WCRI Report on Provider Choice

The Workers' Compensation Research Institute (WCRI) issued a report entitled The Impact of Provider Choice on Workers' Compensation Costs and Outcomes. The report states panel physicians produce objectively better results, which WCRI attributes to an employer and carrier's superior resources in choosing physicians (Liberty Mutual is touting their system to put an even finer point on this).

WCRI's report admits employees report greater satisfaction with physicians they choose. The authors state this response is inconsistent with the poorer return to work outcomes and higher costs of employee chosen providers.

The rub of course is how the provider balances the conflicting interests of the employer and employee. A procedure that makes excessive medical and disability costs apparent to the employee would control costs without the dissatisfaction of restriction of choice.

Insurance Journal Article

Update: A similar study by the Public Policy Institute of California (using Pennsylvania among others as representative states) made similar findings, but with a twist. If the Claimant chose a physician not on the panel, but who the Claimant had seen before, outcomes vs. a panel doctor were not significantly different. The obvious inference would be that the pre-defined preexisting condition could not become part of the work injury in these cases. Article

Supreme Court Holds Section 301(c)(1) Amendment Is Not Bar To Contract Exception To Coming and Going Rule

In Wachs v. WCAB (American Office Systems & Donegal Mutual Ins. Co.) the decedent had a fixed place of business. He worked in his home office and the employer's home office as a technician supervisor. Earlier, the decedent was a technician. When his employer recruited him back from a competitor, the decedent had demanded and was provided with a company car.

On the date of injury, the decedent was called in to the home office to work on two fax machines a client dropped off to be serviced. He drove his company car. The decedent was killed in an automobile accident.

The Court recognized an injury arising in the course and scope of employment does not include "injuries sustained while the employe is operating a motor vehicle provided by the employer if the employe is not otherwise in the course and scope of employment at the time of injury;..." Because the decedent had a fixed place of employment, the coming and going rule applied.

The Court stated however that all common law exceptions to the coming and going rule remain in effect. These are consistent with the language "if the employe is not otherwise in the course and scope of employment at the time of injury." The exceptions are: 1) claimant's employment contract includes transportation to and from work; 2) claimant has no fixed place of work; 3) claimant is on a special mission for employer; or 4) special circumstances are such that claimant was furthering the business of the employer.

In this case, the fact the decedent demanded and was given a company car made his transportation to and from work a part of the Claimant's negotiated employment contract. Accordingly, the accident was within the course and scope of employment by operation of the contract exception to the coming and going rule.

Article further analyzing case.

Commonwealth Court Publishes SERS Pension Offset Case

The Commonwealth Court granted the motion to publish DPW/Polk Center v. WCAB (King), wherein the WCJ rejected the Commonwealth's request for a pension offset under Section 204(a) of the Act. Linda Miller of the State Employees Retirement System testified the Claimant contributed a specific sum, and SERS further credited the Claimant with interest at the flat rate of 8.5%, then SERS assumed all of the rest of the present value of the Claimant's benefit was contributed by the Employer.

Ms. Miller testified she did not know what contributions were made by the Employer to the Claimant's pension. There was no other testimony presented by the Employer.

The Court stated the relevant inquiry is whether the Employer provided any funding to the plan. The WCJ found there was no evidence it did. The Court was particularly concerned about the flat rate of return used, when real rates of return over the course of the Claimant's employment would be available.

The Court did leave the door open to establishing funding through actuarial calculations, noting there was no finding by the WCJ that the Employer could not determine contributions by way of actuarial tables. The corollary to that observation is that if the actuarial tables told the Employer it did not need to make a contribution, it would not be entitled to a credit under Section 204(a).

The Court also clearly stated the burden to establish what it contributed is on the Employer. In Croom v. WCAB (Pennsylvania Hospital) the Court suggested the burden is on the Claimant, and Petition for Allowance of Appeal to the Supreme Court was denied in Croom on September 28.

The Court finally rejected the Employer's request to remand the case to the WCJ for a determination of what credit is appropriate. On the record presented, no credit was appropriate.

Workers' Compensation Office of Adjudication Has New Web Page

The Workers' Compensation Office of Adjudication has created its own web page containing links to materials for adjudication. There is material including directions to hearing locations, and the relatively new policy wherein the Bureau will provide an interpreter without cost.

Roll over each topic in the middle of the page to see the sub topics.

Three Supreme Court Cases At End Of September

At the end of September the Supreme Court published three significant cases. Generally: Kramer v. WCAB (Rite Aid Corporation) held all employers, not just self-insured ones, can take the severance (and presumably the pension) offset of section 204(a); Reifsnyder, Remp & Hoffa v. WCAB (Dana Corporation) held a Claimant remains "employed" for the Section 309(d) average weekly wage calculation during periods of layoff (without inclusion of unemployment compensation benefits received) and Westinghouse Electric Corporation/CBS v. WCAB (Korach) discussed the Claimant's right to add injuries to the description of injury consistent with the Supreme Court's decision in Jeanes Hospital. Also, the Supreme Court held in Rothrock v. Rothrock Motor Sales, Inc. that a supervisor could not be discharged for refusing to attempt to dissuade an employee from seeking workers' compensation benefits.

C&R Unsigned Before Claimant's Death Cannot Be Approved

S. M. Facchine, et al. v. WCAB (Pure Carbon Co. & PMA Group) held that because the statute requires the Compromise and Release be signed and notarized or witnessed, an Agreement could not be approved when the Claimant passed away before signing. The Court stated the plain language of the statute could not be disregarded with the pretext of pursuing its spirit.

Testimony that a Condition is Subject to Periods of Exacerbation and Remission is Competent to Support Reinstatement After Termination

In C. Taylor v. WCAB (Servistar Corporation) the Claimant suffered from work-related plantar fasciitis in 1993. She worked at light duty until December of 1999, when the plant closed. She had stopped treating for the condition in 1997 and was terminated by Order of the WCJ in July 2000.

The Claimant went back to her doctor for orthotics in September of 2000, then went to work for another Employer in March of 2002. In April of 2002 the Claimant went for treatment again, and in May of 2002, the doctor operated on the plantar fasciitis condition.

The Claimant filed for reinstatement. The WCJ rejected the testimony of the Claimant's physician that there was a recurrence of the Claimant's 1993 condition. The Board affirmed.

The Commonwealth Court noted Claimant's doctor's testimony was uncontroverted, and in its analysis, the Court felt the doctor competently testified the condition "continues through cycles of exacerbations and remissions."

The Board had inserted an analysis that the doctor's testimony of recurrence was inconsistent with the prior finding of full recovery and therefore barred by the doctrine of collateral estoppel. The Court rejected this analysis.

The Court did not analyze whether it was simply incredible that the Claimant's 2002 surgery was related to a 1993 onset of plantar fasciitis pain. The WCJ had rejected the credibility of the Claimant's physician and the Claimant's testimony that her subjective complaints were continuing when the finding of full recovery was made.

The Court remanded the matter to the WCJ "for calculation of benefits and a determination of the responsible employer." Both procedurally and based on the evidence there is no way for the WCJ to find the new employer is responsible. Calculation of benefits will be relevant if the WCJ believed the 2002 disability was related to the injury the Claimant sustained in 1993. The treating doctor's testimony is competent, per the Court's holding.

Another Case Holds Notice Of Ability To Return To Work Is Mandatory

In Allegis Group (Onsite) and ITT Hartford v. WCAB (Henry) the Claimant was suspended by the Employer based on available light duty work. When the Claimant filed a claim petition seeking reinstatement, the WCJ agreed the Claimant was able to return to work as the Employer asserted.

The Board, however, reversed the WCJ's suspension. There was no Notice of Ability to Return to Work.

The Court affirmed the Board. Even though the Claimant filed a claim petition, the Employer had the controlling duty to file the Notice of Ability to Return to Work to be entitled to a suspension.

The Court distinguished Burrell v. Workers' Comp. Appeal Bd. (Phila. Gas Works & Compservices Inc.), 849 A.2d 1282 (Pa. Cmwlth. 2004). The Notice of Ability to Return to Work was not required in that case, but surveillance evidence showed the Claimant working elsewhere, and the Claimant's ability to do that work was substantiated by expert vocational evidence.

The Court stated when suspension or modification is based on new medical evidence, a Notice of Ability to Return to Work is required.

Individuals Performing Community Service Not Employees of County

In W. Mooney v. WCAB (County of Schuylkill) the Claimant was performing community service painting a church when he fell and hurt his arm. The WCJ, Board and Court held the Claimant was not an employee of the County.

The Claimant agreed he received no wages and the County received no benefit from his services, but the Claimant argued he was working under the control of the County coordinator on site and he received mitigation of his sentence for completion of community service.

The Court held the Claimant was not performing services for valuable consideration. Although his sentence was mitigated for participating in community service, this was his option and a function of his sentence imposed by the Common Pleas Court, not a benefit provided by the County.

Commonwealth Court Holds W.C. Security Fund Is Not Subject to Penalties

The Commonwealth Court held in G. Luvine v. WCAB (Erisco Industries) that a penalty may not be awarded against the Workers' Compensation Security Fund. The Court stated the Board was correct to apply the case of Chiconella v. Workers' Compensation Appeal Board (Century Steel Erectors, Inc.), 845 A.2d 932, 935 (Pa. Cmwlth. 2004), which held the Subsequent Injury Fund is not subject to penalties. The Court reasoned that the two funds are not "insurers" under the Act because of their limited purpose and the fact they are not included in the statute's definition of "insurer".

Dismissal For Failure To Prosecute May Be With Prejudice Without WCJ's Statement of Same

In A. J. Clayton v. WCAB (Carpentry Concepts, Inc.) the Claimant did not prosecute his case in three hearings, and did not show up at the second or third hearing. Claimant's counsel didn't show up at the first or third hearing. Although the WCJ's dismissal for failure to prosecute did not state the dismissal was with prejudice, the Board made this determination when it affirmed the WCJ.

The Commonwealth Court affirmed, including the determination of prejudice. The Court primarily relied on the nonappearance without excuse of Claimant and Claimant's counsel at the last hearing.

Injured Worker Poem

The Writer's Almanac featured a poem this morning entitled "No Work Poem #1" by Virgil Suarez. You can read the poem or listen to Garrison Keillor read the poem at the August 17, 2005 edition of the Writer's Almanac. On this archive page, scroll down to get to the August 17 edition.