Hilyer v. Workers' Compensation Appeal Board

847 A.2d 232, 2004 Pa. Commw. LEXIS 308
CourtCommonwealth Court of Pennsylvania
DecidedApril 21, 2004
StatusPublished
Cited by16 cases

This text of 847 A.2d 232 (Hilyer v. Workers' Compensation Appeal Board) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hilyer v. Workers' Compensation Appeal Board, 847 A.2d 232, 2004 Pa. Commw. LEXIS 308 (Pa. Ct. App. 2004).

Opinion

OPINION BY Senior Judge KELLEY.

Stephen Hilyer (Claimant) petitions for review of an order of the Workers’ Compensation Appeal Board (Board) which affirmed an order of a Workers’ Compensation Judge (WCJ). The WCJ concluded that Joseph T. Patrick, Jr. Logging (Employer) was entitled, pursuant to the Penn *233 sylvania Workers’ Compensation Act 1 (the Act), to the right to request and receive a second Impairment Rating Evaluation (IRE) within a twelve-month period. We affirm.

Claimant worked for Employer as a logger when, on April 29, 1997, he was struck on the head by a falling tree limb, suffering a work-related injury to his spinal cord. Claimant subsequently began receiving benefits under the Act.

On May 14, 2001, Claimant underwent an IRE by Dr. Matthews, which evaluation yielded an impairment rating of 55 percent. Employer objected to Dr. Matthews’ impairment rating, asserting that a non-work related injury had been considered in rendering the determination. Thereafter, Employer’s insurer, the State Workers’ Insurer Fund (Insurer), 2 requested that Claimant submit to a second IRE, which Claimant refused.

On February 4, 2002, Insurer filed a Review Petition alleging that Claimant had refused the requested second IRE. Claimant timely answered Insurer’s Petition, denying that Insurer was entitled to a second IRE due to Claimant’s submission to the initial IRE.

Hearings before the WCJ were subsequently held, at which the sole issue was stipulated by the parties to be Insurer’s entitlement, under the Act and its promulgated regulations, to a second IRE. Both parties submitted written argument to the WCJ, who concluded that the Act did grant Insurer the right to request and receive an IRE twice in a twelve-month period.

By order dated July 9, 2002, the WCJ granted Insurer’s Petition, and further ordered Claimant’s attendance at a second IRE. The WCJ further ordered that, in the face of Claimant’s failure to so attend as ordered, Insurer shall be entitled to a suspension of Claimant’s benefits. Claimant timely appealed the WCJ’s order and decision to the Board.

The Board thereafter heard Claimant’s appeal without taking additional evidence. In its opinion, the Board specifically rejected Claimant’s argument that Insurer was not entitled to a second IRE within twelve months without providing additional evidence that the status of the impairment has improved, and affirmed the order and decision of the WCJ. Claimant now timely appeals to this Court.

This Court’s scope of review is limited to determining whether there has been a violation of constitutional rights, errors of law committed, or a violation of Board procedures, and whether necessary findings of fact are supported by substantial evidence. Lehigh County Vo-Tech School v. Workmen’s Compensation Appeal Board (Wolfe), 539 Pa. 322, 652 A.2d 797 (1995).

Claimant presents one issue for our review: whether the WCJ erred as a matter of law in granting Insurer’s request for an additional IRE under the relevant provision of the Act, and its promulgated regulation. Claimant argues that Insurer is not entitled to a second IRE without a showing that the status of Claimant’s disability has changed sufficiently to rebut the presumption of continuing disability. We disagree, in that the Act clearly does not require — either implicitly, and unarguably not explicitly — such a prefatory showing as a condition precedent to a second requested IRE. The Act, in both its partie- *234 ular provisions and when read as a whole, grants an Insurer the right to a second IRE within a twelve-month period upon timely request thereof without any prefatory showing.

Section 306(a.2) of the Act 3 reads, in part relevant to the matter sub judies:

Medical examination; impairment rating
(1) When an employe has received total disability compensation pursuant to clause (a) for a period of one hundred four weeks, unless otherwise agreed to, the employe shall be required to submit to a medical examination which shall be requested by the insurer within sixty days upon the expiration of the one hundred four weeks to determine the degree of impairment due to the com-pensable injury, if any. The degree of impairment shall be determined based upon an evaluation by a physician who is licensed in this Commonwealth, who is certified by an American Board of Medical Specialties approved board or its osteopathic equivalent and who is active in clinical practice for at least twenty hours per week, chosen by agreement of the parties, or as designated by the department, pursuant to the most recent edition of the American Medical Association “Guides to the Evaluation of Permanent Impairment.”
(2) If such determination results in an impairment rating that meets a threshold impairment rating that is equal to or greater than fifty per centum impairment under the most recent edition of the American Medical Association “Guides to the Evaluation of Permanent Impairment,” the employe shall be presumed to be totally disabled and shall continue to receive total disability compensation benefits under clause (a). If such determination results in an impairment rating less than fifty per centum impairment under the most recent edition of the American Medical Association “Guides to the Evaluation of Permanent Impairment,” the employe shall then receive partial disability benefits under clause (b): Provided, however, that no reduction shall be made until sixty days’ notice of modification is given.
(5) Total disability shall continue until it is adjudicated or agreed under clause (b) that total disability has ceased or the employe’s condition improves to an impairment rating that is less than fifty per centum of the degree of impairment defined under the most recent edition of the American Medical Association “Guides to the Evaluation of Permanent Impairment.”
(6) Upon request of the insurer, the employe shall submit to an independent medical examination in accordance with the provisions of Section 314 to determine the status of impairment: Provided, however, That for purposes of this clause, the employe shall not be required to submit to more than two independent medical examinations under this clause during a twelve-month period.
* * *
(8)(i) For purposes of this clause, the term “impairment” shall mean an anatomic or functional abnormality or loss that results from the compensable injury and is reasonably presumed to be permanent.
(ii) For purposes of this clause, the term “impairment rating” shall mean the percentage of permanent impairment of the whole body resulting from the compen-sable injury. The percentage rating for impairment under this clause shall rep *235

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Bluebook (online)
847 A.2d 232, 2004 Pa. Commw. LEXIS 308, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hilyer-v-workers-compensation-appeal-board-pacommwct-2004.