Alston v. St. Paul Insurance Companies

612 A.2d 421, 531 Pa. 261, 1992 Pa. LEXIS 377
CourtSupreme Court of Pennsylvania
DecidedJune 17, 1992
Docket59 E.D. Appeal Docket 1991
StatusPublished
Cited by32 cases

This text of 612 A.2d 421 (Alston v. St. Paul Insurance Companies) is published on Counsel Stack Legal Research, covering Supreme Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alston v. St. Paul Insurance Companies, 612 A.2d 421, 531 Pa. 261, 1992 Pa. LEXIS 377 (Pa. 1992).

Opinions

OPINION

ZAPPALA, Justice.

The issue presented in this appeal is whether an employee who sustains an injury covered by the Pennsylvania Workmen’s Compensation Act, 77 P.S. § 1 et seq., may assert a separate tort action for injuries allegedly arising out of malicious and fraudulent conduct and abuse of the legal process to terminate workmen’s compensation benefits by agents of the employer’s insurance carrier. Based upon our decision in Kuney v. PMA Insurance Company, 525 Pa. 171, 578 A.2d 1285 (1990), we conclude that the exclusivity provisions of the Workmen’s Compensation Act prohibit a tort action against the agents of the insurance carrier for injuries allegedly caused by their actions in handling the employee’s compensation claim.

[263]*263This is an appeal from an order of the Superior Court affirming the order of the Delaware County Court of Common Pleas granting summary judgment in favor of St. Paul Insurance Companies, Vocational Rehabilitation Services, Inc., and John T. Williams, M.D. We granted allocatur limited to the issue stated above as it relates to individuals or entities acting on behalf of an employer or the employer’s insurance carrier.

On April 24, 1981, Appellant Calvin Alston fell while working on a ladder and sustained injuries to his wrists, spine, neck and back. St. Paul Insurance Companies (St. Paul), the workmen’s compensation insurance carrier, assigned Alston’s file to Robert Dunham, a claims examiner. Alston began receiving total disability benefits.

St. Paul later contracted with Appellee Vocational Rehabilitation Services, Inc. (Vocational Services) to obtain Alston’s medical records, to monitor his recovery, and to report to St. Paul. On January 7, 1982, Edward Resnick, M.D., an orthopedist, examined Alston as requested by Vocational Services. Dr. Resnick reported that his examination did not reveal any significant findings that could be causally related to the symptoms complained of, or to the injury of April 24, 1981. He stated that there was a strong possibility of chronic pain syndrome, but reserved his final opinion until X-rays could be examined. Alston had refused to allow Dr. Resnick to take any X-rays.

In February, 1982, Vocational Services assigned Alston’s file to an employee, Appellee Janet Rohrer, a “rehabilitation nurse”. Alston was evaluated and treated in February, March, and April, 1982, by J. Brendon Wynne, D.O. Dr. Wynne indicated to Rohrer that he was unable to calculate a firm date on which Alston could return to work. After Rohrer reported Dr. Wynne’s findings to St. Paul, a decision was allegedly made to institute a more aggressive approach toward Alston.

Rohrer arranged to meet with Alston and his wife on May 14, 1982, to discuss his medical treatment and prognosis. At that time, Rohrer indicated that she would like to schedule an appointment for Alston with John T. Williams, M.D., whom [264]*264she allegedly described as a “miracle worker”. Alston agreed to be examined.

On August 31, 1982, Alston was examined by Dr. Williams. Alston alleged that he was not informed that an independent medical examination would occur, or that Dr. Williams had the ability to sign a physician’s affidavit of recovery, or that he was entitled to have his own physician accompany him to the examination. Dr. Williams conducted a brief examination. Without review of Alston’s prior medical records, X-rays, or contact with the treating physician, Dr. Williams told Alston that he was able to return to work.

Dr. Williams executed a physician’s affidavit of recovery. Subsequently, Robert Dunham approached Alston to negotiate a lump sum settlement of his workmen’s compensation benefits. Alston rejected the offer as insufficient. St. Paul then filed a petition to terminate Alston’s benefits.

Alston’s benefits were discontinued for nineteen months, until St. Paul’s petition to terminate was denied. The benefits were reinstated and attorney’s fees were awarded to Alston. St. Paul appealed the referee’s decision to the Workmen’s Compensation Appeal Board. The underlying decision was affirmed, but the award of attorney’s fees was reversed on the Board’s finding of a reasonable contest. No appeal was taken from the Board’s order.

On July 6,1984, the Alstons initiated the trespass action for compensatory and punitive damages from St. Paul, Vocational Services, and Dr. Williams. Ms. Rohrer was joined as an additional defendant by Vocational Services. The essence of the Alstons’ claim is the allegation that the defendants conspired to and made misrepresentations to the Alstons to defraud them of workmen’s compensation benefits.

A motion for summary judgment was filed on behalf of the Appellees. In their motion, the Appellees relied upon the Superior Court’s decision in Rosipal v. Montgomery Ward, 360 Pa.Super. 570, 521 A.2d 49 (1987), alloc. granted, 516 Pa. 635, 533 A.2d 93 (1987), appeal dismissed, 517 Pa. 460, 538 A.2d 495 (1988), holding that an employee’s tort action against her employer was barred by the exclusivity provision of the [265]*265Workmen’s Compensation Act. The trial court granted the summary judgment motion.

On appeal, the Superior Court affirmed. The Superior Court held that the legal immunity that is afforded to employers and their compensation insurers under the exclusivity provisions of the Workmen’s Compensation Act extends not only to acts of negligence, but also to claims based on intentional, wanton and willful misconduct. Citing its decision in Rosipal, supra, the Superior Court concluded that the immunity extended to cover civil tort actions arising from the handling of a workmen’s compensation claim.

In Rosipal, the plaintiff was injured while performing her duties as a security guard. The employer filed a notice of compensation payable and initiated wage indemnity payments. The employer later filed a petition for termination that was supported by a physician’s affidavit of recovery. The plaintiff’s benefits were reinstated following a hearing before a referee.

The plaintiff brought a civil action against her employer, alleging economic duress, intentional infliction of emotional distress, procuring a false affidavit of recovery, and breach of compensation agreement. The employer filed preliminary objections, asserting that it was immune from the action under the Workmen’s Compensation Act. The trial court dismissed the preliminary objections, but the Superior Court granted the employer’s petition for review and reversed.

The Superior Court stated that the Workmen’s Compensation Act barred all civil actions flowing from work-related injuries. In rejecting the argument that the injury did not arise from a work-related accident, the Superior Court reasoned that without a work-related accident, there would have been no workmen’s compensation proceedings out of which the civil action arose. The Superior Court concluded that the plaintiff had failed to state a cause of action as all of the allegations in her complaint had as the ultimate basis an injury compensable under the Workmen’s Compensation Act, and her claims must be considered within its framework.

[266]*266The Superior Court expanded on its analysis in Rosipal in the instant case.

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Bluebook (online)
612 A.2d 421, 531 Pa. 261, 1992 Pa. LEXIS 377, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alston-v-st-paul-insurance-companies-pa-1992.