Justia Public Benefits Opinion SummariesArticles Posted in Pennsylvania Supreme Court
Gentex Corp v. Workers’ Compensation Appeals Bd.
Appellant Anne Marie Morack worked for Appellee Gentex Corporation for over thirty years. In 2005, she left when swelling and pain in her hands were too overwhelming for her to continue work. She sought medical help, and notified her employer of the pain. In early 2005, Appellant applied for short-term disability, noting on her application for benefits that she did not believe her injury was work-related. After consultation with a specialist, Appellee learned that her injury was work-related. Gentex ultimately appealed the Workers' Compensation Appeal Board's decision granting Appellant's claim to the Commonwealth Court, contending that Appellant did not timely notify her supervisor of the injury nor aptly describe the injury to comply with the state workers' compensation act. The Commonwealth Court reversed, finding Appellant did not aptly describe her injury nor give Gentex adequate notice. The Supreme Court granted allocatur to determine what constitutes sufficient notice under the Act, and to "speak to" an employer's duty to conduct reasonable investigations into the circumstances surrounding a work-related injury. Under the Act, notice is a prerequisite to receive workers' compensation benefits, and the claimant bears the burden of demonstrating that proper notice was given. Upon review of the applicable case law in this instance, the Court found that, "consistent with the humanitarian purposes of the Act, [the Court] made it clear that even imperfect notice can satisfy" its strictures. The Court employed a "totality of the circumstances" approach to determining whether Appellant in this case both satisfied the notice and description of the injury in making her claim for benefits. In reversing the Commonwealth Court, the Supreme Court found that Appellant's collective communications with Gentex satisfied the notification requirements of the Act.
Bur. of Workers’ Comp., Aplt v. WCAB
Claimant Kevin Ressler suffered a work-related injury in 1995. He received Workers' Compensation benefits. In 2004, Claimant submitted to an independent medical evaluation (IME). The sequence of events since the IME make up the heart of this appeal. In June 2004, Claimant had surgery related with his work-related injury. In July 2004, his employer petitioned to terminate benefits as of the date of the IME. The employer also requested a supersedeas. The Workers' Compensation Judge (WCJ) denied the superseadas in August 2004. In October of that year, the insurer received the invoice for the June surgery and paid the amount by the end of January, 2005. In June 2005, the WCJ granted the employer's petition to terminate benefits. The Workers' Compensation Appeal Bard (WCAB) affirmed that decision. The insurer then requested reimbursement for the 2004 surgery from the Supersedeas Fund. The Bureau of Workers' Compensation challenged the request because Claimant's surgery predated the supersedeas request. The WCJ found that no obligation to pay arose until the bill was submitted to the insurer in October 2004. Because the obligation to pay arose after the denial of supersedeas, reimbursement was appropriate. The WCAB affirmed. The issue of whether the Supersedeas Fund may deny reimbursement of treatment rendered before the insurer requested supersedeas came before the Supreme Court. Upon review of the trial record and the Workers' Compensation Act, the Court concluded that the lower courts appropriately ordered reimbursement to the insurer for undue payments made after the supersedeas request and in direct response to the earlier denial. The Court affirmed the lower court's decision.
Crozer Chester Med. Ctr. v. Dept. of Labor & Ind.
The Commonwealth Court declined to issue a writ of mandamus to Appellant Crozer Chester Medical Center (Crozer) in its attempt to force the Department of Labor and Industry (Department) to reimburse it for medical fees. Claimant William Radel suffered a work-related injury while lifting a bundle of rebar for his employer. The claimant underwent surgery at Crozer, and Crozer sent claimant's records and the bill to claimant's insurance company, Zurich North American Insurance (Zurich). Zurich did not pay, nor did it deny the claim. Crozer then turned to the State for reimbursement. The Department rejected the application as "premature," because Zurich's non-payment made an "outstanding issue of liability/compensability for the alleged injury." Crozer then petitioned the Commonwealth Court to force the Department to pay. The Supreme Court agreed that Crozer's application for reimbursement was premature. The Court found that Crozer did not try to resolve Zurich's nonpayment before petitioning the State or the Commonwealth Court. The Court affirmed the decision of the Department and the lower court, and dismissed Crozer's petition for a writ of mandamus.