eNotes: Workers’ Compensation – June 2021
June 03, 2021
SIGNIFICANT CASE SUMMARIES
PA CASE SUMMARIES
Weaver v. Breinig
Commonwealth Court of Pennsylvania
No. 490 C.D. 2021 Pa. Commw. Unpub. LEXIS 224
Decided: April 26, 2021
After parking in her usual spot in Employer’s parking spot, Plaintiff’s slip and fall on ice while walking towards the building was considered in the course and scope of employment.
On February 10, 2017, Claimant fell on her way into work while trying to avoid ice on the sidewalk adjacent to Employer’s building. That day, she parked in her usual assigned parking spot in the small, public parking lot owned by the Borough of Carnegie (Borough), located behind Employer’s building. Employer leased spots in the parking lot from the Borough for its employees. The most direct route to Employer’s building was the route used by Claimant.
The claim was denied on the basis that Claimant’s injury was not within the course and scope of employment. Claimant filed Claim Petitions seeking benefits for her alleged work-related injury.
The Court held that Claimant was within the course and scope of her employment when she fell on the sidewalk because she was walking from one part of Employer’s premises (the parking lot) to another (the building). To be compensable under the Act, a claimant’s injury must arise within the course and scope of employment. Injuries are within the “course and scope” of employment when the employee is injured on or off the employer’s premises, as long as the employee was actually engaged “in the furtherance of the employer’s business.” The Act also provides that an injury is within the course of employment if it is caused by a condition of the premises. Premises include those occupied by or under the control of the employer.
The Court’s analysis involved what actually constituted “premises.” In doing so, the Court took a liberal interpretation. The Court indicated that the critical factor was not the employer’s title to or control over the area, but rather the fact the employer had caused the area to be used by its employees in the performance of their assigned tasks. The Court noted that an injury sustained between a private parking area and the actual worksite is compensable if the parking lot used by the employees was integral to the employer’s business as the means of access to the worksite and thus, within the employer’s premises. Specifically, the Court found that Claimant was injured on Employer’s premises because the area where she fell was within a reasonable means of access to the worksite.
This is an example of just how much the definition of course and scope of employment is expanding in “coming and going” cases such as this one. It is important to determine and acknowledge the control over the areas just outside the Employer’s premises, and ownership alone is not dispositive.
Questions about this case can be directed to A. Catherine McLaughlin at (412) 926-1421 or firstname.lastname@example.org.
Wilson v. WCAB (Sch. Dist. Of Phila.)
Commonwealth Court of Pennsylvania
No. 834 C.D. 2021 Pa. Commw. Unpub. LEXIS 153
Decided: March 19, 2021
A Claim Petition is time barred if it is not received electronically through WCAIS or properly postmarked within three years of the date of injury, even where the claim is accepted on a medical only basis. Additionally, a claimant is entitled to a presumption that her additional injuries are work related where there is an “obvious” connection between the new symptoms and the accepted work injury.
On April 11, 2014, a student struck Claimant in the forehead above her left eye using a “loaded bookbag” while Claimant was working as a substitute teacher for Employer. On May 2, 2014, Employer issued a medical-only Notice of Compensation Payable (MONCP) accepting liability for a head contusion. Three years later, Claimant filed a claim petition alleging head and face contusions with associated vision problems, and sought medical and indemnity benefits. Claimant asserted that she had been out of work since 2016, and sought nearly $25,000 in lost wages. Claimant further sought payment of emergency room and ophthalmology visits for blurriness in her left eye, which had been denied by Employer. Claimant did not present medical evidence linking her vision problems to the 2014 work incident. Claimant testified that she filed her petition in April 2017, though the Workers’ Compensation Automation and Integration System (WCAIS) showed no record of a filed petition. Several weeks later, she contacted the Bureau of Workers’ Compensation, who advised that her petition was not received. Claimant mailed a copy of her petition to the Bureau in an envelope which bore a postmark of May 8, 2017. The Workers’ Compensation Judge (WCJ) denied the Claim Petition, finding that she failed to meet her burden of proof regarding payment of medical bills and that her wage loss claim was time barred. On appeal, the Workers’ Compensation Appeal Board (WCAB) affirmed. Claimant appealed to the Commonwealth Court.
In an unpublished opinion, the Commonwealth Court held that claim petitions generally must be filed within three years after the date of injury. Electronically submitted claim petitions are considered filed upon receipt on WCAIS, and hard copy petitions are deemed filed upon deposit into the mailbox, as shown by a postmark. Thus, because Claimant’s claim petition was postmarked more than three years after the injury, her wage loss claim was time barred.
Next, the Commonwealth Court considered whether Employer’s acceptance of the head contusion required coverage of Claimant’s left eye treatment. In general, the claimant bears the burden of proving that an injury is causally related to the work-related accident. However, if the new symptoms have an “obvious” connection to the work injury, then the employer has the burden to disprove causal relatedness. An “obvious” connection “involves a nexus that is so clear that an untrained lay person would not have a problem in making the connection between the new symptoms and the compensated injury.” The evidence showed that Claimant’s left eye issues were obviously related to the accepted head injury, which was described as a strike above her left eye. An untrained layperson would make the connection between blurred vision and being struck above the left eye with a backpack full of books, and Employer presented no medical evidence to the contrary. Therefore, the court reversed the WCJ and ordered Employer to pay Claimant’s left eye medical bills.
This case presents the unusual situation where the claim for wage loss is time barred and the medical portion is timely. This is a classic example of how seemingly minor inattentiveness or unfamiliarity with the workers’ compensation filing system can have serious consequences for time sensitive filings such as a claim petition. Additionally, this decision shows that the causation element may be established for additional symptoms which have a clear and obvious connection to the accepted work injury.
Any questions regarding this case can be addressed to John T. Morgan, Esquire, at email@example.com or (267) 861-7595.
Johnny Pierson, Jr. v. W.C.A.B. (Consol Pennsylvania Coal Company LLC)
Commonwealth Court of Pennsylvania
423 C.D. 2020 (Pa. Commw. 2021)
Decided: February 9, 2021
In a published opinion, the Commonwealth Court held that the IRE mechanism established by Act 111 applies to all Claims, including those with dates of injury predating October 24, 2018.
Claimant sustained a work injury on August 13, 2014. In 2017, The Impairment Rating Evaluation (“IRE”) mechanism in Section 306(a.2) was found unconstitutional. The IRE mechanism permits an employer to change a claimant’s total disability benefits to partial disability benefits. This is an essential tool for employers because partial disability payments are cap at 500 weeks, while total disability payments have no limit. On October 24, 2018, the Legislative Branch enacted Act 111 in an attempt to cure the IRE’s constitutionality issue. Act 111 contained Section 306(a.3) and Section 3(2), which together formed the new IRE mechanism. Under this new IRE mechanism, employers received credit for any partial or total disability benefit paid before October 24, 2018. Additionally, a change in disability status would occur only if claimant’s impairment rating was less than 35% under the 6th edition of the AMA Guides.
On December 19, 2018, Claimant underwent an IRE, which found his impair rating at 3% under the 6th edition of the AMA Guides. Shortly after, Employer filed a Modification Petition seeking to change Claimant’s total disability status to partial disability based on the December 19, 2018 IRE. Claimant raised constitutional arguments against the applicability of the new IRE mechanism. The Workers’ Compensation Judge (“WCJ”) granted Employer’s Modification Petition as Claimant’s IRE followed the new IRE mechanism and found Claimant’s impairment rate to be less than 35%. The WCJ preserved Claimant’s constitutional argument. Claimant appealed, and the WCAB affirmed, again noting that Claimant preserved his constitutional issue correctly. Claimant appealed to the Commonwealth Court.
On appeal to the Court, Claimant argued that the new IRE mechanism could not apply retroactively to his claim because his claim originated before October 24, 2018. Claimant asserted that he had a vested right to benefits as calculated at his time of injury. Therefore, Claimant reasoned that the new IRE mechanism could not affect the calculation of his benefits because no such mechanism existed at his time of injury. The Court rejected Claimant’s argument, noting that a reasonable expectation exists that benefits may change under the Act. The Court further stated that the enactment of the new IRE mechanism did not take away any rights because it did not automatically change Claimant’s disability status but instead only establish the means and requisites for changing Claimant’s disability. Accordingly, the Court held that Act 111 applied to Claims originating before October 24, 2018. The Court affirmed the WCAB’s decision.
The Court’s holding clarifies that the new IRE mechanism enacted on October 24, 2018, applies to all dates of injury, including those that predate October 24, 2018. In short, the Court’s decision gives Employers back its tool to cap Claimant’s disability payments.
Questions about this case can be directed to Marjorie Moreno at (717) 237-7155 or firstname.lastname@example.org.
VA CASE SUMMARY
Alice Buehler v. Virginia Beach City Public Schools
Virginia Workers’ Compensation Commission
Decided: May 18, 2021
In a majority opinion issued by Commissioner Rapaport, the Commission affirmed a denial of benefits on grounds that Claimant failed to provide timely notice, and did not have a justifiable reason for her delayed reporting. Commissioner Marshall issued a dissent, arguing that the delay was justified and benefits should be awarded.
Claimant testified that she rolled her ankle on a piece of gravel and fell as she stepped down to exit the building. She felt stinging everywhere on her left side, and saw a little blood on her scraped ankle. This fall occurred on December 20, 2019, but Claimant did not report the accident day, because she didn’t think she was hurt or injured. She treated with an ice pack and Tylenol, and although the ankle was achy and sore, she did not think it was worth reporting. She finally sought treatment on February 17, 2020, where she was diagnosed with an avulsion fracture of the left fibula. The Deputy Commissioner denied benefits, because Claimant did not report the accident within the requisite 30 days, and Claimant’s excuse was not justified.
The Full Commission affirmed the denial of benefits. The majority disagreed with Claimant’s explanation that she perceived her injury to be trivial, given that Claimant’s text messages to a co-worker on the date of the accident, along with her admission that she experienced multiple, persistent symptoms of ongoing pain and swelling since the accident.
This was not like the Phelps case, as Claimant suggested. In Phelps, a claimant who was receiving ongoing care for aches and pains did not take an injury seriously because she initially perceived the pain to be the same pain for which she was already treating. This was a reasonable excuse for delay in providing notice. In Claimant’s case, however, she was not undergoing any such treatment, so the ongoing pain was clearly related to the accident. Because Claimant had no reasonable excuse for failure to report the accident within 30 days, the Full Commission denied benefits.
Commissioner Marshall dissented. He would have found that Claimant was reasonable in her delay, since the symptoms were benign enough that she did not treat until February 17. She did not know, and reasonably could not have known, that she suffered a fracture until treatment.
In cases like this, where Claimant does not dispute that notice was given late, the focus turns on whether the late notice was justifiable. That question is incredibly fact-specific, and requires much care in crafting discovery. For instance, the Majority relied on the text messages sent on the date of the accident. Without those text messages, this case could have easily turned the other way.
Questions about this case can be directed to Michael Bliley at (571) 464-0435 or email@example.com.