Jefferson Health Services v. Workers' Compensation Appeal Board

746 A.2d 1223, 2000 Pa. Commw. LEXIS 90
CourtCommonwealth Court of Pennsylvania
DecidedFebruary 29, 2000
StatusPublished

This text of 746 A.2d 1223 (Jefferson Health Services 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
Jefferson Health Services v. Workers' Compensation Appeal Board, 746 A.2d 1223, 2000 Pa. Commw. LEXIS 90 (Pa. Ct. App. 2000).

Opinion

McGINLAY, judge.

Jefferson Health Services (Employer) seeks review of the order of the Workers’ Compensation Appeal Board (Board) which affirmed the Workers’ Compensation Judge (WCJ) who denied termination and granted subrogation.

Employer challenged the subrogation on the ground that a determination in a prior proceeding precluded the WCJ from finding that the injury at issue was work-related.

Twila Paradis (Claimant) sustained a work-related injury on September 26, 1994. A notice of compensable payable (NCP) described the injury as a “meniscus tear versus cartilaginous loose body, right knee.” NCP, November 7, 1994; Reproduced Record (R.R.) at 61a. Employer sought a termination/suspension on July 2, 1995. Subsequently, the parties entered into a stipulation which stated that, “the injury did not extend to the right ankle.” (Emphasis added.) Stipulation, August 8, 1997; Appendix A at 9-10. The WCJ adopted the stipulation and suspended benefits, effective July 31, 1996. Decision of the WCJ, September 16, 1997 (First WCJ Decision); Appendix A at 1-7. Intervenor, Capital Blue Cross (Blue Cross) was not a party to the stipulation.1

Pending a resolution of the July 2, 1995, petition, Employer filed a second termination petition and requested a supersede-as on September 2, 1997.2 Petition to Terminate Compensation, September 2, 1997; R.R. at 3a-4a. Claimant denied that she could return to her time-of-injury job without restrictions.

On February 6, 1998, the WCJ issued an interlocutory order and granted Blue Cross’ petition to intervene. Employer [1225]*1225did not oppose Blue Cross’ intervention. Interim/Interlocutory Order of the WCJ, February 6, 1998; Supplemental Reproduced Record (S.R.R.) at 1b-3b.

Employer presented the testimony of H. Andrew Wissinger, M.D. (Dr. Wissinger), a board-certified orthopedic surgeon, who examined Claimant in February 1996, and on August 21, 1997. Dr. Wissinger opined that Claimant could return to her previous occupation as a registered nurse without restrictions. Deposition of H. Andrew Wissinger, November 14, 1997 (Dr. Wis-singer Deposition) at 9; R.R. at 864a. Dr. Wissinger stated that Claimant sustained coronal instability of her right knee and that a degenerative arthritic condition of the right ankle “was exacerbated by the work injury of September 26, 1994, necessitating arthroscopic debridement.” Dr. Wissinger Deposition at 5; R.R. at 860a.

Claimant testified that she underwent arthroscopic surgery to her right knee and later had two operations to her right ankle, in 1995 and 1997, that she continues to suffer pain in her right knee and right ankle and that occasionally her right leg suddenly gives out. Notes of Testimony (N.T.), November 24,1997 at 8-17; R.R. at 261a-270a. Claimant stated that she is unable to avoid falling without the use of a knee brace or a cane. Notes of Testimony, July 13, 1998 at 42; R.R. at 344a.

Claimant presented the testimony of Eric Minde, M.D. (Dr. Minde), a board-certified physiatrist, who reviewed the medical history and examined Claimant on December 3, 1997, and March 18, 1998. Dr. Minde agreed with Dr. Wissinger that Claimant’s condition with respect to both the knee and the ankle was related to the work-injury of 1994, and that she had coronal instability of the right knee. Deposition of Eric Minde, M.D., April 1,1998 (Dr. Minde Deposition) at 11-12, 20-23; R.R. at 404a-405a, 413a-416a. Dr. Minde also stated that Claimant sustained a genuval-gum which he described as a misalignment of the right leg which required support for balance and stability. Dr. Minde Deposition at 16-18; R.R. at 409a-411a. Dr. Minde opined within a reasonable degree of medical certainty that Claimant could not return to work. Dr. Minde Deposition at 21; R.R. at 414a.

Blue Cross presented medical bills and hospital records in support of its demand for subrogation for treatment of Claimant’s right ankle in 1995 pursuant to its agreement with PEBTF. Explanation of Benefits and Medical Records, March 12, 1998; R.R. at 211a-253a. The parties agreed to exchange medical records. N.T., March 12, 1998 at 3-13; R.R. at 291a-301a.

The WCJ determined:

10. It is to be noted that employer and employee [Claimant] in this case sought to “stipulate” that the claimant’s right ankle was not reflective of a work related injury. However the subrogee, Capital Blue Cross, did not make any such stipulation.
17(a). The claimant was not, as alleged, fully recovered from her work-related injury on August 21, 1997, or on any other date.
In so finding, this adjucator [sic] has credited the testimony of the claimant that she continues to have impairment and instability in her right knee.
In so finding, this adjudicator has credited the testimony of Dr. Minde. This adjudicator notes the doctor’s qualifications as a board-certified podiatrist [sic]. He carefully explained why he thought the claimant could not work as a registered nurse, being on her feet all day....
This adjudicator has not credited Dr. Wissinger to the extent that he says claimant is fully recovered. The doctor is credited when he says the claimant has the continued objective sign of coronal instability.
[1226]*122617(b). Despite the stipulation of employer and claimant to the contrary, the credible medical evidence shows the claimant did, indeed, suffer an aggravation of pre-existing degenerative arthritis in her right ankle when she had her injury of September 26, 1994. Dr. Wis-singer is credited to this extent (he has not been credited when he says she is fully recovered from this problem).
17(c). All the billings paid by the sub-rogee, Blue Cross, are for medical treatments causally related to the work-injury. Dr.. Wissinger has been credited. The hospital records submitted by the subrogee, similarly, are found persuasive and rehable. ( Emphases in original.)

Decision of the WCJ, September 4, 1998 (Final WCJ Decision), Findings of Fact, Nos. 10, 17 at 4, 7-8; R.R. at 14a, 17a-18a.

The WCJ concluded:

3. The present matter is treated by this adjucator [sic] as a petition to review the description of injury. Section 413(a) of the Act,[3] 77 P.S. § 771. The NCP is hereby corrected to list the additional injury, “aggravation, degenerative arthritis right ankle.”
4. The subrogee, Capitol Blue Cross, has met the burden of proof required to demonstrate relief on its petition seeking reimbursement.
8. A workers’ compensation judge is not bound by a stipulation which is not supported by any evidence; and, indeed, contrary to the believable evidence. Further the stipulation in the present case is not “fair and equitable to the parties,” as Blue Cross is a party and would be highly prejudiced by the stipulation in this case. 34 Pa.Code § 131.91(b)(1).

Final WCJ Decision, Conclusions of Law, Nos. 3, 4, 8 at 8; R.R. at 18a. The Board affirmed.

The only issue presented for our review is whether the First WCJ Decision adopting the stipulation of facts between Employer and Claimant precludes a subsequent contrary determination by the WCJ.4

Section 413 of the Act, 77 P.S.

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Bluebook (online)
746 A.2d 1223, 2000 Pa. Commw. LEXIS 90, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jefferson-health-services-v-workers-compensation-appeal-board-pacommwct-2000.