Westinghouse Elec. v. WCAB (KORACH)

829 A.2d 387
CourtCommonwealth Court of Pennsylvania
DecidedJuly 1, 2003
StatusPublished

This text of 829 A.2d 387 (Westinghouse Elec. v. WCAB (KORACH)) 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
Westinghouse Elec. v. WCAB (KORACH), 829 A.2d 387 (Pa. Ct. App. 2003).

Opinion

829 A.2d 387 (2003)

WESTINGHOUSE ELECTRIC CORPORATION/CBS, Petitioner,
v.
WORKERS' COMPENSATION APPEAL BOARD (KORACH), Respondent.

Commonwealth Court of Pennsylvania.

Argued May 6, 2003.
Decided July 1, 2003.
Reargument Denied August 25, 2003.

*388 Joseph A. Fricker, Pittsburgh, for petitioner.

Anthony W. DeBernardo, Greensburg, for respondent.

BEFORE: SMITH-RIBNER, Judge, FRIEDMAN, Judge, and KELLEY, Senior Judge.

OPINION BY Judge FRIEDMAN.

Westinghouse Electric Corporation/CBS (Employer) petitions for review of the August 15, 2002, order of the Workers' Compensation Appeal Board (WCAB) that affirmed in part and reversed in part the July 31, 2001, decision of the workers' compensation judge (WCJ) on remand. We affirm.

On December 4, 1984, Employer issued a notice of compensation payable (NCP), acknowledging that, on November 14, 1984, Claimant sustained a work-related injury in the nature of a "back sprain." (WCJ's 9/5/00 Findings of Fact, No. 1; R.R. at 238a.) Claimant had no prior psychological problems, but his personality changed following the injury, and he became severely depressed. In 1989, Claimant went to a psychiatrist, Gerald Lisowitz, M.D., who treated Claimant and prescribed medications that improved Claimant's psychiatric condition. Eventually, Dr. Lisowitz became ill and referred Claimant to another psychiatrist, Jonathan M. Himmelhoch, M.D., for continued treatment. (See WCJ's 9/5/00 Findings of Fact, Nos. 8-9, R.R. at 10a-12a.) Although Claimant's psychological disorder was not identified in the NCP, Employer paid all *389 bills submitted for Claimant's psychiatric treatment.

Pursuant to a supplemental agreement, the parties agreed that work was available to Claimant within his physical limitations effective November 16, 1989.[1] (WCJ's 9/5/00 Findings of Fact, No. 2; R.R. at 239a.) By order dated February 28, 1990, Claimant's benefits were commuted in the sum of $77,000.00. (WCJ's 9/5/00 Findings of Fact, No. 4; R.R. at 248a.) As part of the commutation agreement, the parties stipulated that Employer would remain responsible for payment of reasonable and necessary medical expenses related to Claimant's work injury. (WCJ's 9/5/00 Findings of Fact, No. 3; R.R. at 247a.) Although neither the supplemental agreement nor the stipulation specifically reference a psychiatric component of Claimant's 1984 work injury, Employer continued to pay all bills arising out of Claimant's psychiatric care through August of 1998. (Hearing of May 25, 2000, N.T. at 30, R.R. at 217a, 221a.)

On September 25, 1998, after Employer refused to continue with these payments, Claimant filed a claim petition alleging that he suffered a psychiatric injury in the nature of depression that was precipitated by his 1984 back injury; the petition sought payment of related medical bills as well as counsel fees. In the claim petition, Claimant alleged that Employer's insurance carrier had acknowledged the relationship between Claimant's psychiatric condition and his 1984 back injury and had paid related medical bills through August of 1998, after which the carrier unreasonably refused to pay additional bills. (WCJ's 9/5/00 Findings of Fact, No. 5; R.R. at 1a-2a.)

In its answer to the claim petition, Employer admitted only that Claimant suffered a work-related low back injury on November 14, 1984, for which compensation was commuted on February 28, 1990. Employer also asserted that Claimant's claim of psychic injury was barred by the statute of limitations set forth in section 315 of the Workers' Compensation Act (Act).[2] Further, Employer alleged that Claimant's claim petition should be treated as a petition to review notice of compensation payable, which likewise would be time barred under section 413(a) of the Act.[3]*390 (See WCJ's decision of 9/5/00, Findings of Fact, No. 6; R.R. at 4a-5a.)

During hearings before the WCJ, both parties presented evidence regarding the causal relationship between Claimant's psychiatric treatment and his 1984 work injury. The WCJ specifically credited the testimony of Claimant, Claimant's wife and Claimant's current treating psychiatrist, Dr. Himmelhoch, in support of that relationship, and the WCJ rejected the conflicting testimony of Employer's expert psychiatrist, Stuart S. Burstein, M.D. (See WCJ's 9/5/00 Findings of Fact, Nos. 14-16, 18; R.R. at 14a-16a.) With respect to Employer's statute of limitations argument, the WCJ found that "[d]uring the period of time that [C]laimant was receiving psychiatric care and medications and the insurance carrier was paying, [C]laimant was lulled into a false sense of security that this was the reasonable medical care related to his work injury that was contained in the statement in the commutation where [Employer] stipulated to pay for all reasonable and necessary medications relating to the work injury."[4] (WCJ's 9/5/00 Findings of Fact, No. 19, R.R. at 16a.) Based on these findings, the WCJ concluded that Claimant sustained his burden of proving that he suffered a subsequent depression precipitated by his low back injury of November 14, 1984, and that the psychiatric care and medications received from 1989 and ongoing were reasonable, necessary and causally related to the 1984 work injury. The WCJ further held that Employer's payment of bills for Claimant's psychiatric treatment constituted payments in lieu of compensation[5] that tolled the three-year statute of limitations in section 315 of the Act, 77 P.S. § 602, making Claimant's claim petition timely. (WCJ's 9/5/00 Conclusions of Law, Nos. 2-6; R.R. at 18a.)

Accordingly, on September 5, 2000, the WCJ issued an order granting Claimant's claim petition. The WCJ directed that the NCP be amended to include psychological injuries and ordered Employer to pay *391 medical bills associated with Claimant's psychiatric care from August 1998 and ongoing until such time as they were found to be unreasonable and unnecessary. The WCJ further directed Employer to pay Claimant's attorney's fees for unreasonable contest and to reimburse Claimant's counsel for costs. (R.R. at 19a-20a.)

Employer appealed to the WCAB, which, by decision dated March 23, 2001, affirmed the WCJ in part. Relying on AT & T v. Workmen's Compensation Appeal Board (Hernandez), 707 A.2d 649 (Pa. Cmwlth.1998), the WCAB first concluded that the WCJ properly treated Claimant's petition as a claim petition.[6] Further, the WCAB held that the WCJ appropriately analyzed the timeliness issue under section 315 of the Act and correctly determined that Employer's payment of Claimant's medical expenses for psychiatric treatment tolled the applicable statute of limitations until three years following the most recent voluntary payment of medical benefits in August of 1998. The WCAB affirmed the WCJ's decision to grant the claim petition, but vacated the WCJ's award of attorney's fees, remanding the matter to the WCJ for findings regarding the reasonableness of Employer's contest pursuant to section 440 of the Act, 77 P.S. § 996.

On remand, the WCJ found that Employer failed to present a reasonable contest to the claim and, by decision dated July 31, 2001, awarded Claimant attorney's fees in the amount of $150 per hour for a total of 37.6 hours based upon this unreasonable contest. (R.R.

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