Court Opinion

ID: 9650554
Source: CourtListenerOpinion
Date Created: 2023-08-23 15:43:26.145849+00
Date Added: 2024-06-11T18:12:23.447838
License: Public Domain

*411BROSKY, Judge,
concurring and dissenting.
I am in general agreement with the dissenting members of the panel that the term “injury”, within the meaning of the Workmen’s Compensation Act, does not include fraudulent actions of an insurer as alleged here.
Thus, were an individual able to demonstrate that an insurer fraudulently deprived him or her out of benefits I would find such an action outside the scope of the Act and subject to redress in tort. However, I hesitate to join completely in dissent simply because the Workmen’s Compensation Appeal Board found that the insurer had a “reasonable contest.” This finding, which was neither appealed nor pursued further, it seems to me, would be preclusive of a fraud action in the present case since it would be res judicata in any subsequent proceedings, including the one contemplated here. I simply cannot see the appellant moving to trial in the face of a conclusive determination that the insurer had a reasonable contest to further workmen’s compensation claims. However, in general, I find the majority’s analysis quite suspect.
It is true that Pennsylvania is an industrialized state and that workmen’s compensation provides a useful purpose with mutual trade-offs by both employer and employee. However, nowhere within the concept of work related injury under the Act can you reasonably fit a fraudulent deprivation of a rightfully acquired benefit under the Act. Nor are the purposes of the Act furthered to any perceivable degree by providing a shield to insurers relating to post accident matters and unconnected to the workplace. Allowing a tort action against an insurer which happens to fraudulently deprive an individual of a benefit should not in any way hinder or impair industrial growth and operation, nor should it work to unfairly impose unlimited liability to a good faith employer for events occurring naturally during the course of operating a business. These are general purposes, on the employer’s side, for passage of the Act.
In contrast, preventing an individual from the subject action will in no way aid the injured employee in assuring *412fair and prompt monetary compensation for injury suffered in the workplace regardless of fault. This is the primary purpose for passage of the Act on the employee’s side and certainly it cannot be beneficial to this interest to limit the legal responsibility of an insurer who engages in fraudulent practices to limit its own expenditures to injured employees. Thus, I can concur only in the result reached by the majority.