C. Luby v. WCAB (Valley Crest Nursing, d/b/a Timber Ridge Health Care)
499 C.D. 2016
| Pa. Commw. Ct. | Dec 28, 2016Background
- Claimant (Luby), a CNA, fell at work on June 10, 2012; Employer initially accepted a right ankle/Achilles injury in an NCP and paid benefits through March 13, 2013.
- Luby later sought to amend the NCP to include a left knee injury (torn medial meniscus) and sought reinstatement of disability for surgery and related wage loss; Employer denied left-knee liability and filed a petition to terminate benefits based on an IME.
- Medical evidence: Dr. Feinstein (treating) attributed the left meniscal tear and later total knee replacement to the work fall; Dr. Schmidt (IME) concluded the left injury was a contusion and the complex meniscal tear was degenerative and not work-related.
- The WCJ credited Dr. Schmidt, found work-related injuries were a torn right Achilles and a left knee contusion, and granted Employer’s termination petition, finding Claimant fully recovered as of May 1, 2013; denied Claimant’s request for litigation costs.
- The Board affirmed the WCJ but modified the recovery date to July 26, 2013 (date of Dr. Schmidt’s exam) and recognized the left knee contusion (so the Review Petition was granted in part); it denied litigation costs because Claimant received no financial benefit.
- This Court affirmed the Board: (1) amendment to NCP to add left knee contusion produced no additional benefits so litigation costs were not recoverable under Section 440(a); and (2) the WCJ’s credibility choices and reliance on contemporaneous medical records provided substantial evidence to conclude the meniscal tear was degenerative, not causally related to the work fall, so termination was proper.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Claimant is entitled to litigation costs under Section 440(a) after partial success amending the NCP to add a left knee contusion | Luby: Amendment shows partial victory; Employer should have acknowledged the contusion and costs should be awarded | Employer: Luby sought compensable meniscal injury and benefits; the amendment produced no additional indemnity or medical benefits so no financial gain | Court: Denied costs — partial procedural victory without financial benefit does not satisfy Section 440(a) entitlement (claimant must receive monetary/beneficial relief) |
| Whether substantial evidence supports WCJ’s termination of benefits and rejection of causal link between fall and left meniscal tear | Luby: WCJ improperly credited Dr. Schmidt’s reliance on Concentra note (allegedly hearsay/misdiagnosed) and inappropriately considered weight and other factors; Dr. Feinstein’s causation opinion should control | Employer: Dr. Schmidt’s opinion was consistent with contemporaneous records and proper bases for expert opinion; WCJ as factfinder may credit one expert over another | Court: Affirmed — WCJ may weigh conflicting medical testimony; Dr. Schmidt’s reliance on contemporaneous records was permissible and supported finding meniscal tear degenerative and unrelated to the work fall |
Key Cases Cited
- Watson v. Workers’ Comp. Appeal Bd. (Special People in Northeast), 949 A.2d 949 (Pa. Cmwlth.) (a claimant must obtain a financial benefit to be "partially successful" and recover litigation costs under Section 440(a))
- Minicozzi v. Workers’ Comp. Appeal Bd. (Indust. Metal Plating, Inc.), 873 A.2d 25 (Pa. Cmwlth.) (no litigation costs where claimant obtained no financial benefit despite prevailing on a minor issue)
- W. Pa. Hosp. v. Workers’ Comp. Appeal Bd. (Cassidy), 725 A.2d 1282 (Pa. Cmwlth.) (award of costs when claimant prepared to litigate and employer ultimately accepted liability at hearing; costs issue turned on reimbursable items)
- Ingrassia v. Workers’ Comp. Appeal Bd. (Universal Health Servs.), 126 A.3d 394 (Pa. Cmwlth.) (medical experts may base opinions on other physicians’ records customarily relied upon)
- Cinram Mfg., Inc. v. Workers’ Comp. Appeal Bd. (Hill), 975 A.2d 577 (Pa.) (burden for amending NCP requires proof of additional compensable injuries)