D. Morales v. WCAB (SD of Philadelphia)
D. Morales v. WCAB (SD of Philadelphia) - 110 C.D. 2017
| Pa. Commw. Ct. | Aug 30, 2017Background
- Claimant Diana Morales, a school bus driver, injured herself on January 6, 2012 while turning the bus wheel; Employer issued an NCP accepting left shoulder and cervical sprain/strain.
- Morales filed a Review Petition (incorrect description of injury), a Review Medical Treatment/Billing Petition (unpaid medical bills), and a Penalty Petition; Employer filed a Termination Petition asserting full recovery as of August 11, 2014.
- Testimony and depositions: Claimant and treating Dr. Sofia Lam (anesthesiology/physiology) asserted cervical disc pathology and radicular symptoms; Employer’s IME Dr. Gregory Tadduni (orthopedic surgeon) found chronic MRI changes, no acute radiculopathy, and no objective findings supporting ongoing disability.
- WCJ found Claimant not credible, credited Dr. Tadduni over Dr. Lam, denied the Review Petition and billing/penalty petitions, and granted Employer’s Termination Petition.
- The Board affirmed the WCJ on the Review and Termination petitions but the Commonwealth Court remanded solely to clarify whether chiropractic bills (Exhibit C-5) were properly submitted, unpaid, and if a penalty is warranted.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Employer met burden to terminate benefits | Morales: WCJ/Board lacked reasoned findings; Employer expert incompetent to support termination because he disputed the accepted cervical injury | Employer: Dr. Tadduni competently opined Claimant recovered from accepted injuries and supported termination | Court: Affirmed termination — Dr. Tadduni’s opinion was competent and sufficient to show recovery |
| Credibility determinations of Claimant and treating physician | Morales: WCJ erred in discrediting her testimony and Dr. Lam without record support | Employer: WCJ properly weighed inconsistencies, prior history, and objective testing to reject Claimant and favor IME | Court: WCJ provided adequate reasons; credibility and weight are for WCJ, decision upheld |
| Whether medical bills (Dr. Abdalla/Dr. Lam) were properly submitted and unpaid | Morales: Bills were submitted and unpaid; WCJ failed to order payment and penalty | Employer: Denied any unpaid bills and contested sufficiency of submitted forms | Held: Remanded — unresolved record issue whether Exhibit C‑5 was timely/properly submitted and unpaid; WCJ must make findings and determine penalty liability |
| Whether WCJ/Board issued a reasoned decision per Section 422(a) | Morales: Decision not reasoned because it failed to address competency of Employer expert and other arguments | Employer: WCJ addressed and explained credibility, evidence, and expert opinions | Court: WCJ and Board rendered a reasoned decision as to review and termination claims; remand limited to billing submission issue |
Key Cases Cited
- Westmoreland County v. Workers’ Compensation Appeal Board (Fuller), 942 A.2d 213 (Pa. Cmwlth.) (employer’s expert must opine on recovery or absence of disabling findings to support termination)
- Jackson v. Workers’ Compensation Appeal Board (Resources for Human Development), 877 A.2d 498 (Pa. Cmwlth.) (employer doctor competent when, alternatively, he opines injury resolved)
- To v. Workers’ Compensation Appeal Board (Insaco, Inc.), 819 A.2d 1222 (Pa. Cmwlth.) (employer doctor’s skepticism of causation is acceptable if he opines claimant fully recovered)
- Hall v. Workers’ Compensation Appeal Board (America Service Group), 3 A.3d 734 (Pa. Cmwlth.) (focus is whether expert addresses accepted injury and recovery)
- Daniels v. Workers’ Compensation Appeal Board (Tristate Transport), 828 A.2d 1043 (Pa. 2003) (WCJ must render a reasoned decision and explain rejection of competent evidence)
- SCI‑Waymart v. Workers’ Compensation Appeal Board (Feldman), 766 A.2d 900 (Pa. Cmwlth.) (WCJ is exclusive arbiter of credibility and evidentiary weight)