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I. CASE FACTS: The Claimant sustained a work-related motor vehicle accident on August 5, 1992. He returned to work in May of 1993 and was involved in a second work-related accident on August 30, 1995. The parties entered into a Supplemental Agreement which paid the Claimant total disability benefits beginning November 8, 1995. The Agreement treated the 1995 injury as a recurrence of the 1992 injury.
On October 15, 1998, the Claimant filed a Petition to Review Medical Treatment and/or Billing. On September 30, 1999, the Claimant filed a second Petition to Review Medical Treatment and/or Billing and a Petition to Review Compensation Benefits requesting that the Notice of Compensation Payable and the Supplemental Agreement be amended to include psychological injuries, including sexual dysfunction related to the 1992 injury.
The Workers’ Compensation Judge determined that the Claimant’s sexual dysfunction, chronic pain disorder and depression were related to the 1992 work injury and approved medical treatment for those purposes. The Workers’ Compensation Judge ordered the Notice of Compensation Payable for the 1992 injury to be amended to included sexual dysfunction, chronic pain disorder and depression.
On Appeal, the Employer challenged the Workers’ Compensation Judge’s authority to modify the Notice of Compensation Payable pursuant to § 413(a) of the Workers’ Compensation Act. The Employer argued that the Claimant’s psychological and sexual dysfunction injuries were not the natural consequence of the 1992 injury described as "internal injuries and knee strain in the Notice of Compensation Payable" and, thus, Claimant was compelled to have filed a Claim Petition under § 315 of the Act which requires that the Claimant file a claim for injuries within three (3) years of the work injury (the Statute of Limitations Provision). The Employer asserted that since the Claimant’s Review Petition was filed in February of 2001, nine (9) years after his 1992 injury, the Claimant’s Petition is untimely. The Employer asserted that the case of Jeanes Hospital v. Workers’ Compensation Appeal Board (Hass), 819 A.2d 131 (Pa.Cmwlth. 2003) mandated dismissal of the Petition.
II. CASE HOLDING: The Court reviewed the Jeanes Hospital case in conjunction the instant facts and determined that the Statute of Limitations Provision restriction in Jeanes Hospital did not apply to the instant facts. In Jeanes Hospital, the Claimant had sustained a low back injury which was acknowledged on the Notice of Compensation Payable. Four (4) years after the work injury and in conjunction with Employer’s Petition for Termination, the Claimant filed a Petition for Review alleging that the Claimant had developed a shoulder injury, fibromyalgia and a pain disorder are related to the injury. The Commonwealth Court, in distinguishing in Jeanes Hospital, noted that the Employer Jeanes Hospital was presented with a separate and distinct physical injury after the Claimant’s right to assert a new injury had been extinguished by the Statute of Repose (§ 315 of the Act). In this new case (Westinghouse Electric), the Court noted that the Claimant acknowledged that he had the burden of relating his psychological difficulties to his work injury and specifically sought to amend the N.C.P. The Court stated that as long as there is a causal relationship between the psychological and physical injury, a Claimant is not bound by the Statute of Repose in § 315 of the Act. In making that statement, the Court cited Commercial Credit Claims v. Workers’ Compensation Appeal Board (Lancaster), 556 Pa. 325, 728 A.2d (1999) noting that the Supreme Court had indicated that while the Claimant would retain the burden of proof to establish that a psychiatric injury was causally related to a physical injury where only physical injuries were acknowledged on the Notice of Compensation Payable, the Supreme Court noted that the Claimant was not without recourse and could have filed a Petition for Review (even when sixteen (16) years had passed from the date of injury to the development of psychological problems).
The Commonwealth Court further explained that the Claimant’s Petition in Westinghouse Electric, having been filed under § 413 of the Act, (which provides that a Workers’ Compensation Judge is empowered, at any time, to review, modify or set aside a Notice of Compensation Payable and an Agreement or Supplemental Agreement upon a Petition filed by either party) and was filed within three (3) years of the date of the most recent payment of compensation (which is the Statute of Limitations Provision under § 413) the Claimant’s Petition was timely. Since the Claimant was receiving benefits pursuant to a Supplemental Agreement with the Employer, § 315 would not apply
Attempting to synthesize this current case with the previous case of Jeanes Hospital which had given much flexibility in an attempt by a Claimant to expand the Notice of Compensation Payable is not easy. In reviewing at the Jeanes Hospital case, the Claimant had been receiving payment under a Notice of Compensation Payable. The Claimant was alleging injuries that, on its face, were not the types of injuries that were a natural consequence of a back injury including fibromyalgia , a shoulder condition and depression. Likewise, the Claimant in the instant case was being paid pursuant to a Supplemental Agreement and that his injuries of sexual dysfunction and depression were also not injuries associated with a natural consequence of internal injuries and knee strain as described in the Notice of Compensation Payable.
The Commonwealth Court has apparently realized that by imposing the three (3) year Statute of Repose in § 315 , would preclude acknowledgment of legitimate injuries which would occur over time and would be a consequence of the accepted work injury. Thus, the Commonwealth Court invoked § 413 of the Act which has a different Statute of Limitations Provision that is much more generous. Under § 413, a Claimant would have three (3) years after the last payment of compensation benefits in order to file a Petition. Since Claimants usually file Petitions for Review during the time period in which they receive workers’ compensation benefits, there will be rare opportunities to challenge an attempt by a Claimant to expand the Notice of Compensation Payable by utilizing a Statute of Limitations defense.
The Court Decision has very little discussion regarding whether the medical conditions at issue could be considered a natural consequence of the work-related injury. Certainly, in the case of depression and sexual dysfunction, it would be difficult to associate those conditions as a natural consequence of a physical injury. However, the Court did not decide this case in those terms. Rather, the Court chose a statutory construction interpretation by invoking § 413 of the Act as "trumping" § 315 in application to a Petition for Review for purposes of expanding the Notice of Compensation Payable. While the Court noted in distinguishing Jeanes Hospital that the Claimant in Jeanes Hospital never proved that her physical problems were a natural consequence of the original injury, that analysis is conspicuously absent in the instant case.
III. PRACTICAL HANDLING ADVICE: In any injury that is complex involving a long-term liability, close scrutiny should occur in reviewing and processing medical bills for payment. It is always necessary to separate out those bills which are causally related to non-work related treatment so the payment of medical bills will not be invoked as barring any attempt to limit liability on the work injury.
This case severely challenges an Employer’s/Insurer’s ability to invoke § 315 time limitations as a bar to litigation for expansion of the Notice of Compensation Payable to other injuries or affected body parts. While the Court in Jeanes Hospital seemed to take issue with the fact that the Claimant was unable to prove that the physical problems were a natural consequence of the original injury, that issue was not determinative in this case and in fact played no role as the Court invoked § 413 to permit litigation to go forward so Claimant had the opportunity to prove the case before the Workers’ Compensation Judge. In other words, the Claimant could proceed with the litigation of a Review Petition, however, Claimant must still meet his burden of proof to demonstrate that the psychological (or physical) symptoms, are compensable or a natural and probable consequence of the accepted work injury.