Court Opinion

ID: 9719693
Source: CourtListenerOpinion
Date Created: 2023-08-26 07:59:53.655509+00
Date Added: 2024-06-11T18:24:09.028999
License: Public Domain

Justice NEWMAN,
Dissenting.
The Majority concludes that neither Barbara Gardner (Gardner) nor Leroy Rider (Rider) must submit themselves for an impairment rating evaluation (IRE) based on an interpretation of Section 306(a.2)(l) of the Workers’ Compensation Act (Act),1 77 P.S. § 511.2(1), although the Majority would find *384that Gardner and Rider could be required to submit to an IRE pursuant to Section 306(a.2)(6). Because I believe that the Majority has reached an erroneous result in both matters before us, I must respectfully dissent.
The Act recognizes that the disability of an employee may change over time and accordingly permits modification, reinstatement, suspension, or termination of benefits based upon the degree of change in the employee’s disability. In 1987, this Court issued its landmark decision in Kachinski v. Workmen’s Compensation Appeal Board (Vepco Construction Co.), 516 Pa.240, 532 A.2d 374 (1987), which outlined the steps necessary for a downward modification of benefits when the employee was found capable of gainful employment. In order to achieve that reduction in benefits, we stated that the employer must acquire a favorable opinion from a physician that the employee’s medical condition has changed and that the employee is capable of returning to some degree of employment. Once the favorable opinion was obtained from the physician, the employer then had the burden of producing evidence of a referral to at least one open job in an occupation that the employee was medically cleared to perform. This became the standard and “[t]he resulting return-to-work scenarios devolved into fact-based challenges as to whether a claimant had received medical clearance; whether a claimant had, in good faith, followed up on the employer’s referrals; and whether the employer met the technical requirements of a proper referral, such as age, education, training, experience, distance, medical restrictions, etc.” Caso v. Workers’ Comp. Appeal Bd. (Sch. Dist. of Philadelphia), 576 Pa.287, 839 A.2d 219, 223 (2003) (Newman, J. concurring).
Subsequently, in 1996, the General Assembly enacted Act 57,2 which made sweeping changes to the Act. Through Act 57, the General Assembly sought to reduce the cost of workers’ compensation benefits within the Commonwealth, while maintaining benefits for those workers that were truly injured. If evidence establishes that the worker has regained some or all of his or her pre-injury earning capacity, benefits can be *385modified to reflect a decrease in physical disability. Thus, one of the new procedures chosen by the General Assembly, and one that has been successful among our sister states, is the IRE.
The General Assembly also chose to establish a strict and artificial limitation on the employee’s receipt of total disability benefits. Substantively, and as established by the Act, an injured worker may not receive in excess of one hundred four weeks of total disability payments unless an impairment rating is established that exceeds fifty percent. 77 P.S. § 511.2(7).3 Section 306(a.2)(l) mandates that, if an IRE has not been performed by agreement between the parties by the time that a claimant reaches one hundred four weeks of total disability benefits, then the insurer must request an IRE within sixty days of the one hundred four-week anniversary.4 The statute says that the insurer “shall” make that request and I agree with the Majority that this requires mandatory action on the part of the insurer unless there is an agreement to the contrary.
However, I cannot agree with the Commonwealth Court, as affirmed by the Majority, that failure to obtain an IRE within the statutorily prescribed sixty-day window precludes all future IREs that would result in an automatic reduction in *386benefits. There is simply no logical basis for a presumption that each and every work injury occurring in this Commonwealth will evolve over the course of one hundred four weeks to a level of recovery amenable to an impairment assessment. Neither is there any legislative indication that such a uniform approach was contemplated by Act 57.
The General Assembly chose not to provide a penalty for failure to secure the IRE by the one hundred four-week anniversary. Moreover, because the parties may agree to an IRE prior to the expiration of one hundred four weeks, and the employee is precluded from receiving total disability benefits that extend beyond one hundred four weeks (unless an impairment rating is established that exceeds fifty percent), I believe that the General Assembly permitted an agreement by the parties to extend benefits. In my opinion, this agreement must take place prior to the one hundred four-week anniversary, either explicitly or implicitly. I conclude that this is the situation in the cases sub judice.
The employers here did not cease paying benefits after one hundred four weeks, although Section 306(a.2)(7) permits an employer to do so. Ergo, the parties have implicitly agreed that each claimant’s impairment rating would exceed 50% at the one hundred four-week anniversary.5 This enables total *387disability benefits to extend beyond the one hundred four-week anniversary and its sixty-day window until such time as an IRE is meaningful. It is also noteworthy that the General Assembly did not provide a mechanism by which a claimant can seek to secure an IRE when the employer has failed to act. This is significant because the claimant’s total disability benefits must end after one hundred four weeks if neither an IRE nor an agreement is in place. 77 P.S. § 511.2(7). I am convinced that no such mechanism was provided because the parties, absent an explicit agreement, are deemed to have agreed that a claimant has an impairment rating in excess of 50%.
I find that the Act 57 amendments establish a new total disability scheme. Pursuant to that scheme, no claimant can receive more than one hundred four weeks of total disability benefits unless his or her degree of impairment exceeds 50%. 77 P.S. § 511.2(7). The claimant and the employer can agree on the timing of the IRE. A claimant may submit to an IRE voluntarily before the expiration of one hundred four weeks, but must submit to an IRE request made within sixty days of the one hundred four-week expiration. Where an employer fails to seek an IRE within the allotted timeframe, the employer has implicitly agreed that claimant’s degree of impairment exceeds 50% and the claimant can continue to receive total disability benefits. Once an IRE is performed, additional IREs can be requested to establish the status of the impairment, but no more than two IREs can be sought in any twelve-month period. 77 P.S. § 511.2(6).
*388I cannot agree to a hypertechnical approach to the construction and application of Section 306(a.2), particularly in light of the provision of the General Assembly that permits the parties to deviate from those statutory requirements by agreement. I would find that Genesis Health Ventures implicitly agreed that Gardner was more than 50% impaired when she reached the one hundred four-week anniversary. Thus, Gardner’s total disability benefits could continue beyond October 2, 1998, until Genesis sought an IRE. This Genesis did on June 13, 2001. Accordingly, I would find that Gardner must submit to an IRE pursuant to Section 306(a.2)(l) to establish the status of her impairment.
In applying this same approach to the facts in Wal-Mart Stores, I agree with the Majority that Wal-Mart was responsible for the payment of benefits during litigation. Even though liability remained in dispute until the Board affirmed the award of benefits by the WCJ, no supersedeas was in place and Wal-Mart paid benefits through and beyond the one hundred four-week anniversary. Again, I would find that, because Wal-Mart did not request an IRE within sixty days of the expiration of the one hundred four-week period, it implicitly agreed that Rider’s impairment exceeded 50%. Hence, I would also find that Rider must submit to an IRE.
Based on the foregoing, I would reverse the Order of the Commonwealth Court in Gardner v. Workers’ Compensation Appeal Board (Genesis Health Ventures), 814 A.2d 884 (Pa.Cmwlth.2003), and affirm the decision of the Commonwealth Court in Wal-Mart Stores, Inc. v. Workers’ Compensation Appeal Board (Rider), 837 A.2d 661 (Pa.Cmwlth.2003), albeit on different grounds.

. Act of June 2, 1915, P.L. 736, as amended, 77 P.S. § 511.2(1).

. Act of June 24, 1996, P.L. 350.

. That section states:
In no event shall the total number of weeks of partial disability exceed five hundred weeks for any injury or recurrence thereof, regardless of the changes in status in disability that may occur. In no event shall the total number of weeks of total disability exceed one hundred four weeks for any employe who does not meet a threshold impairment rating that is equal to or greater than fifty per centum impairment under the most recent edition of the American Medical Association "Guides to the Evaluation of Permanent Impairment” for any injury or recurrence thereof.
77 P.S. § 511.2(7).

. That section states in pertinent part:
When an employe has received total disability compensation ... for a period of one hundred four weeks (2 years), unless otherwise agreed to, the employe shall be required to submit to a medical examination which shall be requested by the insurer within sixty days upon the expiration of the one hundred four weeks to determine the degree of impairment due to the compensable injury, if any.
77 P.S. § 511.2(1).

. The Majority believes that I neglected to reconcile subsection five and subsection seven. I fail to see the problem as both sections are clear and there is no conflict. Section 306(a.2)(5) is simply limited by the defined benefit period contained in Section 306(a.2)(7). I further believe that this limitation is an important aspect of the entire impairment rating evaluation scheme. With all due respect, the Majority fails to reconcile all subparts of Section 306(a.2). Nowhere in its analysis, does the Majority even discuss the effect of subsection seven on its interpretation of Section 306(a.2) and subsection seven is read completely out of the statute.
The Majority critically comments that I did not explain “how an agreement to extend benefits under [my] view of Subsection 7 translates into an agreement to extend the deadlines set forth in Subsection 1.” (Op. at 380 n. 9.) The simple answer to that is that Subsection 1 explicitly provides for an agreement between the parties. The text of Subsection 1 states in pertinent part:
When an employe has received total disability compensation ... for a period of one hundred four weeks (2 years), unless otherwise agreed to, the employe shall be required to submit to a medical examination *387which shall be requested by the insurer within sixty days upon the expiration of the one hundred four weeks to determine the degree of impairment due to the compensable injury, if any.
77 P.S. § 511.2(1). The “unless otherwise agreed to” language, where the only limitation on the timing of any agreement is that it must occur before the expiration of one hundred four weeks, means that the parties can agree to have the IRE performed prior to or after the expiration of the one hundred four-week period and the employer still receives the benefit of the automatic modification provision. Claimants also benefit by an agreement in that they may continue to receive total disability benefits after the expiration of one hundred four weeks. 77 P.S. § 511.2(7).