Court Opinion

ID: 9756377
Source: CourtListenerOpinion
Date Created: 2023-08-28 21:26:07.882955+00
Date Added: 2024-06-11T07:28:20.738123
License: Public Domain

DISSENTING OPINION BY
Judge PELLEGRINI.
I respectfully dissent from the majority’s decision because an employer cannot amend a Notice of Compensation Payable (NCP) solely on the basis of information it receives subsequently that the claimant’s injury was not work-related when it could have obtained that very information prior to issuing the NCP. While I realize we do not have a sympathetic Claimant in this case, for the same reason there are statutes of limitations/repose and notice requirements that preclude valid claims because of the need for finality, once the employer issues an NCP, absent fraud and *431the like, that should make the employer’s acceptance of the injury also final.
In this case, Lawrence Mahon (Claimant), who worked as a window washer, was injured at 9:30 a.m. on July 16, 1999, after a ladder he was standing on fell approximately 18 feet to the ground, causing both his ankles to break. He went to the hospital for treatment at which time he admitted to hospital personnel that he had a history of being an alcoholic and consuming two six-packs per day, and that he had consumed two beers that morning at 8:00 a.m. prior to coming to work. The hospital performed blood tests which indicated Claimant’s ethanol level at 11:32 a.m. equaled 238 milligrams per deciliter or between a .25 and .3 blood alcohol level.
Expert Window Cleaning’s (Employer) insurance carrier, State Workers’ Insurance Fund (SWIF), not having the hospital’s information at the time it was evaluating the claim, issued an NCP on July 26, 1999, acknowledging that Claimant’s injuries were work-related and Claimant began receiving workers’ compensation benefits. Sometime thereafter, SWIF obtained Claimant’s hospital record which contained his admission that he had been drinking on the morning of his accident. SWIF then filed a petition to review compensation benefits on September 7, 1999, seeking to set aside the NCP alleging that Claimant had alcohol in his system at the time of his injury and his intoxication was the actual cause of his injuries.
After a hearing before the workers’ compensation judge (WCJ), the WCJ found SWIF’s witness credible that she was unaware that Claimant was intoxicated at the time of his fall when the NCP was issued and SWIF’s medical expert credible that the amount of alcohol in Claimant’s system as indicated by the blood test taken in the hospital was equivalent to 13 one-ounce shots of whiskey or 13-12 ounce beers causing his impairment. The WCJ did not find Claimant credible that he only had two beers before work. The WCJ then concluded that because Claimant’s intoxication caused his injuries, he was not entitled to benefits and, relying upon Section 413 of the Workers’ Compensation Act,1 amended the NCP because it was materially incorrect. Claimant appealed to the Board which affirmed the WCJ.
On appeal to this Court, the majority also affirms the Board because, among other reasons, it reasons that Section 406.1(d)(1) of the Act, 77 P.S. § 717.1(d)(1), only allows for an employer to initiate compensation payments without prejudice and without admitting liability pursuant to a temporary NCP where it is uncertain if a claim is compensable, and “that language suggests that a notice- of temporary compensation payable is warranted only when an employer is ‘uncertain’ as to the com-pensability of the injury and the extent of liability. An employer, or insurer, faced with facts that, on their face, indicate that an injury is compensable, would not be ‘uncertain’ as to whether the injury is com-pensable. In situations where an injury reasonably appears to be the direct result of a work accident, and no apparent exclusions apply, as in the present case, an employer or insurer acts reasonably in assuming that there is no uncertainty as to cause and effect.” (Majority opinion at 7-8.) I disagree because, even if an employer has no reason to question whether a claimant’s injury is work-related, once an NCP is issued, it is final and may not be amended just because information it obtains subsequently but which existed at the time it issued the original NCP changes its position on the matter.
*432The purpose of issuing an NCP is for the employer to admit liability and acknowledge that the claimant has suffered a work-related injury. If that were not the case, the General Assembly would have not found the need to enact Section 406.1(d)(1) of the Act which allows for a “temporary” NCP and provides that the employer is not accepting liability while paying the claimant. If the majority’s position were correct, all NCPs, whether they be temporary or “permanent,” would be temporary because there would be nothing to distinguish between them. No NCP would ever be final because anytime an employer found that it had a defense that was not discovered at the time it issued an NCP, it could simply file a petition to amend benefits seeking to amend the NCP. Because the fact that Claimant was intoxicated at the time of his injury was in the hospital’s report obtained on the date Claimant was injured, but SWIF did not obtain that report until after it issued the NCP, I disagree with the majority that SWIF is entitled to amend its NCP to reflect that information.
Accordingly, I dissent.
Judge SMITH-RIBNER joins.

. Act of June 2, 1915, P.L. 736, as amended, 77 P.S. § 771.