State News : Pennsylvania

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Pennsylvania

RULIS & BOCHICCHIO, LLC

  (412) 904-5021

PENNSYLVANIA WORKERS’ COMPENSATION

SUBROGATION LIEN OUTLINE

 

By: Kevin L. Connors, Esquire

 

 

Recently presenting at a reinsurance conference on the issue of Pennsylvania workers’ compensation subrogation liens, one that all of us probably think about every day, being that not insignificant monies have been expended in paying for workers’ compensation benefits, in the form of wage loss and medical compensation benefits, it occurred to us that the thrill of recovering those monies, through the perfection and prosecution of subrogation lien claims, continues to astonish, dumbfound, and dazzle our claims consciousness, as we simply demand, what we affirmatively believe, are our statutory entitlements.

 

Obviously, this outline is simply a function of Section 319 of the Pennsylvania Workers’ Compensation Act, setting forth:

 

“Where the compensable injury is caused in whole or in part by the act or omission of a third party, the employer shall be subrogated to the right of the employee, his personal representative, his estate or his dependents, against such third party to the extent of the compensation payable under this article by the employer; reasonable attorney’s fees and other proper disbursements incurred in obtaining a recovery or in effecting a compromise settlement shall be prorated between the employer and employee, his personal representative, his estate or his dependents. The employer shall pay that proportion of the attorney’s fees and other proper disbursements that the amount of compensation paid or payable at the time of recovery or settlement bears to the total recovery or settlement. Any recovery against such third person in excess of the compensation theretofore paid by the employer shall be paid forthwith to the employee, his personal representative, his estate or his dependents, and shall be treated as an advance payment by the employer on account of any future installments of compensation.”

 

When workers’ compensation benefits have been paid, and the tantalizing thought exists that a third party is responsible for having caused those payments, in which case the following calculations come into play, in the event that the person that you have paid workers’ compensation benefits to, proves that a third party was responsible for those benefits, to include:

 

           Total amount of third party recovery;

           Accrued workers’ compensation lien, for both wage and medical benefits;

           The expenses of recovery;

           The balance of recovery.

 

With the above cha-ching dollars in play, proceeds must now be distributed, and that requires that the proceeds be distributed, with the following being calculated:

 

           1)        Accrued lien expense reimbursement rate, requiring division of the accrued lien by the total amount of the third party recovery;

 

           2)        Expenses attributable to accrued lien, requiring multiplication of the expenses of recovery by the accrued lien expense reimbursement rate;

 

           3)        Net lien (amount employer to receive in satisfaction of lien), requiring that the expenses attributable to the accrued lien be subtracted from the accrued lien, leaving a net lien.

 

Hold on now, because that might not be the end of our lien calculations.

 

No less true, there might still be future benefits that are payable, potentially empowered by the third party recovery and lien issues, and that future liabilities will require calculations as to the future distribution of proceeds.

 

This requires that we apply the reimbursement rate on future compensation liability, requiring that the expenses of recovery be divided by the total amount of the third party recovery, resulting in the employer/insurer being responsible for paying a percentage of future weekly benefits and medical expenses, to satisfy its obligation to reimburse its pro rata share of the attorney’s fees and expenses that were incurred in securing the carrier’s lien recovery, with that percentage being paid by the employer/insurer until its subrogation interest is exhausted.

 

Upon exhaustion of the subrogation lien interest, compensation liability again attaches at the 100% rate, subject to the wonderful defenses that the Pennsylvania Workers’ Compensation Act provides, whatever they might be on any given day.

 

As for all of these delightful calculations, there are, nevertheless, other considerations, necessitating the statutory purposes for subrogation, being threefold, the first being, prevention of double recoveries, and the second being avoidance of the employer/insurer paying compensation caused by someone else’s fault, and the third being to make the responsible party pay, redistributing liability in reliance upon life as we know it.

 

So what else do we need to know about subrogation?

 

Well, it is an absolute primary right, that attaches upon there being a third party recovery, either through settlement or verdict.

 

It is a right that, unbelievably, is not negated by the employer/insurer’s failure to cooperate in the prosecution, of the third party case, to secure that third party recovery.

 

No less magically, this right is not negated by the injured employee’s comparative negligence.

 

It is an all-inclusive right, meaning that it encompasses all past, present, and future workers’ compensation benefits, although it does not include your administrative claim expenses.

 

As for enforcement issues, therein lies the rub, although workers’ compensation has exclusive jurisdiction over subrogation lien issues, these issues typically arise in the interplay between workers’ compensation and civil litigation, and a workers’ compensation judge’s order, enforcing subrogation, and requiring distribution of third party settlement proceeds in satisfaction of a subrogation lien, might have little effect outside the workers’ compensation province, as a workers’ compensation judge’s order cannot be used as an order of attachment against the corpus, being the body of funds, on deposit in some account somewhere, presumably either counsel’s or the employee’s, such that it might be necessary to seek civil remedies, to enforce attachment via a judgment against the proceeds.

 

So, what else should be considered?

 

Well, subrogation liens cannot be asserted against recoveries that are triggered by ADA-type litigation, as they are regarded as being separate and distinct from the liabilities typically associated with causing the physical/mental injury, that results in the payment of workers’ compensation benefits.

 

Third-party recoveries cannot be re-apportioned, in avoidance of satisfying the lien, in order to try to assign proceeds to spousal consortium claims, and/or to re-allocate the recovery, in satisfaction of non-economic claims for pain and suffering, etc.

 

Subrogation liens are absolutely applicable to legal and medical malpractice claims, although the liens might be limited to benefits paid after the actionable malpractice, and might not, therefore, be all-inclusive, in terms of all benefits paid under the workers’ compensation claim.

 

Moreover, if a workers’ compensation claim is being settled, with the settlement being perfected under a Compromise & Release Agreement, it is necessary that the Compromise & Release Agreement reflect the parties’ agreement, with respect to the subrogation lien issues, and, obviously, any satisfaction of a subrogation lien requires that the parties prepare and submit a Third-Party Settlement Agreement to the Bureau, reflecting the satisfaction of the lien, and setting forth all applicable calculations as to the third party recovery, the applicable lien amounts, the net lien recovery, and the reimbursement rate, in the event that compensation benefits are being suspended, during the period that the employer/insurer would be re-paying its pro rata share of the fees and expenses attributable to its recovery of its subrogation lien.

 

As an absolute matter of practice, every workers’ compensation claim should be viewed through the Newtonian prism of the potential involvement of third party liability, and employers and insurers should be encouraged to place Claimants and counsel on notice of subrogation lien rights as early as possible, in avoidance of being left on the dance floor in between song selections.

 

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 mouthpieces 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 National Workers’ Compensation Defense Network (www.nwcdn.com) 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.

 

Questions that might arise in the context of workers’ compensation claims can be directed to Kevin L. Connors at kconnors@connorslawllp.com (Phone: 610-524-2100 Ext. 112).

 

 

 

TO POST OR NOT TO POST

 

By

Kevin L. Connors, Esquire

 

 

 

Whether tis nobler to post on Facebook, and to suffer the salubrious likes and dislikes of friends promoting health and welfare, while conspicuously visible to the naked eye of the known universe, or to sulk, alas, silently, while a classic battleground has arisen, at least for civil litigation discovery purposes, between those who post and those who use post its!

 

Previously reporting on Facebook issues that arose inMcMillen, yet another Facebook decision has come out of the Pennsylvania Common Pleas system, with the Honorable Richard Walsh, in the Franklin County Court of Common Pleas, granting the Defendants’ Motion to Compel inLargent v. Reed and Penna, compelling the Plaintiff to provide the Defendants with her Facebook e-mail and password, to allow the Defendants access to the Plaintiff’s Facebook postings.

 

The trial court order required Plaintiff to produce this information within fourteen (14) days, allowing the Plaintiff to change her Facebook password thirty-five (35) days after the date of the order, in order to restrict access by defense counsel.

 

Several attributes of Facebook were reviewed by the trial court, in its Opinion, as follows.

 

First, Facebook, although it has a privacy policy, that policy is ever-changing.

 

Next, only people with a user account can access Facebook, although access, for all practical purposes, is available to anyone with an e-mail account, who can then establish a Facebook account.

 

Facebook requires that users be at least 13 years or older, although this policy is impossible to enforce, and appears to be openly flouted.

 

Facebook users can set their privacy settings to various levels, although a user’s name, profile picture and user ID are always publicly available.

 

At the least restrictive setting, being “public”, 800,000,000 (that’s right) Facebook users can view whatever is on a user’s profile.

 

The intermediate level restricts visibility to the user’s Facebook friends, with the most restrictive, only allowing the user to view their profile.

 

Since Facebook permits “tagging”, whereby friends can tag each other in postings, such as photographs, notes, videos, or status updates, Facebook users know that their Facebook information can be shared by default, requiring the user to take affirmative steps to prevent the sharing of such information.

 

InLargent, the defense contended that the Plaintiff must be compelled to disclose her Facebook user name and password, as her profile was public, and the defense contended that the Plaintiff’s Facebook posts contradicted her claims of serious injury. Seeking to block the defense from having access to her Facebook postings, the Plaintiff contended that the information sought was irrelevant, and that the disclosure of this information might potentially cause unreasonable embarrassment and annoyance. The Plaintiff also claimed that disclosure violated privacy laws, in particular, the Stored Communications Act of 1986.

 

In a very well-reasoned Opinion by Judge Walsh, reviewing and resolving Pennsylvania’s discovery standards, potential privilege and privacy concerns, privilege issues under Pennsylvania Law, the Stored Communications Act, in the scope of the defense’s discovery request, Judge Walsh found that the information sought on the Plaintiff’s Facebook profile was not only relevant, was not covered by any specific privilege, and that the requests to produce was not unreasonable, and that the information sought was discoverable.

 

No less true than inMcMillen, which also permitted the defense access to a Plaintiff’s Facebook postings,Largent seems to track the general thrust of Facebook-profile litigation, which is that there is no keeping secret that which is already public.

 

If you post, it is public, and if it is public, it is discoverable.

 

As a routine manner, discovery requests, on both sides of the aisle, account for the humanoid penchant for always gazing with profane wonder into the miraculous caricature of our own lives, replicating postings in the Facebook universe as though sculpting a more perfect image of ourselves, and this is not discoverable why.

 

If Facebook is a still pond, the post that you place on its unbroken face is the ripple substantiating your existence.

 

No matter where you post, there you are!

 

 

Practically Speaking

 

How could you possibly think that this would have any other outcome, other than disclosure.

 

Knowing that no one is alone, Facebook legitimizes a license we all secretly sanction, which is simply self-importance through a medium permitting publication without consequence in terms of historical importance.

 

Face it, we post because we can, and because we can, we are drawn, like moths, to this flame.     

 

 

 

 

 

 

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 at kconnors@connorslawllp.com (Phone: 610-524-2100 Ext. 112).

REFRESH YOURSELF:

THE PERSONAL COMFORT DOCTRINE IN WORKERS’ COMPENSATION

 

By: Kevin L. Connors, Esquire

 

I.         INTRODUCTION:

 

Universal throughout workers’ compensation statutes, the personal comfort doctrine is a real, and sometimes amusingly interesting, result-oriented principle ubiquitous in workers’ compensation decisions and rulings, at times testing the boundaries of compensability, as employees attending to personal needs, for comfort or sustenance, to include work-time breaks for eating, drinking, using the restroom, smoking, or otherwise seeking relief from discomfort, sustain injuries for which compensation is then sought.

 

It is necessity’s offspring, recognizing the need for both rest and refreshment, with its genesis spawned by the policy consideration that “the real reason (for the personal comfort doctrine) is that a working man must live and recognizing this, the employer has provided both physical conveniences and their opportunity for their use. Modern industry conditions provide the real basis for compensation and should be recognized. The Personal Comfort Doctrine, (1960 Wis. L. Rev. 91, 92).

 

Simply stated, the personal comfort doctrine judicially justifies that certain on-the-job acts of personal comfort are “necessarily contemplated” to be incidental to the employment itself, blanketing any inevitably attendant danger with compensability. This doctrine, by its very definition, incorporates a certain element of foreseeability as to compensability, as it marries an accidental work injury with a necessary personal comfort.

 

In the eloquently-sculpted analysis of Professor Larson, the general rule concerning the personal comfort doctrine can be thought of as follows:

 

“Employees, who within the time and space limits of their employment, engage in acts which minister to personal comfort do not thereby leave the course of employment, unless the extent of the departure is so great that an intent to abandon the job temporarily may be inferred, or, unless, in some jurisdictions, the method is so unusual and unreasonable that the conduct cannot be considered an incident of the employment”.

See 2 A. and L. Larson, Larson’s Workers’ Compensation Law § 21 (2002).

 

And the most common personal comfort situations involve work breaks around food, drinking, smoking, hygiene and toiletry functions, and fashion statements involving clothing. 

 

           A.        General Rule:

 

The general rule, almost universally applicable, subject to distinct jurisdictional relevance, is that injuries occurring in the course and scope of employment, while furthering the interests of the employer, are considered to be work-related and, therefore, compensable, with workers’ compensation statutes providing for compensation benefits that will include lost wages, and payment of reasonable, necessary and related medical care expenses. 

No less true, courts analyzing personal comfort cases are oftentimes forced to distinguish between a brief, or minor detour or deviation, as opposed to situations where the activity resulting in injury is one that must be characterized as having broken or severed the chain of what is considered to be the course and scope of employment, necessitating a factual/legal analysis as to whether the injury occurred during an activity incidental to employment, being one that benefits the employer by improving employee efficiency, as opposed to one where the converse was true. 

 

           B.        Personal Comfort Awards in Pennsylvania:

 

The following are Pennsylvania personal comfort cases where benefits were awarded, with compensability being established:

 

·         Employee injured in motor vehicle accident afterstopping for dinner with co-employees while traveling from a construction site to obtain supplies and drop off a co-worker was found to be a compensable injury under the Pennsylvania Workers’ Compensation Act(Employer’s Mutual v. Boiler Correction and Repair, 964 A.2d 381 (Pa. Super. 2008).

 

·         Employee working from an employer-approved home office, was awarded workers’ compensation benefits, when she fell down the stairs, in route to the bathroom, for personal comfort(Verizon Pennsylvania v. WCAB, 900 A.2d 440 (Pa. Cmwlth. 2006).

 

·         Workers’ compensation benefits were awarded when an employee, while completing a furniture delivery to a residence, sustained a traumatic brain injury, while attempting to jump up and touch a basketball rim on the property, with the Pennsylvania Commonwealth Court finding that “intervals of leisure activity during the work day are deemed inconsequential departures from the act of delivering furniture for the employer”(Baby’s Room v. WCAB, 860 A.2d 200 (Pa. Cmwlth. 2004).

 

·         A momentary departure from working, to use a bathroom facility, did not remove the employee from the course of employment.  (Montgomery Hospital v. WCAB, 793 A.2d 182 (Pa. Cmwlth. 2002).

 

·         InCarroll v. WCAB, 750 A.2d 938 (Pa. Cmwlth. 2000), the employee was awarded workers’ compensation benefits for loss of use of an eye, resulting from a detached retina caused by the employee attempting to suppress a sneeze, to avoid spreading germs to co-employees during a business meeting.

 

·         InCity of Harrisburg v. WCAB, 616 A.2d 1369 (Pa. 1992), the Pennsylvania Supreme Court found that a police officer who shot himself while cleaning his weapon at home was in the course and scope of employment, as the police officer had no place to store his weapon at work, and the Court ruled that a work activity performed at home is notper se outside the course and scope of employment.

 

·         InKovalchik Salvage v. WCAB, 519 A.2d 543 (Pa. Cmwlth. 1986), an employee, killed in a head-on collision driving a company car, in route to his home, after stopping for drinks and then taking co-employees home, was found to have sustained compensable fatal injuries, with workers’ compensation benefits being awarded.

 

·         InDe’Agata National v. WCAB, 479 A.2d 98 (Pa. 1984), an employee entering a luncheonette, to purchase a cup of coffee, was found to have sustained compensable injuries, when shot in the head and abdomen.

 

·         Shockingly, an employee, who was shot and killed, after stopping his truck along a roadway in order to relieve himself, was found to have sustained work-related injuries, in the course and scope of employment, by the Pennsylvania Commonwealth Court inWCAB v. Borough of Plum, 340 A.2d 637 (Pa. Cmwlth. 1975).

           

           C.        Personal Comfort Awards in Other Jurisdictions:

 

·         In Utah, its Court of Appeals affirmed an award of workers’ compensation benefits to an injured worker, notwithstanding the fact that the worker had been terminated, after the worker had returned-to-work in a light-duty position, following the employee’s work injury, with the employee having been terminated by the employer for sending pornographic images to other employee’s cell phones, over a company e-mail account. 

 

            Bizarrely, the Utah Court rejected the employer’s argument that light-duty work   continued to be available to the employee, and that the employee’s termination forcause should have been characterized as a constructive refusal of available light-           duty work, due to the employee’s improper activities.

 

·         An Illinois “smoke break” case is illustrative of break-time accidents, as this case involved an employee taking a break to smoke a cigarette, with the employer having a designated smoking area on the floor below where the employee worked, and there was only one stairway connecting where the employee worked to the employer’s designated smoking area; in route to the smoking area, the employee fell, and was injured, with the Illinois Court finding that the injury was compensable, as it fell within the personal comfort doctrine, as the employee’s injury was connected to their employment, the employee was not doing anything unreasonable or dangerous when injured, with the employer being in control of the premises, through designation of the smoking area.

 

·         InLevine v. People’s Broadcasting, decided in 1965, the West Virginia Supreme Court held that an employee who was attempting to raise himself from a toilet seat by leaning on a wash basin, who was injured when a pipe broke, was found to have been acting within the course and scope of his employment, with workers’ compensation benefits awarded, as the Court held “that an employee is within the scope of his employment as provided by the Act when he is administering to his own health and comfort if that be reasonably necessary to his employment, citing toArchibald v. Workmen’s Compensation Commissioner (decided in 1916). 

 

            Moreover, the West Virginia Court noted that an employee is “acting within the   course of his employment when he is engaged in doing, for his master, either the            act consciously and specifically directed or any act which can fairly and       reasonable be deemed to be an ordinary and natural incident or attribute of that act    or a natural, direct, or logical result of it.  If in doing such act, the servant acts            negligently, that is negligence within the course of the employment”.

 

·         Most employers might think that this was a pretty crappy result!

           

·         In Illinois, an employee who was injured attempting to dislodge a bag of Fritos stuck in a vending machine on the employer’s premises was found to have sustained a compensable and work-related injury, notwithstanding the chips having been purchased by a co-worker, such that the employee seeking to retrieve the bag of chips was not doing so for his own consumption. 

 

The Illinois Commission applied the personal comfort doctrine, in awarding workers’ compensation benefits. 

 

This ruling survived appeal, with the Illinois Appellate Court affirming the lower commission’s award of workers’ compensation benefits, as the Court found that the employee’s actions tracked a line of “scope of employment” cases, expanding coverage to employees acting to aid others in emergency situations, although the Court impolitely noted that “what the instant case lacks in urgency, it makes up for in familiarity and collegiality”. 

 

Essentially, the workers’ compensation award survived the employer’s appeal, as the appellate court concluded that the Commission could have reasonably concluded that the employee’s manner of assisting the Frito-purchasing employee did not necessarily cross the line of employment, potentially barring the award of benefits for the Frito-saving employee.

 

See Circuit City Stores v. Illinois Workers’ Comp. (7/9/09).

           

·         The Washington Supreme Court, inBall Foster Glass v. Giovanelli, upheld an award of workers’ compensation benefits to an traveling employee, who regularly traveled around the country rebuilding and fixing furnaces for his employer, when he, on assignment to a company plant in Seattle, was injured on his day off, as he was headed to a park with his supervisor to go to a concert; on crossing a street in front of the hotel, he was struck by a motor vehicle, and was seriously injured. 

 

The employer appealed the award of workers’ compensation benefits, on grounds that the employee had not been engaged in a recreational activity that had any business purpose behind it. 

 

Upholding the compensability of the employee’s injuries, the Court relied upon the “commercial traveler rule” or the “continuous coverage rule”, which is a rule that holds that a traveling employee is considered to be in the course of employment during his or her entire trip, except for a “distinct departure on a personal errand”. 

 

Holding that distinguishing between reasonable personal administrations and purely personal amusement adventures can be difficult, the Washington Supreme Court nevertheless found that compensation courts have routinely had little difficulty denying compensation benefits for unusual or unreasonable activity, such as the denial of compensation benefits for a Florida employee injured during a skiing trip, at a resort 50 miles away from the hotel that the employee had been staying in. 

 

Although the employer in Foster argued that the employee’s activity was a deviation from his employment, and that his actions in crossing a highway without a right of way was an “inherently dangerous” activity, the Washington Supreme Court rebuked that argument, citing to the personal comfort doctrine as follows:

 

“The scope of activities covered by the personal comfort doctrine depends on the particular circumstances of employment. A traveling employee is entitled to broader coverage than a non-traveling employee because a traveling employee is in a significantly different position of risk than a non-traveling employee. The non-traveling employee may satisfy his personal needs without leaving the comfort of            home.  In contrast, the traveling employee must face the perils of the street in order to satisfy basic needs, including sleeping, eating, and seeking fresh air and exercise”.

 

·         In Vermont, workers’ compensation benefits were awarded to an employee who was injured during lunch, while shooting off bottle rockets, with the Vermont Court finding that the injury did fall within the scope of the personal comfort doctrine. See, Notte v. Rutland, 112 Vt. 498 (1942).

 

·         In Georgia, a Claimant was awarded workers’ compensation benefits, when she injured her knee, as she bent over to pick up a pill off the floor. The Claimant was 300 lbs., and her knee buckled, causing her to fall, when she bent over to get the pill. The employer presented evidence that the employee’s knee buckled because of an idiopathic condition. However, the Georgia Court awarded workers’ compensation benefits, finding the claim to have been compensable based on the personal comfort doctrine, as the employee’s job was that of a custodian, sometimes requiring her to pick items off the floor.

 

 

 

In granting compensation benefits, the Court compared this fact scenario with cases where employees were injured when getting food and drink, or using a restroom, while working.

 

                       See Harris v. Peach County Board, 674 S.E. 2ND 36 (2/11/09).

 

·         InLiberty Northwest Insurance v. Nichols, when a 6 Or App 664 (2003), an employee who broke his tooth while eating an employer-supplied piece of candy was awarded workers’ compensation benefits, overcoming the employer’s defense that the Claimant’s injury had not occurred within the course and scope of employment, as the Oregon Board found that the employee’s injury occurred as he was “eating while working”, and that the employee had not been engaged in personal recreational or social activities.

 

·         InThompson v. Keller Foundations, benefits were awarded to a Florida employee, a construction worker, who was injured in an accident that occurred as he was driving home from work, after stopping at a bar to shoot pool with co-workers.  The claim was initially denied by the insurance carrier, as well as by the workers’ compensation judge, but the appeals court reversed the denial of compensation benefits, finding that the employee’s injuries were indeed incidental to employment.

 

This case is illustrative, as the injured employee was traveling for business.  Although travel to and from work is typically not compensable under the “coming and going” rule, Courts take a more inclusive approach in evaluating injuries, when an employee is traveling overnight for business.

 

In reversing the lower court decision, the Florida Court stated:

 

“A traveling employee is deemed to be in the continuous conduct of his employer’s business including those times when he is not actually at work but is engaged in … normal and necessary activities.  Thus, so long as a traveling employee’s injury arises out of a risk which is reasonably incidental to the conditions of employment, the injury will be compensable. Although the appellant may have been engaged in amusement activities immediately prior to the accident, the JCC did not make any findings sufficient to conclude that the traveling construction worker was not attending to a normal creature comfort and a reasonable necessity – driving to dinner – when his injuries were sustained.”

           

This case illustrates the inclusive 24/7 nature of overnight business travel, in terms of compensability.

 

·         In Washington, workers’ compensation benefits were awarded to an employee, inDial v. Taplett Fruit Co., when the employee was injured, as she was walking to her car, during a morning rest break, to smoke a cigarette. As a result of falling, she sustained a low back injury, with the employer denying the claim, on grounds that the employee was not furthering the employer’s business interests when she was injured.  Telling, the employer did allow its employees to smoke in their cars during their rest breaks.

 

                       The Washington Court concluded that the employee had not left the course of her employment, as she was engaged in a “personal comfort that was reasonably incidental to her employment”. So concluding, compensation benefits were awarded to the employee.

 

·         InCooper v. Barnickel Enterprises, the New Jersey Superior Court awarded workers’ compensation benefits to an employee, who was injured while using a company vehicle, that he was using to drive to get coffee.  The employee was a master plumber and foreman. He had driven to a job location, to discuss the job details.  Arriving at the jobsite, the person that he needed to talk was not available, and would not be so for almost 45 minutes.  The employee decided to drive to a deli about 5 miles away, to get some coffee.

           

In route to the deli, the employee was injured in a motor vehicle accident, sustaining several injuries, resulting in the New Jersey Division of Workers’ Compensation awarding workers’ compensation benefits to the employee.  In awarding benefits, the Court found that the employee had been “engaged in exactly the kind of brief activity which if embarked on by an inside employee working under set time and place limitations, would be compensable under the personal comfort doctrine”.

 

·         And now, a pregnant paws worthy of the Australian personal comfort case that “went viral” on the Internet, being the case of the Australian public servant, who sought, was denied, and has now been awarded workers’ compensation benefits, as a result of her being injured while having sexual intercourse on a work-related business trip.

                       

Initially, her claim was denied before the Australian Administrative Appeals Tribunal (AAAT), which denied her claim for workers’ compensation benefits, over the passionately poignant plea of her salaciously libidinous lawyer, who argued that she had sustained her injuries in the “ordinary prevue of human life”, and that she was not injured while engaged in performing any activity of gross misconduct or self-harm, her injury being no different than that of a traveling employee who might be injured while bathing or seeking sustenance, an argument countered by the employer arguing that her injuries were sustained in the course of “frolic of the applicant’s own”, during the course of a “quintessentially private activity”.

 

The employer argument being that “having sex is a different kettle of fish”, clearly distinguishing the “catching” from “caught”.

 

While the AAAT denied the Claimant’s lascivious claim, the Claimant pressed onward, appealing to the Federal Court of Australia, which, on April 19, 2012, overturned the AAAT, setting aside the Tribunal’s lecherous denial, in the course of which the Australian Court rendered 26 Findings, akin to what we refer to as Findings of Fact, followed by an additional 29 Considerations, akin to our Conclusions of Law.

 

In reliance upon personal comfort precedence in Australian compensation law, the Court found in favor of the employee seeking compensation for her sexual misfortune, holding as follows:

 

“Accordingly, it shall now be accepted that an interval or interlude within an overall period or episode of work occurs within the course of employment if, expressly or impliedly, the employer has induced or incurs the employee to spend that interval or interlude at a particular place or in a particular way.  Furthermore, the injuries sustained in such an interval will be within the course of employment if it occurred at that place or while the employee was engaged in that activity unless the employee was guilty of misconduct taking him or outside the course of employment.”

 

                       Well, that certainly settles it!

 

Exactly, where do we go next? The simple rule being, that you need not be working, to be considered “employed”.

 

Although true, the Australian Court went to great lengths to diffuse the splatter effect of a case like this, given that media and Internet buzz created by it, and its infinitely special ability to replicate its affect across multiple jurisdictions, as it twies to avoid being tantalized by tweetfulness.

 

And what might have happened, with altered facts, if the Claimant, in fact, became pregnant and/or contracted a sexually-transmitted disease, are compensation benefits actually owed to the Claimant?

 

                       The answer is, of course, “it depends”.

 

            D.        Denied Personal Comfort Cases in Pennsylvania

 

What follows are illustrations of Pennsylvania personal comfort cases where benefits were denied:

 

·         In theDepartment of Labor & Industry v. WCAB, 977 A.2d 585 (Pa. Cmwlth. 2009), a state employee on a paid break off of the employer’s premises, who was attending to her own personal comfort, was not awarded workers’ compensation benefits, as she was not injured in furtherance of the employer’s business or affairs.

 

·         InGraves v. WCAB, 983 A.2d 241 (Pa. Cmwlth. 2009), an off-duty Philadelphia Housing Authority patrolman who was shot in an altercation with an armed bar patron was not found to have been engaged in police action in furtherance of the employer’s business when injured.

 

·         InBrookhaven Baptist Church v. WCAB, 912 A.2d 770 (Pa. Cmwlth. 2006), a church member and trustee, who was also paid to cut grass on the church grounds, was found to be outside the course and scope of his employment, when he was fatally burned while destroying lawn trimmings that he had gathered from pruning the shrubs.

 

·         InWright v. WCAB, 871 A.2d 281 (Pa. Cmwlth. 2005), an employee who was struck while crossing a highway, as he attempted to retrieve personal items from his own vehicle, was denied compensation benefits, as the Court found that the employee was not required by his employment to be crossing a highway at the time of the incident. 

 

·         DUH!       

 

·         InSchrif v. WCAB, 658 A.2d 2 (Pa. Cmwlth. 1995), an employee who was dismantling a hoist that the employer was permitting the employee to take home to use on a personal home project, was denied workers’ compensation benefits, when he was injured while dismantling the hoist, as the employer had given the hoist to the employee as a courtesy, and the Court found that the injury had not occurred in the scope of employment, nor did it further the employer’s interests.

 

·         InPesta v. WCAB, 621 A.2d 1221 (Pa. Cmwlth. 1993), an employee was collecting cans from the employer’s premises, intending to sell them, was not awarded fatal claim benefits, when he was fatally injured, as he crossed the street, to put the cans in a parked car.

 

·         InHabib v. WCAB, 29 A.3d 409 (Pa. Cmwlth. 2011), the Pennsylvania Commonwealth Court held that an employee, who sustained an injury to his eye, as he and other employees, all laborers, were attempting to smash a bowling ball found near the parking lot where they were working, with several employees having used the bowling ball in a shot-put challenge, after which the employees took turns trying to smash the bowling ball with a sledgehammer, with the injured employee being injured when shattering the bowling ball as a piece of the shattered ball flew into his eye. 

 

The workers’ compensation judge, awarded workers’ compensation benefits to the employee, finding that his actions, while careless, had not taken him outside the course and scope of employment, although the judge’s compensation award was vacated and reversed by the Pennsylvania Workers’ Compensation Appeal Board, which found that the employee had acted in violation of a positive work order, as his supervisor had told him to “knock it off”, further telling the employee that he would not take the employee to the hospital, if the employee was injured hitting the ball. 

 

On further appeal to the Pennsylvania Commonwealth Court, the Court held that the employee’s injury was not compensable, as it occurred while the employee was violating a positive work order, further holding that 3 requirements are necessary to bar an injury for violation of an employer work order, including:

 

                       a)         that the injury must be caused by the violation of the work injury;

                       b)         that the employee must know about the positive work order; and,

                       c)         that the Order must implicate an activity not connected with the                                        employee’s work duties.

 

           E.        Personal Comfort Denials in Other Jurisdictions:

 

The following claims involve Courts denying personal comfort claims, finding that the injuries had not occurred within the course and scope of employment, and that the injured employees had deviated from their normal work activities:

 

·         In Indiana, a morbidly obese long-term employee, weighing over 360 lbs. was not found to have been engaged in an “activity of daily living”, when she suffered a cracked femur as she tried to get herself out of a booth in a university cafeteria, during an employee appreciation dinner. Although she was successful in securing an award of workers’ compensation benefits from the first level factfinder, on appeal, the appellate court held that her injury was personal to her, and that there had been no increased risk created by her work environment, with the Court further observing that her pre-existing physical condition probably contributed to her injuries, and undoubtedly hampered her recovery, resulting in her injuries being found to be personal, and not work-related.

 

·         In a Florida case, in Galaida v. AutoZone (9/27/04), an employee was denied workers’ compensation benefits, when he was injured on a smoke break in the company parking lot. Although the employer allowed employees to take smoke breaks, the employee was getting cigarettes out of his car, when a gun fell out of his car, as he opened the car door, the gun discharged, and shot him in the foot.  The employee was denied workers’ compensation benefits on a deviation from course of employment theorem, which is an extension of the violation of positive work order rule, as the employer had a policy against possessing firearms on company premises.

 

On appeal, the appellate court held:

 

“The personal comfort doctrine incorporates a foreseeability element to the cause of injury.  Thus, inHolly Hill Fruit Products, 473 So. 2nd A29 (1985), an employee was injured while crossing a street to purchase cigarettes was held to have sustained a compensable injury because the “trip was a foreseeable and non-prohibited refreshment break activity, and the employer’s authority over Claimant was not significantly dissipated during the course of the trip”.

 

“Being exposed to a firearm, however, is not a foreseeable consequence of an authorized cigarette break, especially when the possession of a firearm is strictly prohibited by the employer. Moreover, Galaida’s possession of a firearm, in violation of his employer’s policy, was not conducive to the employer’s interests. Thus, he should not benefit from the doctrine.”

 

·         TheOregon Supreme Court in  Roberts v. SAIF, 341 Or 48 (2006) denied workers’ compensation benefits to an employee who was injured while riding a motorcycle around the lot of his employer’s car dealership, with the Oregon Court finding that the employee’s injury was not compensable or work-related, applying the following analysis:

           

“Texturally ORS 656.005(7)(b)(B) raises three questions. The first is whether the worker was engaged in or performing a “recreational or social activity”. The second is whether the worker incurred the injury “while engaging in or performing, or as a result of engaging in or performing,” that activity. The final question is whether the work engaged in or performed the activity “primarily for the worker’s personal pleasure” if the answer to all of these questions is “yes”, then the worker cannot recover”.

 

The Oregon Supreme Court distinguished between activities performed for personal pleasure as opposed to activities performed for personal comfort.

 

            F.         The Smoking Duck:

 

That’s right, a smoking duck is a loaded fowl.

 

So, you as the benevolent employer, must balance stockholder demands against employee retention and productivity.

 

So what are you looking for, when a claim is reported to you, that seems to fall along the fault lines of personal comfort?

 

Well, from a practical and pragmatic perspective, it is axiomatic that the doctrine of common sense, not always applicable in a no-fault compensation system, be applied, as otherwise logic and reason fall prey to the collusive dark ages of intellectual chaos. The relevant analytical template begins with a description of the activity in question, to include lunch breaks, on and off premises, supplied or not by the employer, drinking, smoking, use of toilet facilities, washing hands, changing clothes, and seeking relief from heat, cold, or discomfort, not to include the supervisor’s baneful eye. 

 

Garnish the described activity in question with its time, location and purpose, to determine if, during work hours, after work hours, on your premises, off your premises, during some type of employment-related trip or travel, considering its purpose, the catch all being, was the activity under the compensation microscope advancing your business interests.

 

Then grab your trusty employee handbook, check the described activity in question against permissive and non-permissive stuff. Did you give permission for the activity, or does it violate a work or safety order?

 

II.       LOOSE ENDS:

 

·         Compensability is in the eye of the judge;

·         It is a doctrine as ancient as workers’ compensation law;

·         Universally, it is a doctrine based on decisional authority, untethered to any statutory provisions;

·         Telecommunications expand the scope of both personal comfort and personal discomfort, requiring an intense analysis by the employer as to whether the injury occurred within the course and scope of employment, whether the injury fell within the employee’s job description, whether it occurred in furtherance of the employer’s business interests;

·         This doctrine is intended to balance the personal needs of the employee against the business interests of the employer, so plan accordingly.

By:  Kevin L. Connors

Some lessons in life can never be learned hard enough.

Like, you can make lemonade out of lemons, but try making lemons out of lemonade.

Recently successful in defending a workers’ compensation claim brought by a corpulent Convenience Store Assistant General Manager, who injured herself while she was stocking a walk-in cooler, as she dropped but still managed to catch, a 10 lb. box of coffee milk creamers, the same being absolutely necessary in the universe of convenience stores, in order to keep the in-and-out clientele casually caffeinated, with the Claimant alleging that the coffee creamers, in their very brief flight from shelf to her hands, allegedly caused her to experience immediate mid-back back pain, eventually diagnosed as a thoracic sprain/strain.

Reporting what some might not seem to have been an injury, the Claimant told her convenience store management that she immediately developed severe pain in her mid-back, later referred to in her medical records as being an injury to her thoracic spine, although the creamers were apparently never damaged, however short-lived their convenience experience might have been.

No, the Claimant did not report an injury to her low back.

No, she did not report injuries to any other part of her body.

Yes, she was immediately directed by her very claims-intuitive employer to seek treatment with the employer’s designated panel physicians, as required under the Pennsylvania Workers’ Compensation Act.

Two days later, the treatment phase began, with the working diagnosis being a thoracic sprain/strain, a seemingly minor injury in the grand scheme of the trillions of dollars expended in workers’ compensation circles administering to the travails of spine-related injuries.

True enough, whenever we think of spine-related injuries, we think of either the neck or the low back, with mid-back injuries being, well, conveniently rare.

So, what happens next?

Briefly, the Claimant was off of work, and she was paid workers’ compensation benefits pursuant to the statute.  She was then released to return to work by the employer-designated physicians, and she actually returns to work, with her compensation benefits being suspended, as she is working in a full-time capacity, although working with restrictions, designed to limit her standing, sitting, carrying, lifting, and you guessed it, her reaching.

Now how does reaching come into play as a convenience store assistant general manager.

Well, the 300 lb. plus size convenience store assistant general manager then testified in front of the quixotic workers’ compensation judge, that her light-duty job required her to work the convenience store cash register in the front of the store, which position was akin to a torture chamber of pain, as she was bombarded by store customers asking to buy Powerball tickets, cigarettes, and other items behind the counter, that did not require the customers to walk around the store to pick up, but required the counterperson to reach for behind-the-counter merchandise, as politely requested by store customers.

That reaching caused the Claimant to have so much mid-back pain that after enduring this working torture for about 4 months, she went to the emergency room, although they really could not find anything wrong with her, and she then went to see her grizzled orthopedic surgeon, who some 15 years before had performed a several level fusion on the Claimant’s low back, fusing her spine as the Claimant had severe spondylolisthesis (say that 3 times, if you can).

On the advice of her Methuselahian orthopedic surgeon, who eventually testified in support of her claim for benefits that he never physically examined her, as orthopedic examinations are overrated, the Claimant stopped working in order to undergo diagnostic testing, revealing that the 15 year old fusion was now unstable.

Okay, sounds pretty straightforward so far, so why is this case of any importance to anyone?

Well, this case is about the lemonade that the Claimant tried to squeeze back into the lemons.

So, to prove her case, Ms. Jabba Da Hutt, when testifying before the workers’ compensation judge, told the judge that the two activities that caused her the most pain were standing and reaching, you know, for cigarettes, lottery tickets, and lighter fluid, as the Claimant sat in the courtroom for over an hour, with low back pain, forgetting her thoracic spine injury, as the pain had lowered itself into the end zone of her spine, her low back, and she described her pain as being 24/7, and being 8 out of 10 on a “point to where it hurts” pain scale, with 0 being the absence of any discomfort and 10 being death-like pain, although in millions of years of recorded human history, no one has returned to actually describe that claim-ending experience.

So, during the first act of her hysterically histrionic play, is she academy award material, or perhaps relegated to being, well, the entire backdrop for “One Life To Live”?

Secure in her own pain-generating universe, she made the always claim-fatal mistake of not just downplaying her pre-injury medical history, but she inflated it to a height of physical perfection and fitness, that seems strangely odd coming from someone who 15 years before had several levels in her lumbar spine fused together because of congenital abnormalities.

Repeatedly asked as to whether she had had problems with her back in between the fusion surgery when she was 15 and the sprain/strain that she developed from dropping the coffee creamers 15 years later, she unblinkingly admitted nothing other than pristine spinal health, with the few claims that seemed to have been sprinkled in between the fusion and the present, all involving body parts unrelated to her spinal column.

Flashing forward to her physician’s testimony, he who needs no exam testified that he believed all of her problems were directly related to the box of milk creamers because, well because she had left his office and operating room 15 years before as good as she could be, and she told him that she had no problems until the Greg Louganis-like coffee milk creamers attempted their inward-twisting reverse somersault dive off the walk-in cooler shelf, into her Steve Largent-like hands, and so it must have been the demonic creamers, and yes, she needed surgery, because the fusion that he had stitched together 15 years before was now no longer stable.

By now, everyone who has not left to get their popcorn out of the microwave is wondering, we care why?

We know, there might be a point.

And the point is that she ended up losing her case for several reasons, not the least of which is that she probably had no case to begin with, aside from clearly overreaching, believing herself due for a compensation vacation!

Not really, and, true enough, this stuff squeezes better than it tastes.

But, yes, she lost her case, because she really liked to make a lot of stuff up, and because she forgot a lot of stuff that was too important to forget, because, yes, that kind of stuff had been  splattered over about 2,000 pages of medical and claims records subpoenaed from prior cases, both comp and otherwise, where she had bizarrely, and with seemingly complete historical abandon, sought, petitioned for, complained, of, treated for, been diagnosed with, and otherwise made a really big deal about, having, you got it, lots of issues with her low back, effectively undermining her testimony, “no, Your Honor, I really never had these kinds of problems before, and I do not know why they will not pay my workers’ compensation claim”.

Neither the prior medical records nor prior transcripts lied, and her own courtroom testimony in her prior cases, came back in haunting assassination of her benefit-seeking intentions in this case, as her testimony in prior cases became the crosshairs through which the workers’ compensation judge fired his denial of her claim.

Thirsty for a Guinness?

Brilliant, just brilliant!

Now she had already had some prior problems juxtaposing her testimony in her earlier claims, against her denial of that testimony in this case, but she then painted a surveillance bull’s-eye on her face, when she testified, days before the judge closed the record, that she never helped her mother work at a weekend flea market, with, you guessed it, her driving straight from her record-closing deposition to the flea market, where she was filmed working the flea market, making transactions for her mother, spending all day at the flea market stand, and then, “Alas, poor Yorick”, we witnessed the “I need back surgery”, even though I smoke and weigh over 300 lbs., Rubenesque-Claimant bending in flagrante delicto at the waist, without apparent hesitation or limitation, effectively impaling the nail in the coffin of her claim.

Well, what did she do wrong, beyond almost everything, which is one way of looking at this claim, the converse being what actions were taken to limit/defend the claim?

First, a word of advice.

If you have a back injury, it is not recommended that you testify while sitting motionless for an hour, with 8 out of 10 pain.

It just does not feel right.

Next, make sure that you have a pretty good idea as to what you have claimed in prior claims, as well as what you have testified to before in Court, as where there is a record, there will be cross-examination.

If it was reported before, expect that it will be discovered and made evident.

So what credit is due the employer/administrator in defending the claim, and securing its denial?

First, this claim was meticulously documented, from claim inception, as a claim involving a thoracic spine, with it being limited to a sprain/strain injury, and not involving any spinal abnormalities.

Next, the employer and administrator carefully monitored the Claimant’s medical treatment, to insure the earliest possible return-to-work, securing, a benefits-suspending agreement, on the Claimant’s return.

The relevance of that benefits-suspending agreement, is that the Claimant then had to prove that her alleged disability was, in fact, causally related to the original injury, with the Claimant, of course, claiming that she was suffering from a low back injury, and not the thoracic spine injury, that had been accepted by the employer/administrator.

Next, the employer/administrator secured a very favorable independent medical examination, shortly after the Claimant stopped working, on the questionable advice of the Methuselahian orthopedic surgeon, who never physically examined the Claimant, and simply took the Claimant’s word at face value, that she had not had any problems in between the fusion surgery 15 years earlier, and the suicidal creamers who threw themselves at her in the convenience store walk-in cooler.

And, well, there was also the not so little issue of the Claimant being placed on surveillance, in proximity, in fact, on the same day, as she testified that she could not do certain things, with her Scorsesian video documenting her Oscar-winning performance, as she flounced about the flea market, all too obviously without manifestation of any injury or limitation.

The ballerina-like waist bending, reminiscent of the dancing Hippopotamuses in Disney’s Fantasia, was, no less, a thing of exquisite and wondrous injury-defying beauty.

So, the point being, yes, lemons do make lemonade, but you cannot put the Genie back in the bottle, especially when the bottleneck is so narrow.

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.

By:  Jeffrey D. Snyder, Esquire
ConnorsLaw   LLP

A.        THE CASE:

The Supreme Court of Pennsylvania, in the case of Giant Eagle, Inc. V. WCAB (Givner), No. 14 WAP 2010, decided on March 12, 2012, affirmed a Commonwealth Court holding that a claimant who fails to attend a Court ordered Independent Medical Examination (IME) without reasonable excuse can be subject to the suspension of medical benefits, in addition to wage loss benefits, as a ”measured and gradual” sanction to attempt to secure compliance with the Order.

B.        THE NARROW ISSUE PRESENTED TO THE SUPREME COURT OF PENNSYLVANIA:

The narrow issue accepted by the Supreme Court for its review was:

“Whether ‘compensation’ must include medical benefits as well as wage loss benefits under Section 314(a) of the Workers’ Compensation Act.” (emphasis supplied)

In addressing this narrow issue, the Court determined that “compensation” as used in Section 314(a) of the Pennsylvania Workers’ Compensation Act (Act) [that section of the Act that permits ordering attendance at an IME] can encompass, but need not encompass, medical expenses notwithstanding the availability of Utilization Review.

In other words, an employer may obtain a suspension of reasonable and necessary medical benefits to secure compliance, but does not have the ‘right’ to such relief, as the granting of a suspension of medical benefits remains within the discretion of the Judge.

C.        WHAT DOES “COMPENSATION” MEAN?:

Arriving at the conclusion that the term “compensation” as used in Section 314 includes medical benefits, the Court examined various uses of the term “compensation” in various other sections of the Act to discern Legislative intent, as it considered itself required to do so under Berwick Industries v. WCAB (Spaid), 643 A.2d 1066 (Pa., 1994).

The Court concluded that “compensation” as used within the Act sometimes refers only to wage loss benefits and other times may be implied or does more explicitly encompass medical benefits – depending on purpose and context.  The Court pointed out, for example, that the statute of limitations is a bar to compensability for both wage loss and medical benefits, while other sections of the Act, such as Section 308, refer to periodic payment of compensation, as opposed to medical benefits to be provided: “as and when needed”.

D.        WHAT ARE THE PROCEDURAL STANDARDS?  WHAT ARE THE LIMITS OF DISCRETION?:

Suspending medical benefits on a failure to attend an ordered IME, the Court deferred the precise procedure for later definition. In Giant Eagle, the Supreme Court instructed: “This mechanism is gradual and measured.”, referring further to the mechanism as: “… the measured temporary punishment imposable should he or she refuse.”.

Are we looking at a two step process?

Must the employer first request the suspension of wage loss benefits, and only then have standing to request the suspension of medical benefits on further non-compliance, or is it appropriate to request the relief of the suspension of both wage and medical benefits when initially requesting relief for a failure to attend without reasonable excuse under Order?

Given the Court’s instruction of “gradual and measured” sanctions to encourage compliance, it would seem that indeed there is to be a two step process.

What factors are to be considered and what are the limits of discretion in such circumstance?

If wage loss benefits are suspended and non-compliance continues, does a Judge have unfettered discretion to refuse to suspend medical benefits, or does the burden of proof, or at least the burden of persuasion, shift to the Claimant to show why such relief should not be granted to the employer?

An ancillary question presented is what additional burdens, if any, are going to be placed on the Supersedeas Fund, and ultimately on those entities that fund it, given this new potential for overpayment of [admittedly reasonable, necessary and related] medical expense if an abuse of discretion in the denial of suspension of medical benefits is ultimately established?

E.        Does the holding in this Opinion extend to the refusal of reasonable medical services? Does “all” mean all?:

Does this Supreme Court Opinion provide the employer with other potential relief in the context of the refusal of reasonable medical services?

Consider this fact pattern: a claimant sustained a soft tissue orthopedic work injury some years ago and entered into a commutation of wage loss benefits; that claimant continues to treat with pain management, also consuming a large quantity of addictive prescription medication; that claimant is a Medicare beneficiary and that Medicare requires several hundred thousand dollars to approve a set- aside trust; Utilization Review favors the claimant; an IME finds full recovery and recommends detoxification that will present no undue risk, has a high probability of success and has the goal of reducing disability; and that claimant refuses detoxification.

Forfeiture during the period of non-compliance (i.e., a suspension of wage loss benefits) is essentially a moot point, as wage loss benefits have been commuted.

What “gradual and measured” sanctions will encourage the claimant to enter the detoxification program? The only sanction available is the suspension of medical benefits, exactly as provided for by this Supreme Court Opinion in the context of the refusal without reasonable excuse to attend an ordered IME.

This Supreme Court Opinion has left issue of applicability to the refusal of reasonable medical services as open question in its review of the meaning of “compensation” as used in Section 306 (f.1) (8), a section of the Act which provides:

“If the employe shall refuse reasonable services of health care providers, surgical, medical and hospital services, treatment, medicines and supplies, he shall forfeit all rights to compensation for any injury or increase in his incapacity shown to have resulted from such refusal.” (emphasis in original).

In Giant Eagle, the Court stated: “These sub-clauses [including Section 306 (f.1) (8)] do not indicate, on their face, whether the term “compensation” is meant to include payments for medical benefits.” (emphasis in original)

Does “compensation” include both wage loss benefits and medical benefits unless clearly limited solely to wage loss benefits in a particular section of the Act? Does it matter that Section 306 (f.1) (8) refers to “all” rights to compensation?

Does “all” mean all?

Does the rationale implicit in Giant Eagle, Inc. V. WCAB (Givner), No. 14 WAP 2010 in measured dosages, encourage compliance by claimants with his or her obligations, affor,omg as well, the availability of the relief of suspension of medical benefits on a Petition to Suspend/Forfeit based on the refusal of reasonable medical services.