Court Opinion

ID: 9881014
Source: CourtListenerOpinion
Date Created: 2023-09-29 14:08:26.203487+00
Date Added: 2024-06-11T13:58:52.220775
License: Public Domain

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Solutions Construction LLC,             :
                        Petitioner      :
                                        :
              v.                        : No. 660 C.D. 2022
                                        : Submitted: April 14, 2023
Sidar Garcia                            :
(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 WALLACE                                    FILED: September 29, 2023

      Solutions Construction LLC (Petitioner) petitions for review of the May 31,
2022 order of the Workers’ Compensation Appeal Board (Board) affirming the May
7, 2021 order of the Workers’ Compensation Judge (WCJ) that granted Sidar
Garcia’s (Claimant) Claim Petition for Workers’ Compensation and his Petition for
Penalties and that denied Petitioner’s Petition for Joinder of Additional Defendant
and its Petition to Review Compensation Benefits. After review, we affirm.
      I.      Factual Background and Procedural History
           On May 1, 2018, Claimant filed a Claim Petition for Workers’ Compensation
(Claim Petition) under the Workers’ Compensation Act (Act)1 alleging he sustained
an injury at work on April 5, 2018. Reproduced Record (R.R.) at 2-3. The Claim
Petition explained “Claimant was working on a ladder when the ladder fell, causing
Claimant to fall to the ground.” Id. at 3. Claimant alleged he suffered a “closed head
injury, as well as left upper extremity, left knee, and cervical spine injuries.” Id. at
3. He sought ongoing total disability as of April 5, 2018. Id. at 5. In his Claim
Petition, Claimant listed his employer as Petitioner. Id. at 2. On May 3, 2018, the
Workers’ Compensation Office of Adjudication (WCOA) assigned the Claim
Petition to WCJ Scott Olin. Id. at 8.
           On December 18, 2018, Claimant filed another Claim Petition for Workers’
Compensation (Second Claim Petition), alleging the same injuries as in his Claim
Petition, but adding “dental / facial disfigurement” to his list of injuries. Id. at 15-
16. In the Second Claim Petition, Claimant listed his employer as American
Diamond Builders, Inc. (American Diamond). Id. at 15. On December 19, 2018,
the WCOA assigned the Second Claim Petition to WCJ Olin. Id. at 21. WCJ Olin
held hearings on May 29, August 30, and November 29, 2019; January 17, February
28, May 28, July 23, and December 12, 2019; and on March 12, July 13, and
September 8, 2020. WCJ Dec., 5/10/21, at 4.
           On July 26, 2019, WCJ Olin issued an interlocutory order under Section 410
of the Act2 (Section 410 Order) against Petitioner and American Diamond. R.R. at

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

2
    Section 410 of the Act provides:

(Footnote continued on next page…)

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47. WCJ Olin acknowledged both entities disputed which was Claimant’s employer,
and he ordered both Petitioner and American Diamond to remit one-half of
Claimant’s temporary total disability benefits and one-half of all medical bills
incurred from the date of the injury (April 5, 2018) through November 14, 2019. Id.
In Claimant’s independent medical evaluations (IME) two doctors opined the date
Claimant was fully recovered from his work injury. Id. at 103. WCJ Olin chose
November 14, 2019, as it was the later of the two dates. Id.
       On September 18, 2019, Petitioner issued a Notice of Temporary
Compensation Payable (NTCP). Id. at 49. On September 27, 2019, Petitioner issued
an Amended Notice of Compensation Payable (Amended NCP). Id. at 52.
       On February 4, 2020, Claimant filed a Petition for Penalties (Penalty Petition)
based on Petitioner’s “violation of the Act, Rules and Regulations.” Id. at 28.
Claimant asserted Petitioner did not issue payments in compliance with the Section
410 Order. Id.
       On October 5, 2020, Petitioner filed a Petition to Review Compensation
Benefits (Review Petition) requesting the WCJ set aside the NTCP and Amended
NCP as materially incorrect. Id. at 36. Also on October 5, 2020, Petitioner filed a
Petition for Joinder of Additional Defendant (Joinder Petition) to add American
Diamond and its insurer, the State Workers’ Insurance Fund (SWIF), as defendants

       Whenever any claim for compensation is presented and the only issue involved is
       the liability as between the defendant or the carrier or two or more defendants or
       carriers, the [WCJ] of the department to whom the claim in such case is presented
       shall forthwith order payments to be immediately made by the defendants or the
       carriers in said case. After the department’s [WCJ] or the board on appeal, render
       a final decision, the payments made by the defendant or carrier not liable in the case
       shall be awarded or assessed against the defendant or carrier liable in the case, as
       costs in the proceedings, in favor of the defendant or carrier not liable in the case.

77 P.S. § 751.

                                                 3
in the Claim Petition and Penalty Petition. Id. at 40. Petitioner argued the WCJ
should join American Diamond and SWIF because “all allegations contained in the
Claim and Penalty Petitions are the sole responsibility of the above[-]named
Employer/Insurer.” Id. at 41.
       On November 5, 2020, following WCJ Olin’s retirement, the WCOA
reassigned the matter to WCJ Sandra Craig. Id. at 43. WCJ Craig held a hearing on
December 11, 2020. WCJ Dec., 5/10/21, at 4. WCJ Craig noted “[e]vidence was
submitted, the record closed, and briefs were submitted.” Id. at 5. On May 10, 2021,
WCJ Craig issued a decision and order (WCJ Order) granting Claimant’s Claim
Petition and Penalty Petition and ordering Petitioner to reimburse American
Diamond for the benefits it paid consistent with Section 410 of the Act. Id. at 15.
WCJ Craig also denied Petitioner’s Joinder Petition and its Review Petition. Id.
       Petitioner appealed the WCJ Order to the Board. On May 31, 2022, the Board
issued an order (Board Order) affirming the May 10, 2021 WCJ Order.3 Board Op.,
5/31/22, at 17. Thereafter, on June 29, 2022, Petitioner filed a Petition for Review
with this Court.4
       In its Petition for Review, Petitioner contends WCJ Craig erred by granting
Claimant’s Claim Petition and Penalty Petition and denying its Joinder Petition and
Review Petition. See Petition for Review ¶¶ 13-15. Specifically, Petitioner argues
it was error to grant the Claim Petition because substantial evidence did not support
a finding that Petitioner was Claimant’s employer. Id. ¶ 13. Petitioner also argues
substantial evidence did not support denying its Joinder Petition. Id. Petitioner

3
 The Board Order affirmed the WCJ Order that denied American Diamond’s Termination Petition,
however, American Diamond does not appeal.

4
 On August 19, 2022, American Diamond filed a Notice of Intervention and on December 12,
2022, filed an Intervenor’s Brief in opposition to Petitioner’s Petition for Review.

                                             4
further asserts denying the Review Petition was “not based upon substantial facts in
the record,” and the “erroneously generated” NTCP did not admit liability. Id. ¶ 14.
Lastly, Petitioner claims “[s]ubstantial competent credible evidence did not support
finding a violation of the Act by Petitioner.” Id. ¶ 15. Based on the alleged errors,
Petitioner argues it was error for the Board to affirm the WCJ Order.
   II.      Discussion
         This Court reviews workers’ compensation orders for violations of the
petitioner’s constitutional rights, violations of agency practice and procedure, and
other errors of law. 2 Pa.C.S. § 704. We also review whether substantial evidence
supports the findings of fact necessary to sustain the decision. Id. In our review, we
remain mindful that the WCJ is the fact-finder in workers’ compensation cases and
is entitled to weigh the evidence and assess credibility of witnesses. Montano v.
Advance Stores Co., Inc. (Workers’ Comp. Appeal Bd.), 278 A.3d 969, 978 n.4 (Pa.
Cmwlth. 2022) (citing Sharkey v. Workers’ Comp. Appeal Bd. (Fed. Express), 786
A.2d 1035, 1038 (Pa. Cmwlth. 2001)). We must view the evidence in the light most
favorable to the party that prevailed before the WCJ, drawing all reasonable
inferences in support of the WCJ’s decision. Id.
Claim Petition
         In a claim petition, a claimant has the burden of establishing an entitlement to
benefits and must prove all the elements necessary to support an award of benefits.
Schafer v. Workers’ Comp. Appeal Bd. (Martin Schafer Jr., Inc.), 935 A.2d 890, 893
(Pa. Cmwlth. 2007). One of the necessary elements for a claimant to prove is the
existence of an employer-employee relationship at the time of the injury. Id. at 894.
A claimant’s employment status is a critical threshold determination for liability
under the Act. Universal Am–Can, Ltd. v. Workers’ Comp. Appeal Bd.

                                             5
(Minteer), 762 A.2d 328 (Pa. 2000). The existence of an employer-employee
relationship is a question of law based on the finding of facts. Id. at 330-31.
      Claimant testified Carlos Viera (Viera) worked for Petitioner, was his
supervisor, and was his supervisor the day of his accident. R.R. at 121-23. Claimant
testified Daniel Ramos (Ramos) worked with him every day, directed him what to
do, paid him, and worked for Viera and Petitioner. Id. at 81, 130-31. Claimant
testified he received his payment in cash, inside an envelope with his name on it,
without a pay stub or statement included. Id. at 122. Claimant testified Viera would
give Ramos the cash to give to him. Id. at 88. Claimant testified he had not heard
of the company American Diamond. Id. at 122.
      Viera testified he was the owner of Petitioner and never employed Claimant.
Id. at 144-45. Viera testified he paid American Diamond by check, and not anyone
else. Id. at 155-156. On cross-examination, counsel asked Viera if he had copies of
the checks he paid to American Diamond, and Viera responded he did Id. at 156.
Counsel asked Viera to provide the copies, and Viera replied “Okay.” Id. However,
despite testimony he would, Viera never provided copies of checks paid to American
Diamond. WCJ Dec., 5/10/21, ¶ 22.
      Viera said Ramos was the person for whom Claimant worked. R.R. at 155.
Petitioner argues Claimant was “simply mistaken” that Ramos worked for Petitioner,
because Ramos was an employee of American Diamond. Petition for Review ¶ 7.
Viera testified Ramos gave him a Certificate of Liability Insurance for American
Diamond.     R.R. at 149-51.     Petitioner argues this document was “objective,
uncontradicted evidence that established Claimant was not Petitioner’s employee.”
Petition for Review ¶ 6.      However, Viera did not explain how the document
evidencing insurance proved Petitioner did not employ Claimant. WCJ Craig found

                                          6
Viera’s testimony “unquestionably self-serving” and “not credible.”       WCJ Dec.,
5/10/21, ¶ 22.
      WCJ Craig found Claimant was an employee of Petitioner at the time of his
work injury. Id. ¶ 23. Substantial evidence existed on this issue in the form of
testimony from Claimant and Viera.      Credibility determinations are the essential
function of the fact-finder and, therefore, we conclude substantial evidence in the
record established Claimant met his burden of proof on his Claim Petition.
Accordingly, the Board did not err in affirming the WCJ Order granting Claimant’s
Claim Petition.
Penalty Petition
      Petitioner argues it was error for WCJ Craig to find it violated the Act and
grant Claimant’s Penalty Petition. Petition for Review ¶ 15. WCJ Craig granted
Claimant’s Penalty Petition, but only in part. The granting of penalties is within the
discretion of the WCJ. Brutico v. Workers’ Comp. Appeal Bd. (US Airways, Inc.),
866 A.2d 1152, 1156 (Pa. Cmwlth. 2004).
      Pursuant to Section 428 of the Act, added by the Act of June 26, 1919, P.L.
642, Employer had 30 days to make payment following WCJ Olin’s July 26, 2019
Section 410 Order. 77 P.S. § 921. Petitioner did not make payment until September
18, 2019, more than 30 days after WCJ Olin issued the Section 410 Order. See R.R.
at 177. Accordingly, WCJ Craig awarded penalties based upon Petitioner’s failure
to make payment as the Act required.
      Additionally, WCJ Craig found Petitioner violated the Act by not paying
benefits according to the September 27, 2019 Amended NCP. See Section 406.1 of
the Act, added by the Act of February 8, 1972, P.L. 25, 77 P.S. § 717.1. However,
given the “somewhat novel [Bureau computer system] issue,” WCJ Craig declined

                                          7
to award penalties for Petitioner’s failure to pay benefits on the Amended NCP.
WCJ Dec., 5/10/21, ¶ 6.
      WCJ Craig’s exercise of discretion was not “manifestly unreasonable[] or the
result of partiality, prejudice, bias or ill will.” Zappala v. Brandolini Prop. Mgmt.,
Inc., 909 A.2d 1272, 1284 (Pa. 2006). WCJ Craig considered the circumstances of
Petitioner’s violations of the Act, and she awarded penalties for only one of them.
The Board did not err in affirming the partial grant of the Penalty Petition.
Joinder Petition
      The regulations governing practice and procedure before WCJs set forth
requirements for all pleadings.     Specifically, Title 34, Section 131.26 of the
Pennsylvania Code addresses petitions for joinder and allows a party to join another
defendant as a matter of right, subject to the requirements of the regulation. One of
the requirements instructs a party file the petition “no later than 20 days after the
first hearing at which evidence is received regarding the reason for which joinder is
sought.” 34 Pa. Code § 131.36.
      WCJ Olin held a hearing on July 23, 2019, on both the Claim Petition and the
Second Claim Petition.       R.R. at 99.       WCJ Olin acknowledged there was
disagreement regarding “[which entity] is the employer.” Id. Petitioner sought
joinder of American Diamond based on the question of which entity employed
Claimant. Therefore, the reason Petitioner sought joinder was clear at the July 23,
2019 hearing. Using the July 23, 2019 hearing date, it is evident Petitioner’s filing
on October 5, 2020, was outside the 20-day deadline provided in the regulation.
      While neither the WCJ nor the Board offered Section 131.36 of the code as
the reason for denying the Joinder Petitioner, we conclude denying it was correct

                                           8
given Petitioner’s failure to file the Joinder Petition within 20 days of the July 23,
2019 hearing.5
Review Petition
      Petitioner filed a Review Petition to set aside the NTCP and Amended NCP,
alleging they were materially incorrect. Id. at 135. Petitioner argued the NTCP and
Amended NCP were “generated erroneously as a result of processing payment under
the Interim [Section] 410 Order.” Petition for Review ¶ 9. The electronic data
interchange (EDI) system is the system a claims adjuster uses to issue forms like the
NTCP or NCP and to update a claim’s status. WCJ Dec., 5/10/21, ¶ 12.a. On
September 18, 2019, an initial payment transaction on the Section 410 Order
triggered the issuance of an NTCP. Id. ¶ 12.c. Petitioner argues the EDI system
erroneously generated the NTCP and Amended NCP. “It is the burden of the party
seeking modification of the notice of compensation payable to prove that a material
mistake of fact or law was made at the time the notice of compensation payable was
issued.” Birmingham Fire Ins. Co. v. Workmen’s Comp. Appeal Bd. (Kennedy), 657
A.2d 96, 99 (Pa. Cmwlth. 1995) (citation omitted).
       Two individuals supplied testimony about the EDI system and the process for
generating NCPs. Tracey Palmaioli (Palmaioli) was an employee of Petitioner’s
insurer, Berkshire Hathaway Guard Insurance Company (Guard). R.R. at 172. She
was a repricing supervisor, responsible for overseeing an EDI analyst and the
medical bill repricing department. Id. Palmaioli said she held that position since
May, 2019, and before that she was an EDI analyst. Id. The WCJ found credible
Palmaioli’s testimony (1) claims actions trigger the EDI, (2) an insurer’s EDI

5
 This Court may affirm the lower tribunal’s decision on any basis appearing in the record.
Commonwealth v. Tighe, 224 A.3d 1268 (Pa. 2020).

                                            9
transaction generates electronic forms such as an NCP, and (3) she did not know
what information an adjuster entered to generate an NCP. WCJ Dec., 5/10/21, ¶ 24.
      Palmaioli also testified no one from Guard issued the NTCP or Amended
NCP, all forms are “generated through EDI transactions,” and the NTCP was
generated “due to the State’s conversion to compensable.” R.R. at 179, 184. The
WCJ did not find this testimony credible. WCJ Dec., 5/10/21, ¶ 24. The WCJ found
Palmaioli’s statement that the Bureau of Workers’ Compensation (Bureau) issued
the NTCP demonstrated she did not fully understand the EDI system. WCJ Dec.,
5/10/21, ¶ 24.
      Harte Pricer (Pricer) testified she was the manager of the EDI system for the
Bureau since 2015, responsible for the EDI system and the staff who responded to
inquiries. R.R. at 226-227. Pricer explained that a claims adjuster enters data in the
EDI to generate forms such as an NCP. Id. at 230. Further, Pricer offered ways an
adjuster could enter information without generating an NCP. Id. at 231-32. The
WCJ considered Pricer’s testimony credible and found she “demonstrated a
thorough knowledge of the EDI system” and the process by which it generated
forms. WCJ Dec., 5/10/21, ¶ 25.
      Ultimately, the WCJ found Petitioner and its insurer issued an NTCP and
admitted liability. This finding was based upon the WCJ’s credibility determinations
of Palmaioli and Pricer and the weight the WCJ afforded the evidence they
presented. Credibility and weight of the evidence determinations are areas within
the WCJ’s domain, and they have support in the record. Accordingly, we conclude
the Board did not err in affirming WCJ Craig’s determination that Petitioner failed
to meet its burden of proving a material mistake.

                                         10
   III.   Conclusion
      For the foregoing reasons, we conclude WCJ Craig’s findings are supported
by substantial evidence, she did not abuse her discretion, and the Board properly
affirmed the WCJ Order. Accordingly, we affirm the Board’s Order.

                                       ______________________________
                                       STACY WALLACE, Judge

Judge Fizzano Cannon did not participate in the decision of this case.
Judge Dumas did not participate in the decision of this case.

                                         11
         IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Solutions Construction LLC,            :
                        Petitioner     :
                                       :
             v.                        : No. 660 C.D. 2022
                                       :
Sidar Garcia                           :
(Workers’ Compensation Appeal          :
Board),                                :
                       Respondent      :

                                     ORDER

     AND NOW, this 29th day of September 2023, the May 31, 2022 order of the
Workers’ Compensation Appeal Board is AFFIRMED.

                                       ______________________________
                                       STACY WALLACE, Judge