Duffey v. Workers' Compensation Appeal Board (Trola-Dyne, Inc.)
2017 Pa. LEXIS 132
| Pa. | 2017Background
- Claimant Michael Duffey was electrocuted at work; Employer issued an NCP listing compensable injury as electrical burn to bilateral hands (nerve and joint pain).
- After 104 weeks of total disability benefits, Employer requested an IRE; physician-evaluator (Dr. Sicilia) performed an evaluation and assigned a 6% whole‑body impairment rating, triggering conversion from total to partial disability.
- Claimant alleged the IRE was invalid because it did not address work-related psychological conditions (adjustment disorder with depressed mood and chronic PTSD) he reported at the IRE.
- WCJ credited Claimant’s medical testimony, found the evaluator failed to consider those psychological conditions and their causation, ordered the NCP amended to include them, and invalidated the IRE; the Board and Commonwealth Court reversed, upholding the IRE as limited to injuries listed on the NCP.
- Pennsylvania Supreme Court reversed the Commonwealth Court, holding that physician-evaluators must use professional judgment to assess whole‑body impairment "due to the compensable injury," including making causation determinations and, when appropriate, addressing psychological conditions reported at the IRE.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Scope of IRE: whether an IRE is limited to injuries listed on the NCP | Duffey: the evaluator must address all work‑related conditions known at the time of the IRE, including psychological conditions | Trola‑Dyne: evaluator may properly limit IRE to accepted injuries on the NCP; claimant must amend NCP before IRE | Court: evaluator must exercise professional judgment to determine the degree of whole‑body impairment due to the compensable injury and consider causation; evaluator may not refuse to assess conditions solely because they are not listed on the NCP |
| Who determines causation for impairments | Duffey: evaluator should consider and rate impairments fairly attributable to the compensable injury | Employer: causation and compensability are matters for WCJ and NCP; requiring evaluator to decide expands evaluator role improperly | Court: statute assigns physicians responsibility to determine impairment "due to" compensable injury consistent with AMA Guides; evaluators must address causation as part of IRE |
| Effect of claimant mentioning additional conditions at IRE | Duffey: mentioning conditions triggers evaluator duty to assess them | Employer: allowing that would permit strategic last‑minute claims to defeat compliant IREs; claimant should timely amend NCP | Court: evaluator must consider reported conditions using professional judgment, but statutory safeguards (e.g., appeal thresholds) mitigate malingering concerns |
| Role of AMA Guides editions and psychiatric ratings | Duffey: psychological impairments should be rated where appropriate under the Guides | Employer/dissent: earlier Guides (4th ed.) reject assigning percentages to mental disorders and Sixth Ed. issues; reliance on Guides cannot expand IRE scope | Court: evaluators must follow the AMA Guides incorporated by statute and may, consistent with the Guides, incorporate psychological effects in whole‑body ratings or use Chapter 14 when appropriate; questions about specific editions are beyond present case scope |
Key Cases Cited
- Barrett v. WCAB (Sunoco, Inc.), 987 A.2d 1280 (Pa. Cmwlth. 2010) (60‑day challenge rule to IRE conversion decisions)
- Harrison v. WCAB (Auto Truck Transp. Corp.), 78 A.3d 699 (Pa. Cmwlth. 2013) (NCP defines compensable injury for impairment inquiry)
- Westmoreland Reg’l Hosp. v. WCAB (Pickford), 29 A.3d 120 (Pa. Cmwlth. 2011) (IRE assesses claimant’s condition at time of evaluation)
- IA Constr. Corp. v. WCAB (Rhodes), 139 A.3d 154 (Pa. 2016) (summary of impairment‑rating regime and statute)
- Protz v. WCAB (Derry Area Sch. Dist.), 124 A.3d 406 (Pa. Cmwlth. 2015) (issues concerning which edition of AMA Guides is permissible in Pennsylvania)
- Commercial Credit Claims v. WCAB (Lancaster), 728 A.2d 902 (Pa. 1999) (NCP is binding unless modified; separate psychological injury not covered by an NCP listing different physical injuries)