Opioid medications have become a major problem in the New Jersey workers’ compensation system.  The number of workers being prescribed opioids has increased dramatically along with other attendant issues, such as addictions to the medications, excessive periods of use, and large numbers of unused opioid pills.  Every workers’ compensation professional can attest to these and other problems with opioid medications, including cases where urine testing shows no trace of opioids in the system despite repeated renewals of prescriptions.

            A draft of a bill to be introduced in the New Jersey Senate proposes that medical expenses shall not include coverage of opioid drugs unless the prescribing doctor does the following:

            1) takes a thorough medical history and physical examination focusing on the cause of the patient’s pain;

            2) does a complete assessment of the potential addiction of the patient to opioids, which would include a baseline urine test and assessment of past and current depression, anxiety disorders and other mood disorders associated with risk of opioid abuse;

            3) provides a written treatment plan with measurable objectives, a list of all medications being taken and dosages, a justification for the continued use of opioid medications, a description of the pain relief from the medications, documentation of attempts at weaning, a description of how the patient responds to the medication, and alternative treatments under consideration;

            4) provides a description of either sustained improvement in function and pain reduction or consultation with a pain management specialist (if the dosage exceeds 120 mg morphine-equivalent dose or if the duration of treatment exceeds 14 days);

            5) provides an explanation to the patient of the risks and benefits of the prescribed medications and expected duration of treatment.

            The Act will allow an employer, carrier or TPA to disqualify any physician from its network who fails to provide such documentation.  If approved, this Bill would be a major step forward for the New Jersey workers’ compensation system.  New Jersey is a member of the National Prescription Drug Monitoring program, which allows physicians to check on an electronic database for prior or current prescriptions for controlled substances before dispensing narcotic pain medication to a patient. 

The PDMP program along with this proposed bill would go a long way to curb the abuse of opioid medications in workers’ compensation, often among patients who have a history of problems with opioids and other controlled substances.  The bill simply establishes a list of best practices that physicians would need to follow in order to prescribe opioids in the workers’ compensation system, as well as in personal injury protection coverage in automobile insurance. It would not prevent the dispensing of medications to those with chronic or short term pain; it would simply require the physician to undergo careful written analysis before making the decision to prescribe opioid drugs.  Many pain management doctors already engage in these practices and require their patients to sign pain management contracts allowing for urine testing.  However, not all physicians who prescribe opioid medications follow these practices, and this Bill is aimed squarely at those physicians

Jennifer Caswell andErin Fox successfully obtained a reversal of the trial court’s award of medical and indemnity benefits to the claimant following an appeal. The trial court awarded additional medical evaluation and ongoing temporary total disability benefits. The Nebraska Court of Appeals agreed with the employer’s argument that there was insufficient evidence in the record to support the trial court’s finding that the employee’s work caused her injury. The Court also agreed that some portions of the trial court’s decision were clearly erroneous. Therefore, the decision was reversed in full and no benefits were due.
Roness v. Wal-Mart Stores, 21 Neb. App. 211 (2013).

Nancy Haley worked as a Registered Nurse for Community Mercy Health Partners doing business as Springfield Regional Medical Center (hereinafter SRMC).  She began there in June of 1978.  In November 2009, she was diagnosed with breast cancer and underwent two surgical procedures.  She took approximately five and a half weeks of FMLA leave during this time period and returned to work on January 18, 2010.

SRMC had a progressive discipline policy which involved discipline pursuant to “Corrective Action.”  There were four steps in the Corrective Action process, the first of which was an oral warning.  The second step involved a written warning, the third a “final warning,” and the last led to termination. 

In the summer of 2009, SRMC issued a written warning because Haley missed pages while she was on call.  She did not initially respond to the hospital’s page, was called at home, and arrived at the hospital 37 minutes after the initial page on June 2, 2009.  A similar incident occurred a month later.

SRMC placed Haley on level three discipline in November 9, 2009 for two incidents involving patient “site marking,” which required marking the site of surgery for the surgeon.  On October 9, 2009, Haley took an unmarked patient in the operating room. 

Haley used several FMLA days in 2010 for her serious health condition.  The last FMLA day was April 16, 2010.

On February 12, 2010, Haley’s husband was transported to SRMC with a serious heart condition.  Haley contacted SRMC regarding her inability to work her shift that day and the next two days. SMRC marked her absence on February 12, 2010 as unexcused.

Three days after returning from her April 16, 2010 FMLA leave, SRMC terminated her employment.  Haley’s absence on February 12, 2010, when she was with her husband, was listed as one of the three unexcused absences on the Corrective Action form completed in support of her termination.  Her three unexcused absences along with 11 instances of tardiness were listed as the reasons for placing her at the final termination stage.

Haley sued for violations of her FMLA and ADA rights.  She argued that her cancer condition was covered under the ADA. The court said, “Haley’s cancer was a physiological condition affecting multiple body systems and was treated by a mastectomy, resulting in an anatomical loss.  It unquestionably qualifies as an impairment under the ADA.”

Next, the court considered whether that impairment substantially limited a major life activity with reference to the Americans with Disabilities Act Amendment Acts of 2008. “A major life activity may also include ‘the operation of a major bodily function’ such as ‘’normal cell growth.’”The court added:

A reasonable jury could conclude that Haley was disabled under the ADA, and therefore fulfills the first element of her prima facie claim  She was obviously disabled when the cancer was active, as it substantially limited the major life activity of normal cell growth.  In addition, the cancer substantially limited the major life activity of her work.  Haley took extensive time off for surgery and recuperation between the end of November 2009 and January 18, 2010, during which time she could not work at all.

The Court noted that it does not matter that the cancer was in remission at the time her employment was terminated.  She was still covered under the ADA.

SRMC argued that Haley said in her deposition before trial that she did not consider herself disabled.  The court said that Haley’s own statements “are not particularly probative of the determination of whether she is disabled under the ADA, which is a legal definition quite distinct from the colloquial meaning of ‘disabled.’”  The Court held that Haley made out a prima facie case and therefore denied SRMC’s motion for summary judgment, leaving the matter for the jury to decide.

On the FMLA issue, the court held that a jury “could reasonably conclude that Haley gave sufficient and timely notice that FMLA leave might apply to her absence on February 12, 2010, because SRMC knew of it the day it occurred and it concerned her husband’s serious medical condition.”  The court said that a reasonable jury could conclude that SRMC denied her FMLA leave by categorizing her February 12, 2010 absence as unexcused.

This case is a reminder to employers to fully analyze FMLA and ADA considerations before making termination decisions, even if there is a specific step plan of discipline in place. The case may be found atHaley v. Community Mercy Health Partners, 2013 U.S. Dist. LEXIS 11193 (January 28, 2013).

On September 27, 2013, the Alabama Supreme Court released its opinion in Ex parte Schnitzer Steel Industries, Inc. wherein it addressed the discoverability of post-accident investigation reports.　　 The subject report was prepared following a workplace accident resulting in an amputation.　The trial court initially ruled that the report was privileged and not discoverable.　The judge later reversed that ruling and ordered that the report be produced.　The employer then petitioned the Alabama Supreme Court for a writ of mandamus directing the judge to vacate the order.

On appeal, the employer argued that the report was prepared in anticipation of litigation and, thus, protected as work product.　 On the flip side, the employee argued that the employer conducted post-accident investigations and prepared reports containing the findings of the investigation for all accidents regardless of whether or not there was any anticipation of litigation.

In this case, the employer’s workers’ compensation manager testified that there was no written policy that a post-accident investigation be undertaken and that such a report　is only prepared when litigation is anticipated.　The employer’s safety director, however, testified that the report was prepared in the normal course of business and to address safety concerns and not in anticipation of litigation.　The Court resolved the inconsistencies between the two deponents by pointing out that, while it is necessary for the report to be prepared in anticipation in order to be afforded the protection of the work product doctrine, it does not have to be the sole reason.　　 Since it was reasonable under the circumstances for the employer to assume that litigation could be expected, the Court granted the petition　 and issued the writ directing the trial court to vacate its order granting the motion to compel the discovery of the report.

My Two Cents:

This opinion makes it very clear that employers must reasonably expect future litigation when preparing investigative reports in order to enjoy the protections of the work product doctrine.　 A standard post-accident investigation report may end up being discoverable unless it can be shown that there was some perceived threat of a lawsuit at the time the report was created.　 For this reason, it is advisable to do something different than your standard operating procedure when you do expect litigation such as involve an attorney in the investigation phase of a claim.

_______________________

About the Author

This article was written by Michael I. Fish, Esq. of Fish Nelson LLC, a law firm dedicated to representing employers, self-insured employers and insurance carriers in workers’ compensation matters. Fish Nelson is a member of The National Workers’ Compensation Network (NWCDN). If you have any questions about this article or Alabama workers’ compensation issues in general, please feel free to contact the author atmfish@fishnelson.com　or any firm member at 205-332-3430.

On September 20, 2013, the Alabama Court of Civil Appeals released its opinion in the case of Malone v. Steelcase, Inc., dealing with the applicability of § 25-5-57(c)(3) of The Alabama Workers’ Compensation Act. § 25-5-57(c)(3), known as the set-off statute, provides that an employer is allowed a set-off against compensation benefits owed to an injured employee when the employer continues the salary of the employee during the period in which benefits are owed. Malone suffered an injury to her lower back occurring in and arising out of her employment with Steelcase, but she was able to return to her job earning wages equal to those she was earning prior to the injury. The trial court awarded permanent partial disability benefits for a 25% disability to Malone’s body as a whole, in the amount of $81.54 per week. However, the trial court also awarded Steelcase an offset in the amount of $67.30 per week for wages Steelcase paid to Malone after she was placed at maximum medical improvement, pursuant to § 25-5-57(c)(3). Malone appealed, and the Court of Appeals reversed the trial court’s decision.

Malone argued that § 25-5-57(a)(3)i, which is often referred to as the "return to work statute" was controlling, and that under that statute, her compensation for her injury was to be based on her physical disability rating, without consideration for loss of earnings capacity. Malone argued that under that statute, Steelcase was not entitled to a set-off, because § 25-5-57(c)(3) did not apply to her situation. In reaching its decision, the Court of Appeals stated that it agreed with Malone, because when two statutes conflict, the "more specific" statute is controlling, and § 25-5-57(a)(3)i is the more specific statute. The Court further stated that § 25-5-57(a)(3)i would be rendered meaningless under the interpretation of the set-off statute advocated by Steelcase. The Court of Appeals noted that benefits awarded in cases where the return to work statute applies, like scheduled benefits, should be awarded regardless of whether an employee is receiving full wages.

_______________________________

MY TWO CENTS:

The Court of Appeals’ analysis begs the question: So exactly when does the set-off statute apply? The Court of Appeals’ ruling is interesting in that it found that § 25-5-57(a)(3)i would be rendered meaningless if the employer was allowed an offset against an award for wages paid in situations where the employee is earning wages equal to her pre-injury wage. The decision further implies that the set-off statute does not apply in scheduled member injury cases either, for the same reason. The only other statute that applies to permanent partial disability awards is § 25-5-57(a)(3)g, which provides that an employee’s compensation for injury is equal to 66 2/3% of the difference between her average weekly earnings at the time of the injury and the average weekly earnings she is able to earn in her partially disabled condition. It certainly seems that if the legislature intended that the set-off statute only apply to awards made under § 25-5-57(a)(3)g that the statute would clearly and unambiguously state as much. However, the answer is contained in the statutory language concerning the employer continuing the salary of the employee. It appears that the Court of Appeals’ interpreted it to mean when the employer continues thefull salary of the employee. In other words, when the employer is paying the employee herfull wages for either performing less work, or for performing a less demanding job, the employer is entitled to a set-off, but when the employee is performing her regular job for her regular wages, the employer is not entitled to a set-off.

_______________________________

ABOUT THE AUTHOR

This article was written by Charley M. Drummond, Esq. of Fish Nelson, LLC. Fish Nelson is a law firm located in Birmingham, Alabama dedicated to representing employers, self-insured employers, and insurance carriers in workers’ compensation cases and related liability matters. Drummond and his firm are members of The National Workers’ Compensation Defense Network (NWCDN). The NWCDN is a national and Canadian network of reputable law firms organized to provide employers and insurers access to the highest quality representation in workers’ compensation and related employer liability fields. If you have questions about this article or Alabama workers’ compensation issues in general, please feel free to contact the author at cdrummond@fishnelson.com or (205) 332-3414.

Employers cannot always make accommodations to persons with disabilities, and the obligation only arises if the employee can show that he or she is qualified to perform the essential functions of the job with or without accommodation. 

            In the case of Atkins v. Eric Holder, Attorney General, 2013 U.S. App. LEXIS 12340 (4^th Cir. 2013), the plaintiff was a Correctional Counselor for the Federal Bureau of Prisons.  He suffered from a disability due to polyarthropathy of the right  knee and degenerative disc disease.  As a result of his medical conditions, he had significant restrictions limiting the amount of time he could walk or stand.  In fact, he utilized two metal canes and stated that sometimes he was afraid for his safety in working.  His doctors indicated that his restrictions were permanent in nature.

            The Bureau of Prisons terminated Atkins’s employment because it concluded that there was no way for him to safely perform his job.  Atkins sued and argued that he was discriminated against on the basis of his disability.  The federal district court and the Fourth Circuit Court of Appeals rejected his law suit.  It laid out the requirements for Atkins to prove his case:  “(1) that he has a disability; (2) that he is otherwise qualified for the employment or benefit in question; and (3) that he was excluded from the employment or benefit due to discrimination solely on the basis of the disability.”

            The Court ruled in favor of the Federal Bureau of Prisons on the ground that Atkins could not show he was otherwise qualified:

There is no dispute that Atkins was disabled at the time of his termination.  However, we conclude that the district court did not err when it held that Atkins was not otherwise qualified for his position.  Only persons who are ‘qualified’ for the position in question may state a claim for disability discrimination.

The Court went on to explain that the plaintiff has to show that he can perform the essential functions of the employment position that he holds or desires.  42U.S.C. § 12111(8) (2006). See also 29 C.F.R. § 1630.(m) (2012).  It further held:

At the time of his termination, Atkins was under several medical restrictions that significantly curtailed the time he was allowed to walk or stand.  Prior to being barred from the institution, Atkins was assisted by two metal canes with forearm braces and stated that he was afraid for his safety.  Because the correctional counselor position was a law enforcement position that required Atkins to physically restrain and control inmates, and no accommodation could be made to alleviate his restrictions, we conclude that Atkins did not make a prima facie claim for disability discrimination.

On September 9, 2013, the Alabama Court of Civil Appeals released its opinion inSouthernCare, Inc v. Margaret Cowart wherein it reaffirmed that a mere possibility does not establish medical causation. Although it affirmed the trial court’s finding of medical causation, it reversed the permanent and total disability award and remanded it for the trial court to determine the level of disability.

The facts before the Court involved a preexisting back injury and then 4 separate accidents injuring the lower back over a 3 year period with SouthernCare, Inc. Prior to a 2004 fall on the job, Cowart had a preexisting back injury but she had been working without restriction. After the 2004 fall and injury, Cowart had periods of disability but returned to full duty. She then had 2 incidents in 2005 and 2 in 2007 where she felt pain in the same region and of the same nature as she did after the 2004 fall. After the 2007 injury was determined not to be work related by the employer, Cowart returned to work but testified that she worked in constant pain. Cowart suffered another accident on the job injuring the same area of the back but testified that the pain was even more excruciating this time.

Cowart was seen by several different doctors and all the medical records indicated that the tests were unremarkable and that Cowart’s symptoms were degenerative or related to fibromamyalgia and not work related. After the June 2007 injury Cowart was treat by Dr. James White. Dr. White opined that without further testing he could not say if stenosis was causing the symptoms or if there was a herniated disk below the stenosis. Dr. White also testified that without further testing he could not say if the injury was work related. He did testify that the back pain could be due to fibromyalgia but the fact that Cowart did not have radiating pain prior to the first fall in 2004 indicated that fibromyalgia was not causing the current symptoms.

The trial court considered the medical records, Dr. White’s testimony and heard the plaintiff’s testimony in a compensability hearing and found the injury compensable and ordered the tests requested by Dr. White. The trial court later held a disability hearing with the only testimony being the employer’s vocational expert, which resulted in a permanent and total disability award. The employer then appealed the compensability decision and the permanent and total disability award.

The Court of Civil Appeals reviewed the testimony but did not re-weigh the evidence as it related to the decision on medical causation and permanent and total disability. The Court noted that the applicable standard for medical causation set forth by the Alabama Supreme Court was the evidence must establish more than a mere possibility that the injury was caused by the work place accident.Ex parte Southern Energy Homes, 873 So. 2d 1116, 1121-22 (Ala. 2003). The court also stated the "expert medical testimony is not always required to establish medical causation; however, an employee’s testimony, while not always insufficient alone to establish medical causation, cannot establish medical causation when ‘the evidence as a whole weighs heavily against finding the [employee’s] testimony alone to be substantial evidence of medical causation.’"Id at 1122. In the instant case the Court of Appeals noted that the only record that specifically said the injury was not related was from a doctor that reviewed the wrong MRI after the first 2007 incident. In addition, Cowart’s doctors stated that her symptoms were related to degenerative problem and/or fibromylgia. The Court then turned to the only detailed opinion on the subject of medical causation, Dr. White’s deposition testimony. This testimony stated that without further testing he could not say if the symptoms were related to the falls at work or not but that it was not until after the fall that Cowart reported radiating pain. The Court of Appeals then turned to Cowart’s testimony to determine if, when viewed with all the evidence, it could provide substantial evidence as to medical causation. Cowart’s testimony was that prior to the 2004 fall her fibromylgia had seldom caused her to miss work. She also testified that after the first fall she had returned to work at full duty with several subsequent incidents causing severe pain in the same region of her back. Cowart further testified that after the first incident in 2007 she returned to work but was in constant pain. The Court of Appeals pointed out that the trial court may infer medical causation from circumstantial evidence that indicates the employee was working normally before the incident, but afterwards the symptoms appeared and continued. Based on this, the Court of Appeals found that substantial evidence was present for the trial court to find medical causation.

The Court of Appeals did find that there was not sufficient evidence to support the permanent and total disability award. They pointed to Cowart’s testimony that she had been able to perform her duties despite her pain, her testimony that she desired to return to work and the employers vocational expert stating she had transferable skills and no loss of earnings capacity. Based on this, the Court of Appeals found there was not sufficient evidence to support a permanent and total disability award and the trial court should review the evidence again to determine the level of disability.

Of Note:

It has long been the position of the Alabama Appellate Courts that they are not to re-weigh the evidence in a workers’ compensation appeal. However, Judge Moore, in his concurring opinion, stated that when the legislature eliminated the certiorari review of workers’ compensation case in 1992 and created the substantial evidence standard, the standard of review for an appeal also changed. Judge Moore stated that the prior standard of review applicable to certiorari review only required support by any evidence, not substantial evidence. Therefore, by changing to the substantial evidence standard the legislature intended to change the standard of review and allow the Court of Appeals to re-weigh the evidence. Judge Moore also asserted that, under the current ruling by the Alabama Supreme Court, the Court of Appeals cannot re-weigh the evidence and must leave the trial court’s ruling alone if there is any evidence that supports the trial court’s ruling, which is the same as the certiorari review pre 1992 amendment. With the legislature creating the substantial evidence standard, Judge Moore opined that the Court of Appeals should be allowed to re-weigh the evidence to establish if there is substantial evidence and not just any evidence to support the decision.

ABOUT THE AUTHOR

The article was written by Joshua G. Holden, Esq. a Member of Fish Nelson, LLC, a law firm dedicated to representing employers, self-insured employers and insurance carriers in workers’ compensation and related liability matters. Mr. Holden is AV rated by Martindale-Hubbell, which is the highest rating an attorney can receive. He is the current Chair of the ABA/ TIPS Workers’ Compensation and Employers’ Liability Committee. He is also on the Board of the Alabama Workers Compensation Organization and a member of numerous other associations and organizations. Holden has been selected as a "Rising Star" by Super Lawyers.

Holden and his firm are members of The National Workers’ Compensation Defense Network (NWCDN). The NWCDN is a national and Canadian network of reputable law firms organized to provide employers and insurers access to the highest quality representation in workers’ compensation and related employer liability fields.

If you have questions about this article or Alabama workers’ compensation issues in general, please feel free to contact the author atjholden@fishnelson.com or 205-332-1428.

A POSTSCRIPT TO PENNSYLVANIA RETIREMENTS INVOLVING WORKERS’ COMPENSATION

By

Jeffrey D. Snyder, Esquire and Kevin L. Connors, Esquire

On the Achilles heel of the Pennsylvania Supreme Court’s recent Opinion in theCity of Pittsburgh UPMC v. WCAB, a Decision that discussed the burden of proof in voluntary withdrawals from the workforce cases, the Commonwealth   Court has now rendered an Opinion on that same issue inFitchett v. WCAB, decided on April 8, 2013.

Fitchett involved a 2001 injury.

The Claimant was working as a Teacher’s Instruction Aide, and was injured in a student attack.

Multiple Petitions were litigated, including a Termination Petition, a Review Benefit Offset Petition, and a Penalty Petition.

Obviously, the employer, the PhiladelphiaSchool District, was litigating the Termination and Review Petitions, and the Claimant was retaliating with a Penalty Petition.

Oddly enough, there were no pleadings, nor amendments to pleadings, under which the employer had alleged that it was seeking a suspension of indemnity compensation benefits, based on the Claimant’s voluntary withdrawal from the workforce.

That issue was, however, nevertheless the subject of testimony in the course of the claim being litigated before the WCJ.

The Claimant began receiving Pension benefits in April of 2002, and then began receiving Social Security Retirement benefits in October of 2004.  After the work injury, the Claimant never sought any other work as the Claimant agreed that she was collecting “retirement” with her testifying that “but for” her work injuries, she would have continued working.

Questioned as to whether she had retired, she responded “at this point”, … “yes”, although she clarified her testimony, by indicating that she had left the workforce because of her work injuries.

She testified that she would still be working, if she was able to do so.

The WCJ found that the Claimant had retired, and voluntarily withdrawn herself from the workforce.  On credibility issues, the WCJ commented that the Claimant’s testimony “sounds good”, but “on close inspection falls apart”.

Moreover, the WCJ found that the surgery that the Claimant had undergone was unrelated to the work injury, that the Claimant had not searched for employment of any sort, while the Claimant was contending that she took a Pension benefit, as well as, Social Security Retirement benefits due to financial hardship, but that at the time she applied for the Pension benefits, she was receiving workers’ compensation benefits.

The Workers’ Compensation Appeal Board affirmed the WCJ’s Decision.

Before the Commonwealth Court, the Claimant argued that the WCJ had erred in deciding the issue of voluntary retirement, claiming that the employer never requested a suspension of benefits on the basis of retirement, and that there had never been any amendments to the pending Petition seeking that form of relief.

Brushing aside the Claimant’s arguments, the Commonwealth Court held that the issues before the WCJ and WCAB included issues related to the employer’s entitlement to an offset for Pension and Social Security Retirement benefits, such that the presence of those offset issues should have put the Claimant on general notice that her wage loss benefits could be suspended, based on a voluntary withdrawal from the workforce, under the “totality of the circumstances”, a legal nexus that the Pennsylvania Supreme Court had utilized in the City of Pittsburgh UPMC Decision, a recently issued decision.

No less true, the Commonwealth Court held that the issue of the Claimant’s voluntary retirement had been fully litigated before the WCJ, and that issue had been preserved for the WCAB.

Holding that the employer need not prove the availability of suitable work, when the employer establishes, under a totality of the circumstances, that a Claimant has voluntarily retired from the workforce, theFitchett Court also considered that a voluntary retirement from the workforce can be presumed from the acceptance of a Retirement Pension, a holding seemingly in some conflict with the Pennsylvania Supreme Court’s Decision inCity of Pittsburgh UPMC.

If we are to remove the notice issue from the Fitchett Decision, as the Claimant had argued that she did not have “notice” of the potential suspension of her workers’ compensation benefits based on a voluntary withdrawal from the workforce analysis, the Commonwealth Court appears to be following the Opinion rendered by the Supreme Court in theCity of Pittsburgh UPMC, with two key caveats.

The first, is that the Fitchett Court appears to be of the view, in stark contrast to theCity of Pittsburgh UPMC holding, that the receipt of a Retirement Pension benefit results in a rebuttable presumption of a voluntary withdrawal from the workforce.

Secondarily, the Fitchett Court is indicating that the issue of a voluntary withdrawal from the workforce is a matter of credibility for the WCJ to decide, making it a question of fact, rather than a pure question of law, or even a mixed question of fact and law.

What remains as the clear directive is that when an employer seeks to establish a voluntary withdrawal from the workforce, it remains the employer’s burden of proof to establish that a Claimant has done so under a “totality of the circumstances”, as is the holding of the Supreme Court in the City of Pittsburgh UPMC.

Practical Tips

Get it in writing!

Sustain your burden!

Make it real!

Make the Claimant look incredible!

ConnorsLaw LLP

Trust us, we just get it!  It is trust well spent!

Defending workers’ compensation claims throughout Pennsylvania for employers, self-insureds, insurance carriers, and third party administrators, our 100+ years of cumulative experience defending our clients against compensation-related liabilities, empowers our workers’ compensation practice group attorneys to be more than mere claim denials, entrusting us to create the factual and legal leverage to expeditiously resolve claims, in the course of limiting/reducing/extinguishing our clients’ liabilities under the Pennsylvania’s Workers’ Compensation Act.

With every member of our workers’ compensation practice group being AV-rated, our partnership with the NWCDN magnifies the lens through which our professional expertise imperiously demands that we always be dynamic and exacting advocates for our clients, businesses, corporations, and insurance carriers, seeking our trial and compensation acumen, navigating the frustrating and form-intensive minefield pervasive throughout Pennsylvania workers’ compensation practice and procedure.

“YOU TALKIN TO ME?”

By Jeffrey D. Snyder, Esquire and Kevin L. Connors, Esquire

The Pennsylvania Supreme Court’s recent Decision in Bowman v. Sunoco, Inc., decided on April 25, 2013, validates an agreement that an employee had entered into, when initially hired by her employer, Allied Barton, under which the employee agreed that he/she would not bring a third-party claim or action against Allied Barton’s customers, in the event of a work injury which might otherwise have triggered consideration of third-party liability, predicated in a tort-based negligence action for personal injuries.

Thus, we are talkin to you!

Bowman involved a private security guard employed by Allied Barton Security Services, who had signed a workers’ compensation disclaimer, under which she had waived her right to sue Allied’s clients for damages related to any injuries that would otherwise be covered under the Pennsylvania Workers’ Compensation Act.

The disclaimer stated:

            “I understand that state workers’ compensation statutes cover work-related injuries that may be sustained by me.  If I am injured on the job, I understand that I am required to notify my manager immediately.  The manager will inform me of my state’s workers’ compensation law as it pertains to seeking medical treatment.  This is to assure that reasonable medical treatment for an injury will be paid for by Allied workers’ compensation insurance.

            As a result, and in consideration of Allied Security offering me employment, I hereby waive and forever release any and all rights that I may have to:

-          Make a claim, or

-          Commence a lawsuit, or

-       &nnbsp;  Recover damages for losses

from or against any customer (and the employees of any customer) of Allied Security to which I may be assigned, arising from or related to injuries which are covered under the workers’ compensation statues”.

Falling on either snow or ice while providing security at a Sunoco refinery, the employee filed a workers’ compensation benefits claim, and then received workers’ compensation benefits pursuant to the Pennsylvania Workers’ Compensation Act.

She then filed a negligence lawsuit against Sunoco, under which she alleged that Sunoco had been negligent in failing to maintain and inspect its premises, resulting in the employee sustaining her work-related injuries.

In the course of discovery being conducted in the personal injury lawsuit, the employee’s disclaimer, entered into at her hiring by Allied Barton, was produced through discovery, evidencing the employee’s waiver of her right to file a personal injury claim against Allied Barton’s clients or customers, as well as evidencing her receipt of workers’ compensation benefits, with Sunoco filing a Motion for Judgment on the Pleadings, in support of which Sunoco argued that the employee’s negligence claim had to be barred by the employee’s voluntary disclaimer and waiver.

The employee argued that the disclaimer was void, claiming that it was contrary to public policy.

Specifically, the employee argued that the disclaimer violated the public policy considerations embedded in Section 204(a) of the Workers’ Compensation Act.  Her argument was framed around the disclaimer allegedly improperly waiving a cause of action that had not yet accrued.

Section 204(a) of the WCA sets forth:

            “No agreement, composition, or release of damages made before the date of any injury shall be valid or shall bar the claim for damages resulting therefrom; and any such agreement is declared to be against the public policy of this Commonwealth.”

At the trial court level, the disclaimer was not found to have violated the public policies articulated in Section 204(a), with the trial court granting Sunoco’s Motion for Judgment on the Pleadings.

The employee appealed the trial court Judgment to the Superior Court, with the Superior Court also agreeing that the disclaimer was not violative of public policy, reasoning that the employee had waived only her right to sue third-party customers for injury covered by workers’ compensation laws, and that the waiver/disclaimer was not an attempt to deprive her of rights under the Workers’ Compensation Act, nor was it intended to shield Allied from liability or to deprive the employee of compensation for any work-related harm or injuries.

Finding that the third-party release was not contrary to public policy, the Superior Court agreed with the trial court, affirming the Judgment against the employee and in favor of Sunoco.

The Supreme Court granted allocator to determine:

            “Did the Superior Court, in a decision of first impression of state-wide substantial significance, disregard the public policy of the Commonwealth of Pennsylvania and the plain meaning of the Pennsylvania Workers’ Compensation Act when it decided that a third-party release in the form of a ‘Workers’ Comp Disclaimer’, signed in consideration for employment or receipt of compensation benefits, which further required the waiver and eternal release of any and all rights to make a claim, commence a lawsuit, or recover damages or losses not void against public policy when the language of the disclaimer openly conflicts with the language of Section 204(a) of the Pennsylvania Workers’ Compensation Act, which expressly renders such agreements as void against public policy?”

Before the Supreme Court, the employee argued that the disclaimer that she had signed, the same being a condition of her employment and initial hire, violated the first sentence of Section 204(a) of the Pennsylvania Workers’ Compensation Act, as that sentence reads:

            “No agreement, composition, release of damages made before the date of any injury shall be valid or shall bar a claim for damages resulting therefrom; and any such agreements declared to be against public policy of this Commonwealth.”

Arguing that the sentence was plain and unambiguous, the employee asked the Supreme Court to invalidate the disclaimer that she had clearly consented to when hired.  A second basis for invalidation was asserted by the employee, as she contended that the disclaimer clearly contravene the subrogation clause of Section 319 of the Pennsylvania Workers’ Compensation Act, claiming that it was absurd for an employer to forego an opportunity to recoup expenses spent on an injured worker, effectively arguing that the negation of subrogation resulted in economic harm to her employer, Allied.

Sunoco responded by arguing that Section 204(a) only applied to an employer’s attempts to limit its own liability for workers’ compensation benefits and claims, and that it had no application whatsoever to releases that might involve third parties, ones not governed by the well-muscled reach of the Pennsylvania Workers’ Compensation Act.

Further arguing that the employee had never argued that the disclaimer was a contract of adhesion, or that it resulted from mistake, duress, fraud, or that it was either ambiguous or unsupported by consideration, Sunoco sought validation of the disclaimer, as waiver of any claim by the employee against it for a fall of personal injuries.

Dissecting Section 204(a) of the Pennsylvania Workers’ Compensation Act, the Supreme Court, in a majority opinion authored by Justice Eakin, held that only the first sentence of Section 204(a) deals with public policy issues, as the remaining sentences primarily discuss various sources and funds that an employee might receive, that might impact on the employee’s receipt and entitlement to workers’ compensation benefits.

Initially conceding that the first sentence in Section 204(a) was not free from ambiguity, the Supreme Court then examined the inter-relationship between Article II of the Act, in which Section 204 is one of five Sections as that Article related to the Pennsylvania Workers’ Compensation Act as a whole, as Article II is entitled “Damages by Action and Law”.  As had been observed by the Supreme Court in its 1999 DecisionFonner v. Shandon, Inc. fundamental premise of the Pennsylvania Workers’ Compensation Act is that the relations between the employee and the employer under the Act are essentially contractual in nature, as the employee embraced the right of exclusive remedy, and the employer embraced the right of statutory immunity, establishing a duality of purpose inuring to the benefit of both parties.

Interpreting legislative history, the Supreme Court determined that the legislature had originally intended that the provisions of Section 204(a) would only apply to agreements between an employer and employee that might bar an employee’s right to make a claim against their employer, and not, by extension, to bar claims against third parties.

Stripping away legislative ambiguities and contractual aversion, the Supreme Court held that the disclaimer and waiver entered into by the employee did not prevent the employee from receiving full and just compensation for her work-related injuries, and that its effective negation of Allied’s potential right of subrogation, was a business decision that only affected Allied, and that it was not a deprivation of the employee’s rights.

Another argument advanced by the employee was that the disclaimer/waiver contemplated actions that could only occur in the future, with the Court holding that the disclaimer was a condition of employment, under which the parties, both the employee and employer, and that it certainly contemplated that it would affect future causes of action, as the disclaimer dictated how claims for work injuries would be handled in the future.

Holding that the employee was never forced to sign the disclaimer, and that the disclaimer did not prevent her from receiving workers’ compensation benefits for her work-related injuries, the Supreme Court held that the disclaimer/waiver was merely a guarantee to Allied’s customers that they would not be held legally responsible or liable for injuries sustained by Allied’s employees.

Justice Eakin’s Opinion was joined in by Justices Castille, Saylor, Todd, and McCaffery.

A concurring Opinion was issued by Justice Saylor, with Justice McCaffery joining in that concurring Opinion.

The concurring Opinion posed a “modest reservation”, in the course of invoking the concept of a “double recovery”, and the public policy reasons behind subrogation, with Justice Saylor confessing to some circumspection as to whether an injured employee is ever able to fully recover in tort, where the recovery is diminished by compromise, settlement, litigation costs, and subrogation.

Justice Baer dissented, predicating the dissent on the first sentence of Section 204(a) of the Act being “clear and unambiguous”, resulting in Justice Baer concluding that the disclaimer/waiver at issue clearly was prohibited by the plain language of that sentence.

Practical Tips:

Does the Bowman Decision place employers who do not secure the Bowman-type disclaimer/waivers at a competitive disadvantage to employers who do not secure such a disclaimer or waiver?

Will these types of disclaimers raise questions as to the adequacy of consideration, a question that might arise, if someone already employed is asked to execute such a disclaimer/waiver, in the wake ofBowman?

Is it possible to argue that continued retention of employment is, in fact, adequate consideration for aBowman-type disclaimer/waiver?

What if an employee refuses to sign the disclaimer/waiver?

No less true, what if an employee is terminated for refusing to sign the disclaimer/waiver?

And where do we begin to analyze the definition of either a “customer or client” under the disclaimer/waiver?

Given what is at stake by application of the Bowman rule, additional litigation is clearly forecast in the future with this novel issue.

ConnorsLaw LLP

Trust us, we just get it!

It is trust well spent!

Defending liability-based lawsuits throughout Pennsylvania, on behalf of insurance carriers, third-party administrators, and self-insured businesses and corporations, our 100+ years of cumulative experience defending our clients against negligence and occurrence-based liabilities, empowers our Casualty Practice Trial Group attorneys to be entrusted to create the factual and legal leverage to expeditiously resolve lawsuits and claims, in the course of limiting/reducing/extinguishing our clients’ potential liabilities under Pennsylvania’s common law, trial practices, and rules of civil procedure.

With every member of our trial practice group being AV-rated, our partnership with the Pennsylvania Defense Institute and the Counsel on Litigation Management magnifies the lens through which our professional expertise imperiously demands that we remain dynamic and exacting advocates for our clients, the same being businesses, corporations, insurance carriers, seeking our trial and litigation acumen, to navigate the frustrating and liability-intensive minefield pervasive throughout Pennsylvania trial practice and procedure.

Questions concerning tort and/or contract liability that might arise in the context of casualty claims can be directed to Kevin L. Connors atkconnors@connorslawllp.com (Phone: 610-524-2100 Ext. 112).

Jaime Whitesell v. WCAB (Staples, Inc.) No. 205 C.D. 2013 (Pa. Cmwlth. July 10, 2013)

By:  Lisa A. Miller, Esquire

The Court affirmed the Decision of the Appeal Board which denied the Claimant’s Fatal Claim Petition because the death did not occur within 300 weeks of the date of the original work-injury as required by Section 301 (c)(1) of the Workers’ Compensation Act.

Pursuant to an NCP, the Employer recognized that the Claimant/Decedent sustained an injury in the course of her employment described as a “lumbar strain/sprain” on October 15, 2003.  The Claimant/Decedent underwent two spine surgeries.  On June 28, 2006, the WCJ granted the Claimant’s Review Petitions in accordance with the parties’ stipulation that the description of the work injury be amended to “lumbar strain/sprain and lumbar disc disruption L4-5, resulting in total disc arthroplasty at L4-5 level.”

On June 8, 2011, the Claimant filed a Fatal Claim Petition alleging that on June 13, 2010, the Claimant/Decedent died as a result of mixed drug toxicity from medications prescribed by her treating physician.  Employer filed a timely Answer denying the allegations and asserting that the Petition must be dismissed because the Claimant/Decedent’s death did not occur within 300 weeks of her work injury (October 15, 2003) pursuant to Section 301 (c) of the Act.

The WCJ denied the Fatal Claim Petition holding that the Claimant/Decedent died more than 300 weeks after the date of her injury.  As such, the WCJ held that the Fatal Claim Petition was barred under Section 301 (c) of the Act.

Claimant appealed and argued to the Board that Claimant/Decedent’s death arose from an additional “injury” that was accepted pursuant to the WCJ’s 2006 decision, the Claimant/Decedent’s death was within the 300 week time limitation.

The Board held that the 300-week period of Section 301 (c) applies to the Claimant/Decedent because she sustained a work-injury as opposed to an occupational disease.   The Board citedShoemaker v. WCAB (Jenmar Corporation), 604 A.2d 1145 (Pa. Cmwlth. 1992), noting that “even in the case of an apparently consequential injury, arising subsequent to the date of the recognized injury, the 300-week period between a decedent’s work injury and death will be calculated beginning with the date of the original work injury.”

The Board also rejected Claimant’s argument that the reason for distinguishing between a work-injury and occupational disease does not apply to this matter because the Claimant/Decedent had an “additional insidious injury.”  The Board explained that the Commonwealth court has concluded that when the condition arose from a work-injury as opposed to an occupational disease that the death must occur within 300 weeks of the original work-injury, without exception under Section 301 (c).

Citing Shoemaker, the Commonwealth Court affirmed the Board, noting that the Commonwealth Court has consistently held, without exception, that Section 301 (c) (1) denies benefits where more than 300 weeks has elapsed between the commencement of the compensable injury and the injury related death.