‘Partial termination’ of workers’ comp benefits improper, partner Dave Stern tells Commonwealth Court

Pond Lehocky Stern Giordano partner David Stern recently argued before an en banc panel of the Pennsylvania Commonwealth Court, seeking to establish law that could benefit all injured workers in the state

At issue is whether it is whether Pennsylvania workers’ compensation law allows for a “partial termination” of benefits with respect to a portion of an injured worker’s injuries. Stern argued that there is no statutory provision or precedential caselaw that supports a “partial termination” and that termination of benefits is only appropriate where the claimant has fully recovered from all accepted or adjudicated work-related injuries.

In the case at hand, a workers’ compensation judge granted a partial termination regarding the psychological component of an injured worker’s injuries while not finding him fully recovered from his accepted and adjudicated physical injuries.

The claimant was injured in September 2010 when he tripped and fell out of a vehicle, suffering strains and sprains to his lower back and buttocks. The injury also resulted in psychological condition, diagnosed as an adjustment disorder with anxiety and depressive features.

The employer accepted all the injuries. Eventually, the parties entered into a compromise and release agreement resolving the wage-loss portion of the claim. However, the employer agreed to remain on the hook for all ongoing related medical expenses.

The employer filed a termination petition in June 2106, alleging that the claimant was fully recovered from all his injuries. However, the employer only submitted evidence regarding the claimant’s psychological injuries. The employer’s expert, a psychiatrist, acknowledged that the claimant still suffered from anxiety, but concluded that that condition was unrelated to his work injury.

The workers’ compensation judge granted a “partial termination” regarding only the psychological portion of the claimant’s injury. The ruling relieved the employer from paying any ongoing bills for the claimant’s psychological treatment. The employer remains on the hook for treatment of the physical injury.

The claimant appealed to the Workers’ Compensation Appeal Board, which upheld the decision.

On appeal before the Commonwealth Court, Stern argued Pennsylvania workers’ compensation law “does not allow for piecemeal termination petitions.”

“It is virtually axiomatic in workers’ compensation law that termination of benefits is only proper when all work-related disability has ceased, which is the employer’s high burden to prove,” Stern wrote in a brief submitted on behalf of the claimant.

At oral argument, Stern cited Central Park Lodge v. WCAB (Robinson), 718 A.2d 368 (Pa. Cmwlth. 1998), in which the Commonwealth Court held that for a termination petition, the employer must prove that “all of the claimant’s work-related disability has ceased.”

“[I]n this court’s holdings and in the Supreme Court’s holdings, the word ‘all” has been used many times,” Stern said.

He argued that there are already procedures available, namely the utilization review process, that the employer could have followed to seek relief from liability for the psychological component of the claimant’s injury.

Stern wrote in his brief that the employer “disingenuously” filed a termination petition rather than seeking a utilization review, then “did not even bother in good faith” that the claimant had fully recovered from all his injuries.

“[The] employer instead openly flouted the settled termination burden of proof, presenting a psychiatrist to opine solely on the psychological aspects,” the brief said. “This kind of practice and conduct by a party drains judicial time and resources.”

At the oral argument, he expounded on this point.

“Let’s say that there’s this substantial injury and there are 10 injuries on the Notice of Compensation Payable,” Stern argued. “Does my client, doesn’t need to be me, have to defend ten termination petitions? That seems burdensome.”

The case is currently pending a decision.

Pond Lehocky Stern Giordano opened its doors in July 2010 with six attorneys and only 22 total staff members. Today, it is the largest workers’ compensation and Social Security disability law firm in the region, boasting more than 40 attorneys and 240 staff members. The firm has also recently expanded into new practice areas for workers, including employment law and long-term disability, and has a national referral network, which has helped 86,000 clients with referrals.

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