Court Opinion

ID: 9712145
Source: CourtListenerOpinion
Date Created: 2023-08-26 04:47:24.272239+00
Date Added: 2024-06-11T18:23:10.297632
License: Public Domain

DISSENTING OPINION

SAYLOR, Justice.
I agree with the opinion announcing the judgment of the Court that one seeking to file a claim petition for personal injury outside the three-year period of repose generally bears the burden of proving that the claim fits a statutory exception such as Section 315’s “in lieu of compensation” tolling clause. See 77 P.S. § 6Q2.1 Further, I join the lead opinion in holding that this tolling provision may be triggered by the voluntary payment of medical expenses and, correspondingly,’ in overruling Paolis v. Tower Hill Connellsville Coke Co., 265 Pa. 291, 108 A. 638 (1919). I differ with the lead concerning the manner in which the applicability of the in lieu of compensation exception should be judged, and further, regarding the appropriate disposition of this appeal.
First, in selecting the legal principles appropriate to the resolution of the appeal, I believe that it is important to further clarify the procedure employed by the WCJ in dis*544missing the claim petition. As noted by the lead, the WCJ bifurcated the case to resolve the statute of repose issue as a threshold matter and also permitted only the Claimant to present evidence on such question. See R.R. at 52a-53a. The WCJ reasoned that, since it was undisputed that the petition on its face was barred by Section 315, it would be efficacious to test the legal sufficiency of the Claimant’s contention that an exception (tolling) was implicated. In dismissing the claim petition, then, the WCJ effectively entered a nonsuit against Claimant, concluding that Claimant had failed to make out a prima faeie case for tolling.
I recognize that the lead opinion’s analysis proceeds from the manner in which the appeal has been framed by the parties addressing, as they do, shifting burdens and legal presumptions related to the effect of payment of medical expenses upon the Section 315 tolling inquiry. Nevertheless, given the character of the WCJ’s decision as described above, I would not craft a disposition grounded in such concepts. Rather, I would evaluate the WCJ’s ruling on its terms, namely, as one entailing a judgment that the Claimant presented insufficient evidence to proceed to the factfinding stage.2
*545In this regard, one core component of the WCJ’s ruling was that “payment of medical bills does not toll the statute of limitations.” This prescription, however, was based upon the Paolis line of cases and therefore is entirely disposed of in the opening segment of the lead’s discussion in which Paolis is expressly overruled. For this reason alone, the WCJ’s decision to dismiss the claim petition cannot be sustained on its own terms. I believe, nonetheless, that it is also appropriate for the Court to evaluate whether the WCJ’s decision to dismiss the claim petition based upon the failure to adduce sufficient evidence to implicate Section 315’s “in lieu of payment” exception may be sustained for other reasons deriving from the record.3
Employer maintains that, even in a post-PaoKs landscape, undisputed voluntariness associated with payment of medical expenses should defeat the characterization of such payments as in lieu of compensation and, correspondingly, any tolling effect. Significantly, however, the Commonwealth Court has frequently stated that “payment in lieu of compensation” means “any voluntary or informal compensation, apart from the Act, paid with the intent to compensate for a work-related injury.” 4 Facially, this standard requires proof of only two *546elements: 1) actual payment of compensation, i.e., remuneration for a type of loss for which the Act would require recompense if the employer were to be found liable (for example, wage loss or medical expenses); and 2) an intent to redress such loss in relation to a specific work-related injury. The intent component does not contemplate the acknowledgment of actual liability or other similar element of involuntariness — indeed, the overall standard by its express terms contemplates instances of voluntary payments. As I believe that the above-quoted formulation provides an appropriate, workable standard consistent with the statutory framework, I would adopt it here and, correspondingly, reject Employer’s assertion that the voluntariness of its payments should be viewed as negating the effect of Section 315’s tolling clause. Indeed, I would recognize Employer’s argument in this regard as merely a vestige of the Paolis rationale, which the Court has now expressly disavowed.
The only remaining inquiry which I would deem necessary to the disposition of the appeal is whether the record reflects sufficient evidence concerning Employer’s intent, to warrant proceeding to factfinding on such question. In this regard, I agree with the lead’s conclusion that a claimant bears the burden of proof by a preponderance of the evidence, and that the claimant’s proof concerning intent should, at a minimum, demonstrate that the employer had actual or constructive knowledge of the particular work-related injury at issue. See Opinion Announcing the Judgment of the Court, slip op. at 970.5 Further, against the background of this case, I believe that it would be appropriate to direct that such knowledge should also include awareness (actual or constructive) of the *547specific work-related event that forms the basis of a claimant’s assertion of work-relatedness.6 Here, however, Claimant failed to present any evidence that he advised Employer of the asserted connection between his experience in the mining flood disaster and subsequent mental health treatment. Further, by not specifying on the record how much time had elapsed between the flood and his subsequent mental health treatment,7 Claimant failed to establish a sufficiently close association to support an inference that the asserted connection should have been immediately apparent to Employer.8 Therefore, Claimant’s best case is to suggest that his testimony supports the inference that, in light of the magnitude of the flood event, and the physical character of Claimant’s subsequent back injury, Employer on its own would have disregarded the temporal connection between the back injury and the *548pertinent medical invoices, and instead, associated the psychological treatment with the flood event. The Commonwealth Court found such an inference to be compelling and, indeed, conclusive. See Schreffler v. WCAB (Kocher Coal Co.), 745 A.2d 697, 700 (Pa.Cmwlth.2000). In my view, however, on this record such inference is simply too weak to support a claim of constructive notice (for purposes of the statutory tolling provision) that the treatment related to the flood event, since I believe that conclusions supported by alternative inferences, see, e.g., supra note 8, are at least equally as plausible.9
I would note, however, that Claimant also pursued an equitable estoppel theory before the WCJ and as the'appellant before the WCAB and in the Commonwealth Court. See supra note l.10 The Commonwealth Court, however, did not address this equitable theory given its conclusion that the statutory tolling provision was implicated, and therefore, that the claim petition should proceed to a merits determination. Accordingly, and as I would overturn the Commonwealth Court’s decision concerning statutory tolling, I believe that the appropriate course is to remand to the Commonwealth Court for consideration of Claimant’s alternate, equitable theory.
Justice CASTILLE joins this dissenting opinion.

. The Commonwealth Court has stated that a claimant may also avoid the effect of the three-year slatute by proving, by clear and convincing evidence, that the actions oí the employer or its insurance carrier lulled him into a false sense of security regarding the filing of the claim. See, e.g., Golley v. WCAB (AAA Mid-Atlantic, Inc.), 747 A.2d 1253, 1255 (Pa.Cmwlth.2000)(citing Zafran v. WCAB (Empire Kosher Poultry, Inc.), 713 A.2d 698, 700 (Pa.Cmwlth.1998)).

. While I do not necessarily disfavor use of a rebuttable presumption in the Section 315 context, I am not as certain as the majority that a distinction between cases involving total and partial disability would need to be drawn where the presumption is deemed to arise by virtue of the voluntary payment of medical expenses. As the lead opinion acknowledges, the line of Commonwealth Court decisions from which it draws the presumption concern disability policy and wage payments rather than medical expenses. It appears to me that the inference/presumption language was utilized in' such cases because it is often difficult to distinguish whether payments to an employee reflect the employer's contractual obligation to provide compensation for continuing services rendered, or whether all or some component represents compensation for a work-related loss of earning capacity sustained. This problem is particularly troublesome in instances in which the employee remains working, for example, in a light duty capacity. Compare Cotton v. John Wood Mfg. Co., 126 Pa.Super. 528, 531-32, 191 A. 189, 190 (1937)(holding that payments equivalent to wages made to an injured worker who returned to work in a light duty capacity but "couldn’t do a capable day’s work” were in lieu of compensation), with Elkins v. Cambria Library Ass'n, 82 Pa.Super. 144, 147-48 (1923)(find-ing that a claimant who returned to full employment in her time-of-*545injury job presented insufficient evidence to support a conclusion (hat continuing payments represented anything other than wages). Where the payment at issue is of medical expenses and admittedly is made by the employer or its insurer on a voluntary basis, it is far less difficult to determine that such payments redress an injury-related loss, regardless of whether or not the employee remains working.

. The focus of such further inquiry should be limited, however, to the sufficiency of Claimant’s evidence, if believed, to créale a legal controversy, since this is the framework in which the record was developed.

. Wallace v. WCAB (Pittsburgh Steelers), 722 A.2d 1168, 1170 (Pa.Cmwlth.1999)(quoting Pittsburgh Steelers Sports, Inc. v. WCAB (Erenberg), 145 Pa.Cmwlth. 547, 552, 604 A.2d 319, 322 (1992)); see also Bethlehem Steel Corp. v. WCAB (Gounaris), 714 A.2d 550, 551-52 n. 4 (Pa.Cmwlth.1998); Toborkey v. WCAB (H.J.Heinz), 655 A.2d 636, 638 n. 3 (Pa.Cmwlth. 1995); Martin v. WCAB (United Suites Steel Corp.), 132 Pa.Cmwlth. 370, 377, 572 A.2d 1307, 1311 (1990); NUS Corp. v. WCAB (Garrison), 119 Pa.Cmwlth. 385, 389, 547 A.2d 806, 809 (1988). These citations include decisions involving employer credit for loss compensation paid prior to the assertion of a claim and cases concerning the *546tolling effect of Section 315, since payments in lieu of compensation are equally relevant in both contexts.

. This conclusion suggests — correctly, in my view — that a showing of constructive knowledge of a work-related injury may, in some instances, substitute for a showing of actual knowledge, notwithstanding the lead’s emphasis in the overall inquiry on the employer's subjective intent. See Opinion Announcing the Judgment of the Court, slip op. at 970 & n. 3.

. In the present ease, it could be argued that Employer plainly had constructive knowledge of a mental health-related injury, since its insurer received and paid bills for mental health treatment. But in light of the Workers’ Compensation Act's requirement of work-relatedriess, and the differing standards governing relief which may apply depending upon the character of the causal factor, compare Good Shepherd Workshop v. WCAB (Caffrey), 124 Pa.Cmwlth. 262, 267-69, 555 A.2d 1374, 1377-78 (1989)(describing the Commonwealth Court's prevailing standard for work-relatedness associated with physical injury caused bv some discrete physical event), with Davis v. WCAB (Swarthmore Borough), 561 Pa. 462, 473, 751 A.2d 168, 174 (2000)(elaborating upon the "abnormal working conditions" requirement pertaining to claims for "psychic injurfies]”), it would seem appropriate to require a claimant to establish an employer’s actual or constructive knowledge of the basis for the claim of work-relatedness as a component of his proofs on the intent question.

. After the close of the record, the WCJ attempted to obtain a stipulation concerning the date of the flood event. Claimant’s counsel reported that Claimant indicated that the event occurred in March of 1979; however, no stipulation to this effect appears as of record. Further, the WCJ’s findings reflect uncertainty in this regard.

. Notably, it appears from Claimant's testimony that the mental health treatment was ultimately initiated on the advice of the physician who treated Claimant for his back injury. See, R.R. at 57a. This circumstance provides support for alternative inferences such as that advocated by Employer, namely, that its insurer received the invoices for mental health treatment contemporaneously with those pertaining to the acknowledged, work-related back injury, and therefore, Employer and its insurer failed to apprehend that the mental health treatment pertained to an entirely separate work event.

. Like the lead, I would note that employers whose benefit plans compensate for non-occupational injuries ordinarily have the ability under the statute to prevent the tolling effect merely by designating the payments at issue as other than compensation. See 77 P.S. § 602 (providing, inter alia, that "any payment made under an established plan or policy of insurance for the payment of benefits on account of non-occupational illness or injury and which payment is identified as not being workmen's compensation shall not be considered to be payment in lieu of workmen’s compensation, and such payment shall not loll the running of the statute of limitations"). I support the Commonwealth Court’s emphasis on this provision as a general matter, see Schreffler, 745 A.2d at 700; however, I find such emphasis inapplicable where, as here, the claimant fails to establish, at a minimum, sufficient actual or constructive notice to the employer of the specific work-related injury from which the medical bills arise.

. Specifically, Claimant took the position that the payment for the mental health treatment by Employer's insurer for thirteen years without question lulled Claimant into a false sense of security.