id. As
noted above, the WCJ found that Dr. Zemanek treated Claimant’s depression as
connected to her work injury, and the medications he prescribed were causally
related to her work injury. R.R. at 283a-84a. The WCJ credited Dr. Zemanek’s

       4
           See Pa. R.A.P. 126(b)(1)-(2) (“As used in this rule, ‘non-precedential decision’ refers to
. . . an unreported memorandum opinion of the Commonwealth Court filed after January 15, 2008.
[] Non-precedential decisions . . . may be cited for their persuasive value.”).
                                                11
testimony and evidence presented that all four medications prescribed related to the
work injury of September 18, 1996, that was expanded by agreement in 2003 to
include “major depression.” Id. at 284a. The Board agreed and found that Dr.
Zemanek “related the depression to chronic pain, difficulty with functioning, loss of
work, and the stress of chronic pain resulting from the work injury[] and noted the
possibility of mood shifts due to the use of steroids in the past.” R.R. at 306a-07a.
Therefore, Employer’s argument that the WCJ capriciously disregarded Dr.
Zemanek’s testimony must fail. The WCJ did not “deliberately ignore[] relevant,
competent evidence” when she reviewed the entirety of Dr. Zemanek’s testimony
and determined that it was credible and competent as to the issues raised by the
Penalty Petition. Williams, 862 A.2d at 145. We are bound by the WCJ’s credibility
determinations. Davis, 753 A.2d at 909.
             Employer next argues that Dr. Zemanek’s testimony is legally
incompetent because he disregarded or otherwise challenged the adjudicated work
injury. Petitioner’s Brief at 29. Employer specifically notes the following exchange
and argues that it should render Dr. Zemanek’s testimony as incompetent.

             Q. Now, Doctor [Zemanek], Attorney Greenberg[,
             Employer’s attorney,] mentioned the accepted injury as
             being major depression and these letter[s] of medical
             necessity major depressive disorder. Can you explain the
             difference if there is a difference?

             A. Between major depressive disorder and [B]ipolar II
             major depressive type?

             Q. Actually[,] major depression.

             A. And.

             Q. Major depressive disorder.

                                         12
             A. Major depression is sort of when people complain of
             being depressed but major depressive disorder is you have
             couple week period of depression or anhedonia with poor
             sleep, loss of concentrating, change in appetite, second
             motor agitation or retardation, helplessness, hopelessness,
             suicidal thoughts.

             Q. And with regard to just major depression?

             A. Major depression, again, if it’s not a disorder, people
             can say that they’re feeling depressed.
Petitioner’s Brief at 30; R.R. at 112a-13a. Employer argues that when an expert
medical witness disregards or otherwise challenges the adjudicated work injury,
his/her effort to reconfigure the nature and extent of the work injury will be viewed
as “worthless [,]” citing in support GA & FC Wagman, Inc. v. Workers’
Compensation Appeal Board (Aucker), 785 A.2d 1087 (Pa. Cmwlth. 2001).
Employer argues that Dr. Zemanek’s testimony provided above shows that he
disregarded or challenged the accepted work injury of “major depression” by
opining that Claimant suffered from “major depressive disorder.”           Claimant
responds that a medical expert’s opinion is not rendered incompetent unless it is
solely based on inaccurate or false information and must be viewed as a whole, citing
in support Casne, 962 A.2d 14. Claimant further responds that the WCJ here did not
err in crediting Dr. Zemanek’s testimony, when it reviewed the entire testimony and
declined to interpret Dr. Zemanek’s quoted statement as an attempt to challenge the
accepted work injury.
             We discern no error when the Board affirmed the WCJ regarding the
competency of Dr. Zemanek’s testimony. The Board explained that

             [w]hether medical opinion evidence is competent or
             equivocal is a question of law based upon a review of the
             opinion testimony as a whole. Lewis [], 498 A.2d 800 [].
             In conducting such a review, a final decision should not

                                         13
            rest upon a few words taken out of context. Id. An
            expert’s opinion which is based on assumptions contrary
            to the established facts is worthless in a workers’
            compensation proceeding. Noverati v. W[orkmen’s]
            C[ompensation] A[ppeal] B[oard] (Newtown Squire Inn),
            686 A.2d 455 (Pa. Cmwlth. 1996).
R.R. at 301a.   The Board rejected Employer’s argument that Dr. Zemanek’s
testimony was incompetent based on his explanation about the difference between
“major depression” and “major depressive disorder.” The Board concluded that

            [Dr. Zemanek’s] testimony explaining major depression
            and major depressive disorder is reminiscent of testimony
            concerning disc herniations and disc protrusions, where
            different clinicians read imaging studies but use slightly
            difference descriptions.      Medical testimony is not
            evaluated on the basis of a few words taken out of context.
            Lewis. We determine no error.
R.R. at 307a.
            Employer’s argument that Dr. Zemanek disregarded or challenged the
adjudicated work injury is contradicted by the WCJ’s finding based on the credited
testimony of Dr. Zemanek that the medications prescribed by Dr. Zemanek are
related to Claimant’s major depression as included in the adjudicated work injury.
R.R. at 284. The Board rejected Employer’s argument, noting that “Claimant’s
work-related diagnoses include major depression and a sleep disorder. The WCJ
concluded that Dr. Zemanek’s diagnosis of Bipolar II, major depressive type
encompassed the adjudicated major depression, and that the medications at issue
were prescribed to treat Claimant’s work-related major depression and sleep
disorder.” R.R. at 306a. We may not disturb the WCJ’s credibility determinations.
Davis, 753 A.2d at 909. Further, we decline to do as Employer suggests and take
Dr. Zemanek’s above-quoted testimony out of context and render his testimony

                                        14
incompetent. Instead, we must view the testimony as a whole. Lewis, 498 A.2d at
803. Accordingly, we discern no error in the Board’s conclusion on this issue.
             Lastly, Employer argues that the WCJ erred in accepting Dr.
Zemanek’s testimony and granting Claimant’s Penalty Petition when Dr. Zemanek
impermissibly expanded the description of Claimant’s accepted work injury.
Employer argues that this expansion of the scope of injury violates the principles of
res judicata or collateral estoppel. Employer argues that Dr. Zemanek treated
Claimant for injuries outside the adjudicated injury, and Employer should not be
responsible for costs of medication used to treat injuries outside the accepted work
injury. Claimant again responds that Employer voluntarily agreed to modify the
work injury to include major depression, and the WCJ’s findings were supported by
substantial evidence.

             The doctrine of res judicata encompasses two related, yet
             distinct, principles: technical res judicata and collateral
             estoppel.      PMA Insurance Group v. Workmen’s
             Compensation Appeal Board (Kelley), 665 A.2d 538 (Pa.
             Cmwlth. 1995). Technical res judicata [] provides that
             when a final judgment on the merits exists, a future suit
             between the parties on the same cause of action is
             precluded. Id. Collateral estoppel, on the other hand, acts
             to foreclose litigation in a later action of issues of law or
             fact that were actually litigated and necessary to a previous
             final judgment. Id.

             Technical res judicata applies when the following four
             factors are present: (1) identity in the thing sued upon or
             for; (2) identity of the cause of action; (3) identity of the
             persons and parties to the action; and (4) identity of the
             quality or capacity of the parties suing or sued. Patel v.
             Workmen’s Compensation Appeal Board (Sauquoit Fibers
             Co.), [] 488 A.2d 1177 ([Pa. Cmwlth.] 1985).

                                          15
Maranc v. Workers’ Compensation Appeal Board (Beinenfeld), 751 A.2d 1196,
1199 (Pa. Cmwlth. 2000).
             We are unpersuaded by Employer’s argument on this issue. Employer
relies on our decision in Weney v. Workers’ Compensation Appeal Board (Mac
Sprinkler Systems, Inc.), 960 A.2d 949 (Pa. Cmwlth. 2008), where this Court found
that a claimant’s second review petition was barred under technical res judicata and
collateral estoppel. The claimant in Weney sought to have an NCP amended to
include “additional injuries of which he was aware[,] and knew to be related to a
particular work incident, during earlier review petition proceedings.” Id. at 957.
Because the claimant attempted to raise a matter through his second review petition
that should have been litigated during the earlier proceedings on his first review
petition, the claimant’s second review petition was barred by technical res judicata.
Id. at 956. However, the holding in Weney is not analogous to this matter.
             Here, Claimant was not petitioning for an expansion of the work injury,
nor did the holdings by the WCJ and Board describe any new medical conditions to
be included in the NCP. As Employer stated in its brief, the adjudicated work injury
was amended without dispute in prior litigation to include “major depression” and a
“sleep disorder” in connection with the work injury. Petitioner’s Brief at 23.
Because of our determination that the Board did not err in concluding that Dr.
Zemanek’s testimony was competent and credible as to Claimant’s diagnosis of
major depression and the medications he prescribed to treat Claimant’s depression,
we must also reject Employer’s argument that Dr. Zemanek’s testimony should be
barred by res judicata or collateral estoppel. Because Dr. Zemanek did not seek to
expand Claimant’s accepted work injury, the findings and conclusions based on his

                                         16
testimony do not constitute an attempt to relitigate the scope of Claimant’s work
injury. Maranc, 751 A.2d at 1199.
             An employer that fails to pay for medical treatment based solely on
causation is subject to penalties at the discretion of the WCJ, if the WCJ finds the
bills to be causally related to the work injury. Delarosa, 934 A.2d at 169-70. Here,
Employer did not file a review petition to dispute causality or seek a utilization
review determination regarding the four medications prescribed to treat Claimant’s
accepted work injury of depression, but instead took the risk that it would be subject
to the Penalty Petition Claimant filed here. Therefore, we discern no error in the
WCJ’s decision to grant the Penalty Petition and assess the penalty against
Employer.
             Accordingly, the Board’s order is affirmed.

                                       MICHAEL H. WOJCIK, Judge

                                         17
         IN THE COMMONWEALTH COURT OF PENNSYLVANIA

St. Luke's Physician Group,            :
                                       :
                        Petitioner     :
                                       :
                v.                     : No. 955 C.D. 2022
                                       :
Sheila Kuzo (Workers’ Compensation     :
Appeal Board),                         :
                                       :
                        Respondent     :

                                     ORDER

            AND NOW, this 29th day of April, 2024, the Order of the Workers’
Compensation Appeal Board dated August 16, 2022, is AFFIRMED.

                                      MICHAEL H. WOJCIK, Judge