SIGNIFICANT CASE SUMMARIES
Pennsylvania Case Summaries
Steets v. Celebration Fireworks (WCAB)
No. 3 MAP 2024
Supreme Court of Pennsylvania
Decided: May 30, 2025
When a claimant dies as a result of a work injury while adjudicating a claim for specific loss benefits, the entire balance of that specific loss award is payable to the claimant’s dependents or to estate if there are no dependents.
Background:
The Claimant sustained significant work-related injuries from an explosion and was paid ongoing total disability benefits. She petitioned for recognition of various specific loss injuries, which the WCJ granted in the amount of 840 weeks of benefits, to commence upon cessation of total disability benefits. The Employer appealed this decision. During the pendency of the appeal, the Claimant passed away due to her work injuries. She did not have any dependents. The Claimant’s estate filed petitions seeking payment of the previously awarded specific loss benefits. The WCJ, WCAB, and Commonwealth Court all concluded that the estate was only entitled to burial costs. Claimant appealed to the Pennsylvania Supreme Court.
Holding:
The Court held that under Section 410 of the Act, the claimant’s estate is entitled to the full balance of a claimant’s specific loss benefits where the claimant dies without dependents as a result of the work injury before the final adjudication of the specific loss claim. The Court overruled Estate of Harris and Burns insofar as they conflicted with this outcome. The Court noted that Section 410 is not contingent upon the manner of death, or the types of benefits contested.
Takeaway:
This holding appears to apply only to a very narrow subset of claims – namely, claims with a specific loss award in litigation at the time a claimant dies because of the work injury. The Court’s analysis suggests that the outcome would have been different if the Claimant had died after the final adjudication of her specific loss claim. In that case, it seems Claimant’s estate would have only received reasonable burial costs. Thus, the timing of the final adjudication ultimately made the difference between an extra 840 weeks of benefits and just $7,000.00 in burial expenses. This opinion drew sharp criticism from two dissenting justices, who argued that Section 410 only entitles the estate to benefits “due” to the Claimant “to the date of death,” implying that specific loss benefits are exempted because they are not “due” at that time. However, only the legislature can change the Act at this point to close this apparent new loophole created by the Court.
Questions about this case can be directed to John Morgan at 267-861-7580 or jmorgan@tthlaw.com.
Pioneer Construction Co., Inc. v. Insight Pharmaceuticals, LLC
No. 867 C.D. 2022
Commonwealth Court of Pennsylvania
Decided: May 12, 2025
Background:
An insurer mistakenly paid over $30,000 to a pharmacy for compounded medications that had previously been deemed unreasonable and unnecessary through a utilization review (UR). The insurer sought to recover the overpayment by filing a billing review petition, and the Workers’ Compensation Judge (WCJ) issued a decision ordering the pharmacy to repay the insurer. Relying on that order, the insurer filed a praecipe for judgment in the Court of Common Pleas under Section 428 of the Workers’ Compensation Act. The trial court entered judgment, but the pharmacy appealed, challenging the WCJ’s authority to issue the repayment order and the validity of the judgment.
Holding:
The Commonwealth Court reversed the WCJ’s decision and vacated the judgment. It held that WCJs lack subject matter jurisdiction to order medical providers to reimburse insurers, as the Workers’ Compensation Act does not authorize such relief. Section 428 permits only injured workers or their dependents to enforce awards against employers or insurers; it does not permit insurers to obtain judgments against providers. The court further emphasized that equitable arguments cannot substitute for statutory authority. Because the reimbursement order was beyond the WCJ’s legal power, it was void and unenforceable.
Takeaway:
Insurers cannot use the workers’ compensation system to recoup overpayments from providers—even when the payments were clearly made in error. There is no statutory mechanism to compel reimbursement, and WCJ orders directing repayment are unenforceable. Although filing a separate civil action in the Court of Common Pleas remains a theoretical option, that path is uncertain and unsupported by precedent. Recent case law makes clear that the current makeup of courts will not create remedies for employers and insurance defendants where the legislature has not —they’ve reserved that tool for claimants only.
For now, insurers must rely on strong front-end controls—such as UR enforcement and bill review—to prevent improper payments, because recovery options after the fact are extremely limited under current law. Audit everything. Deny early. And triple-check UR outcomes before cutting a check—because once you do, recouping is exceedingly difficult, if not impossible.
Questions about this case can be directed to Christopher L. Scott at 717-237-7111 or cscott@tthlaw.com.
MM Metals USA, LLC v. Warner (WCAB)
No. 668 C.D. 2024
Commonwealth Court of Pennsylvania
Decided: June 4, 2025
A WCJ cannot rely solely on an operative report over a hearsay objection to find that surgery is work-related. A WCJ abuses her discretion by awarding a percentage of all outstanding indemnity benefits due as of the circulation date for untimely Bureau documents.
Background:
The Claimant filed a Claim and Penalty Petition seeking benefits for a left shoulder injury and penalties because a Notice of Denial was not issued until more than 21 days after the alleged date of injury. Notably, the Claimant initially pursued his claim in New Jersey. The Claimant also called out of work due to cold symptoms rather than attributing his absences to a work injury, ultimately leading to his termination. The WCJ granted the claim petition and awarded nearly two years of total disability benefits. The WCJ also found that the Claimant’s left shoulder surgery was work-related based solely on an operative report from a non-testifying physician admitted over the Employer’s hearsay objection. The WCJ then awarded a penalty of 20% of all indemnity benefits due as of the date of her order because of an untimely filed Notice of Denial. Employer appealed.
Holding:
The Commonwealth Court reversed insofar as the WCJ found that the left shoulder surgery was work-related and awarded a 20% penalty of all outstanding indemnity benefits. The Court held that the operative report was properly objected to as hearsay without exception, and under the Walker rule, could not support a finding by the WCJ as there was no other competent evidence in the record to support her conclusion that the surgery was work-related. The Court further held that the penalty here was manifestly unreasonable and “extreme” given the minor technical violation of the Act and the lack of any prejudice to Claimant.
Takeaway:
TTH attorneys Marc Aoun and John Morgan handled this appeal on behalf of the Employer and obtained this favorable outcome. This case shows that WCJs should not penalize untimely filed Bureau documents by awarding a blanket penalty as a percentage of total indemnity benefits due, as it is manifestly unreasonable. This case further demonstrates the importance of raising and preserving objections to hearsay evidence, as it can create a reversible issue on appeal in the event of an adverse decision.
Questions about this case can be directed to Marc Aoun at 610-332-7006 or maoun@tthlaw.com, or John Morgan at 267-861-7580 or jmorgan@tthlaw.com.
SB801 Aims to Expand Liability for Occupational Diseases Under the Act
On June 3, 2025, SB801 was introduced in the General Assembly. This bill significantly expands the potential liability for occupational diseases. Currently, an occupational disease must manifest within 300 weeks of the last date of exposure (or 600 weeks if the occupational disease is cancer suffered by a firefighter) to be compensable. If passed, the bill would enable claimants to meet their burden of proof even when the disease manifested beyond that timeframe by proving that the latency period of the disease is greater than 300 weeks. The claimant has 3 years from the date of diagnosis to file a Claim Petition. If the claimant dies from the occupational disease and was not already receiving benefits, then a death claim must be filed within 300 weeks of the date of diagnosis and 3 years of death. The bill provides that the Act is the exclusive remedy for any injury or disease that may arise out of occupational exposure, whether the disease is compensable or not.
On its face, this bill makes it possible for claimants to pursue claims for occupational diseases that did not arise until decades after the last date of exposure. The purpose of the bill seems to be to subsume all claims for occupational exposure under the Act. This would supersede Toey v. AK Steel Corp., 81 A.3d 851 (Pa. 2013), which held that occupational disease claims that manifest more than 300 weeks after the date of last exposure are not barred by the exclusive remedy provision. The end result could mean the end of those notorious and complex mesothelioma lawsuits with dozens of defendants, though that burden may only be shifted to the workers’ compensation system. Employers and insurers responding to claims under this bill may have the same difficulties when it comes to identifying dates of exposure and insurance coverage. However, unlike in the status quo, the exposure would be limited to wage loss, medical bills, and specific loss, and there would no longer be other damages at play which could be awarded by a jury such as pain and suffering.
Questions about this bill can be directed to John Morgan at (267)-861-7580 or jmorgan@tthlaw.com.