Burks v. WCAB (City of Pittsburgh), 36 A.3d 639 (Pa. Cmwlth., 2012).
Here, the claimant suffered from both a work-related injury and an unrelated medical condition. The claimant then applied for and began receiving Social Security Disability (SSD) benefits because of the latter conditions. After having the claimant examined by its doctor, the employer filed a petition to suspend the claimant’s workers’ compensation benefits, alleging that she was physically capable of performing work, but had voluntarily removed herself from the workforce. The claimant had not worked or looked for work since 1984.
The Commonwealth Court found that the claimant’s failure to seek work since 1984, in and of itself, was not sufficient to support a finding that she had voluntarily withdrawn herself from the workforce. However, because the claimant sought a disability pension, based on her inability to be gainfully employed, and because the work injury did not prevent the claimant from working, the employer was entitled to a suspension of benefits because the claimant had voluntarily withdrawn from the workforce.
The Court then looked at the claimant’s receipt of SSD benefits and observed that if a WCJ finds that a claimant suffers from a work injury, and from no other non-work-related medical condition, then the receipt of SSD establishes that the claimant’s work injury forced him out of the labor market. In contrast, if the WCJ finds that a claimant suffers from a work injury and a non-work-related condition, and that the work injury does not prevent the claimant from working, the receipt of SSD establishes that the claimant has removed himself for reasons unrelated to the work injury.
Verity v. WCAB (The Malvern School), No. 356 C.D. 2011 (Pa. Cmwlth., filed October 11, 2011).
The claimant was working in a light duty capacity and receiving TPD through a supplemental agreement. The employer filed a termination petition and the claimant filed a reinstatement petition, alleging a worsening of condition and no restricted work available. The claimant stopped working after receiving a note from her doctor concerning work-restrictions which her employer could not accommodate.
The Commonwealth Court examined the burden of proof where a claimant is seeking a reinstatement of suspended benefits, by looking to the recent Supreme Court decision, Bufford v. WCAB (North American Telecom), 2 A.3d 548 (2010). Through Bufford, the Supreme Court eliminated the requirement that a claimant must prove that his loss of earnings was through no fault of his own, when seeking a reinstatement after a suspension of benefits. Accordingly, the modified burden is on the claimant to show that his earning power is once again adversely affected by his disability and that the disability is a continuation of that which arose from the original claim. The burden then shifts to the employer to show that the claimant’s loss of earnings is not caused by the disability arising from the work injury.
Here, the Commonwealth Court affirmed that the claimant had failed to meet her burden of proving that her earning power was once again adversely affected by the work-related injury. Specifically, the claimant had not stopped working due to the elimination of her light duty position, but because her doctor had authored a note containing incorrect restrictions, which the employer could not accommodate. Finding that the claimant was aware that the restriction was incorrect, the Court noted that it was the claimant’s failure to secure a new note with the proper restrictions which caused the loss of her job, not her medical condition or the employer’s conduct.
Caputo v. WCAB (Commonwealth of Pennsylvania), 34 A.3d 908 (Pa. Cmwlth., filed January 5, 2012).
The claimant argued that the offset for Social Security retirement benefits, permitted by Section 204(a) of the Act, is unconstitutional. The Commonwealth Court addressed the claimant’s constitutional challenge, finding that the offset for 50% of an individual’s Social Security retirement benefits does not violate the Equal Protection Clause of the Pennsylvania Constitution because it is reasonably related to the legitimate governmental objectives of reducing workers’ compensation costs for Pennsylvania employers.
The Court also found that it was not its place to speculate as to whether the 50% offset was the wisest or best means to accomplish the legitimate legislative goal of cost containment. The Court went on to find that the offset was also reasonably related to the legitimate goal of encouraging individuals already receiving Social Security retirement benefits to remain in or to re-enter the workforce because the offset does not apply if old age Social Security benefits were received prior to the compensable injury. In this regard, a retired worker already collecting old age Social Security can continue to work, knowing that if he gets injured at work, his disability benefits will be unaffected by his Social Security income.
Zuchelli v. WCAB (Indiana University of Pennsylvania), 35 A.3d 801 (Pa. Cmwlth., 2011)
Nine days after a claimant was injured, the employer filed an NCD, which indicated that although an injury had occurred, the claimant was not disabled. The claimant filed a claim petition and a penalty petition, alleging that although she had stopped working, due to work-related surgery, the employer had not paid any wage loss benefits, nor certain medical expenses, and it did not promptly investigate the cause of her disability until after her return to work. The WCJ denied the claim and penalty petitions. The Board affirmed and the claimant appealed.
The claimant first argued that based on the undisputed facts that she had stopped working due to surgery, the employer had violated Section 406.1 of the Act, which required it to promptly investigate the cause of her disability, accept the injury, or issue a TNCP if “uncertain.” The claimant argued that the employer’s failure to do so lead to a finding of compensability, as a matter of law, under Section 406(d). She also argued that the use of an NCD was invalid under the Jordan case and that the refusal to pay wage loss benefits while she was out of work due to surgery, without evidence to contradict her doctor’s opinion of a work injury, violated the Act.
The Commonwealth Court rejected the argument that the Employer’s failure to issue appropriate Bureau documents rendered the claim compensable as a matter of law. Furthermore, given the WCJ’s rejection of the claimant’s evidence, the claimant was not entitled to an award of benefits.
The Court also rejected the argument that the employer violated the Act by failing to issue proper documentation regarding the injury and by failing to properly investigate the case of disability. The issuance of a Box 4 Denial was appropriate, since the claimant had returned to work after the injury and had not sustained any disability at that time. The claimant’s reliance on Jordan was misplaced, since the employer in Jordan had never acknowledged that the claimant had sustained a work injury.
The Court also rejected the argument that the employer should have issueda TNCP, since it had timely issued a NCD. The employer was not obligated to rescind the NCD when the claimant underwent surgery, since it disputed the work incident had caused any disability. In the alternative, the claimant argued that the WCJ and Board erred in concluding that her disability, caused by the surgery, was not compensable. However, the WCJ had determined that the surgery was performed to address a pre-existing condition and not the work injury.
Cozzone v. WCAB (PA/Municipal/East Goshen Township), No. 664 C.D. 2011 (Pa. Cmwlth., filed January 5, 2012).
The claimant suffered a work injury and began receiving TTD, until he returned to work without a loss of earnings. His benefits were reinstated numerous times, by various supplemental agreements, as he continued to work for the employer. He later began working in a modified duty capacity for a different employer, and his benefits were reduced by way of supplement agreement to TPD. He eventually stopped working for the different employer in January of 2008, because he no longer felt capable of modified duty work. The claimant filed a reinstatement petition, requesting a reinstatement to TTD as of January of 2008 and a penalty petition, alleging a unilaterally stoppage of benefits.
The WCJ granted the reinstatement and penalty petitions. The Board reversed, finding that the WCJ erred in applying the doctrine of equitable estoppel because the claimant’s right to compensation had extinguished by the expiration of the statute of repose, set forth in Section 413(a). The Board noted that any of the employer’s actions after the expiration of the statute of repose, by way of issuing supplemental agreements, did not affect the claimant’s right to compensation. Accordingly, the Board found that the WCJ erred in not finding the reinstatement petition time barred by the statute of repose. The penalty was also revered. The claimant appealed.
The Commonwealth Court held that where a claimant’s benefits are suspended because of no current loss of earnings, benefits may be resumed only if the claimant files a reinstatement petition within 500 weeks of the effective date of the suspension. Absent circumstances justifying application of the doctrine of equitable estoppel, a reinstatement petition filed outside of the 500 week period will be considered time-barred by the statue of repose.
Here, the claimant’s benefits were suspended on September 29, 1989 due to a return to work without a loss of earnings. He then had until April 1999 to file a reinstatement petition, but failed to file his petition until 2008. In the context of the statute of repose, the relevant inquiry to see whether the doctrine of equitable estoppel applies focuses on whether the employer’s words or conduct convinced the claimant not to pursue his claim within the statutory period.
The Commonwealth Court dismissed the claimant’s argument that equitable estoppel should apply because the employer had suspended his benefits without a supplemental agreement or WCJ’s order. In keeping with Bellows, the Court observed that the particular facts entitled the employer to a suspension of benefits on September 20, 1989, notwithstanding the fact that there was not supplemental agreement or judicial order. It did not accept the claimant’s argument that his ignorance to the law created an estoppel.
The Court also found no detriment to the claimant, if it accepted his argument that he was unaware of the suspension or its effect on his right to seek a reinstatement. Since the claimant had worked for over 14 years before seeking a reinstatement, he would not have sought reinstatement within the 500 week statue of repose, even if the employer had formally informed claimant of its existence.
The claimant’s argument that the employer should be equitably estopped from raising the statute of repose defensesince it voluntarily reinstated benefits after the 500 week statute of repose had already expired was also dismissed. The relevant inquiry is whether the employer’s words or conduct convinced the claimant to not pursue his claim within the statutory period. The employer’s actions after the expiration of the statute of repose then could not have induced the claimant to not seek reinstatement within the statutory period.
The claimant’s argument that because his reinstatement petition was filed within three years of his last payment of compensation was also dismissed because his benefits had been suspended, based on a return to his pre-injury position without a loss of earnings, making the 500 week statute of repose in Section 413(a) applicable.
The denial of the penalty petition was also upheld. The claimant’s right to compensation had extinguished by the expiration of the 500 week statute of repose. While the parties had entered into a supplemental agreement after the expiration date, the agreement had no bearing on the claimant’s right to compensation under the Act. Because the supplemental agreement was void and unenforceable, either (1) the employer had no obligation to pay benefits and therefore did not violate the Act or (2) even if it had violated the Act, no past compensation was due, upon which an award of penalties could be assessed. Either way, the claimant was not entitled to penalties.
Palaschak v. WCAB (US Airways), 35 A.3d 1242 (Pa. Cmwlth., 2012).
The claimant’s disability benefits were suspended on February 5, 1996, based on a return to work with no loss of earnings. He continued to work until March of 2006, at which point his doctor imposed a work-related restriction, which the employer could not accommodate. The claimant filed a reinstatement petition in 2006, as well as a modification petition, alleging that the injury caused him to miss work at various points in time between 1996 and 2006, and that he had not been paid indemnity benefits. He also filed a claim alleging an injury date in March of 2006, after the employer argued that the reinstatement and modification petitions were time-barred.
The WCJ denied the claim petition and denied the reinstatement and modification petitions, concluding that they were time-barred because they had been filed more than 500 weeks after benefits had been suspended. The Board affirmed. The claimant raised one issue on appeal: whether the WCJ and Board erred in dismissing the reinstatement petition as being time barred.
The Commonwealth Court affirmed the denial of the reinstatement petition, holding that a claimant on suspension status must file a reinstatement petition within 500 weeks of the payment of compensation.
The Court observed that Section 413(a) generally provides that a reinstatement petition must be filed within three years of the most recent payment of compensation. If benefits have been suspended, however, a claimant may seek reinstatement at any time during the period for which compensation for partial disability is payable, or 500 weeks/9.6 years from the date of their last payment of compensation.
Because the claimant was in suspension status, his right to seek reinstatement was limited to within 500 weeks of the suspension date. Accordingly, the Commonwealth Court found that the reinstatement was time barred and properly denied. In addition, the Court noted that even if the claimant’s petition had not been time barred, his evidence was rejected. Accordingly, he was not entitled to a reinstatement because he failed to prove that he had an “increased, work-related impairment” that precluded the continuation of his light duty job as of March of 2006.