Gardner v. Workers' Compensation Appeal Board

888 A.2d 758, 585 Pa. 366, 2005 Pa. LEXIS 3098
Supreme Court of Pennsylvania·Decided December 28, 2005·No. 14 EAP 2004 and 103 MAP 2004·Published·Cited by 83 cases

Opinions

OPINION

Chief Justice CAPPY.

These cases, consolidated for purposes of this appeal, require us to resolve issues dealing with the timing of when an insurer is required to request that an injured employee submit to an impairment rating evaluation (“IRE”) for the purpose of obtaining an automatic reduction in benefits under the Workers’ Compensation Act, 77 P.S. § 511.2 (“Act”).1 For the [369] following reasons, we affirm the Commonwealth Court’s decision in Gardner v. Workers’ Compensation Appeal Board (Genesis Health Ventures), 814 A.2d 884 (Pa.Commw.Ct.2003)(“Gardner’’) and reverse the Commonwealth Court’s decision in Wal-Mart Stores, Inc. v. Workers’ Compensation Appeal Board (Rider), 837 A.2d 661 (Pa.Commw.Ct.2003)(“Rider ”). A brief discussion of the facts and procedural history of each of these matters precedes our discussion of the legal issues involved.

The facts of Gardner were stipulated by the parties, and, thus, are not in dispute. Barbara Gardner (“Gardner”) sustained a compensable work injury on October 2, 1996. As of October 2, 1998, she had received temporary total disability benefits for a total of 104 weeks. On June 13, 2001, Gardner’s employer, Genesis Health Ventures (“Genesis”), requested that she submit to an IRE. Gardner objected to this request, claiming that the request was impermissible under 77 P.S. § 511.2(1), as it was not made within sixty days of her receipt of 104 weeks of temporary total disability benefits. Genesis, subsequent to Gardner’s objection, filed a Petition for Physical Examination on August 10, 2001, requesting that a Workers’ Compensation Judge (“WCJ”) order Gardner to submit to an IRE. The WCJ, on November 2, 2001, denied the Petition based on Section 511.2(1),2 which the WCJ found to require the insurer to request the IRE within the sixty-day period of Gardner’s receipt of 104 weeks of temporary total benefits, which had commenced October 2, 1998. Genesis appealed the WCJ’s decision to the Workers’ Compensation Appeal Board (“WCAB”). On August 1, 2002, the WCAB reversed, based on its conclusion that 511.2(1) was ambiguous and that 34 Pa. Code § 123.102(f) properly interpreted that provision not as a statute of limitations, but rather as a “window in which the insurer must act for the ‘adjustment of benefit status’ ‘to [370] relate back to the expiration of the employee receipt of 104 weeks of total disability benefits.’ ” See WCAB Op. at p. 3. Gardner, in turn, appealed the WCAB’s decision to the Commonwealth Court. In a published opinion, the Commonwealth Court en banc reversed the WCAB order, holding that the language of Section 511.2(1) is clear and free from ambiguity. As such, the Commonwealth Court held that an insurer must request that the claimant submit to a medical examination within sixty days of the claimant’s receipt of 104 weeks of total disability benefits or be forever precluded from modifying the claimant’s benefits based on the procedure set forth in 77 P.S. § 511.2. The Commonwealth Court specifically noted in Gardner, however, that an employer may, at any time, request that a claimant submit to a medical examination under 77 P.S. § 651 in order to modify a claimant’s benefits based on a change in medical condition and earning power. Gardner, 814 A.2d at 887 n. 9. Genesis sought allowance of appeal, which we granted.

Turning now to the Rider matter, the facts and procedural history of that case are as follows: Appellee Wal-Mart Stores, Inc. (“Wal-Mart”) had employed Leroy Rider (“Rider”) as a truck driver since 1993. On July 31, 1998, Rider sustained a neck injury while in the course and scope of his employment. He underwent chiropractic therapy and treatment through his family physician. This course showed promise but was short-lived, as he was diagnosed with a ruptured cervical disc. Rider stopped working for Wal-Mart on October 21, 1998. He filed a Claim Petition on November 1, 1998, alleging total disability from October 21, 1998, and underwent corrective surgery on November 20, 1998. A WCJ, on December 16, 1999, found Rider’s injuries to be work-related and awarded temporary total disability benefits from October 21, 1998. Wal-Mart appealed this decision to the WCAB and also requested a supersedeas order. On January 12, 2000, the WCAB granted Wal-Mart’s supersedeas request only as to the payment of attorneys’ fees for unreasonable contest and as to Rider’s claim for disfiguring scarring. This order was unequivocal that “Supersedeas is denied in all other respects.” [371] (WCAB Order of January 12, 2000) The WCAB remanded the case to the WCJ and, on November 20, 2001, the WCJ again found for Rider, awarding him total disability benefits from October 21, 1998. Wal-Mart did not contest this decision.

On December 10, 2001, 163 weeks after the date when disability benefits began, but within sixty days of the final adjudication of Rider’s claim, Wal-Mart requested Rider submit to an IRE. On January 11, 2002, Wal-Mart informed Rider that his disability status, following the IRE,3 changed from total to partial. Rider responded with a petition to reinstate his total disability status, alleging that Wal-Mart’s IRE request was untimely under Section 511.2(1). The WCJ agreed with Rider, granting his reinstatement petition on June 28, 2002, on grounds that Wal-Mart’s IRE request did not comply with the statute, as it was requested beyond the sixty days following Rider’s receipt of 104 weeks of benefits. The 104-week period began, according to the WCJ, on the date of Rider’s injury, October 21,1998, and ended October 21, 2000. Wal-Mart thus had until December 20, 2000, to request that Rider submit to the IRE. Moreover, the WCJ concluded that the pertinent language of Section 511.2(1) is mandatory in requiring the insurer to request the IRE within sixty days upon expiration of the 104 weeks. Wal-Mart appealed that decision to the WCAB, which affirmed on May 12, 2003. A three-judge panel of the Commonwealth Court reversed the WCAB in a published decision. The Rider court distinguished itself from Gardner on the grounds that, unlike Gardner, the employer disputed Rider’s entitlement to benefits. Wal-Mart Stores, Inc., 837 A.2d at 664. Because Wal-Mart litigated Rider’s claim, regardless of the amount of benefits Rider accrued, the Rider court held that he did not “receive” 104 weeks of total disability benefits until the WCJ rendered its decision on November 21, 2001. Id. Rider sought allowance of appeal, which we granted.

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Gardner v. Workers' Compensation Appeal Board, 888 A.2d 758, 585 Pa. 366, 2005 Pa. LEXIS 3098 (Pa. 2005).

888 A.2d 758 (Gardner v. Workers' Compensation Appeal Board) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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