Gelvin v. Workers' Compensation Appeal Board
120 A.3d 473
| Pa. Commw. Ct. | 2015Background
- Claimant, a former state trooper, was awarded workers’ compensation for work-related PTSD with benefits beginning December 21, 2006; Employer had accepted the injury and begun payments.
- Claimant applied for and received a disability pension from SERS effective February 2011 (checks paid beginning February 29, 2012, with a retroactive lump sum); she returned an LIBC-756 reporting form in March 2012.
- Employer sent LIBC-756 forms (Dec. 21, 2011 and March 2012) and on March 27, 2012 issued a LIBC-761 notice of offset seeking recoupment of $19,597.99 and suspended workers’ compensation benefits effective April 21, 2012.
- WCJ found Employer violated the Act/regulations by unilaterally recouping without proper procedure and granted reinstatement, a 50% penalty for the suspension period, and counsels’ fees for unreasonable contest.
- The Workers’ Compensation Appeal Board reversed, holding Employer was entitled to a retrospective offset (back to February 2011) because Employer had fulfilled its notice obligations; Employer’s unilateral offset was permitted by regulation.
- On appeal to this Court, the court affirmed the Board: Employer satisfied notification duties, recoupment was lawful beginning February 2011, no entitlement to counsel fees because Claimant did not prevail, and penalties were improper.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Employer may recoup retroactive pension benefits prior to the date LIBC-756 was returned | Gelvin: recoupment should be limited to date Employer provided LIBC-756 (WCJ’s view); earlier recoupment imposes hardship | Employer: statute/regulation allows offset of pension benefits it funded and no requirement to wait for a specific LIBC-756 receipt date | Court: Employer entitled to retrospective offset beginning February 2011; Board correctly reversed WCJ |
| Employer duty to notify claimant and frequency of LIBC-756 forms | Gelvin: Maxim Crane/Muir require employer diligence and six-month reminders; lack of form limits recoupment | Employer: it timely provided LIBC-756 (Dec 2011 and March 2012) and satisfied its duties | Court: Employer satisfied Maxim Crane/Muir duty; sending forms within the relevant period negates presumption of prejudice |
| Whether WCJ must perform hardship analysis or may restructure recoupment | Gelvin: WCJ should have modified recoupment to reduce hardship (relying on Wright) | Employer: no request to modify recoupment; recoupment within regulatory scheme | Court: WCJ did not make a binding hardship finding; Wright allows structuring but does not require modification absent request; no relief due to no prevailing claim |
| Whether Employer’s unilateral suspension/recoupment and denial of benefits warranted penalties and counsel fees | Gelvin: suspension without agreement/order and hardship justify 50% penalty and counsel fees | Employer: regulation permits unilateral offset and it acted lawfully, so no unreasonable contest | Court: Regulation permits unilateral offsets; Employer did not unreasonably contest claims; counsel fees and penalties reversed |
Key Cases Cited
- Maxim Crane Works v. Workers’ Compensation Appeal Board (Solano), 931 A.2d 816 (Pa. Cmwlth.) (employer’s lack of timely notice can bar retrospective recoupment)
- Muir v. Workers’ Compensation Appeal Board (Visteon Systems LLC), 5 A.3d 847 (Pa. Cmwlth.) (employer must provide LIBC-756 reminders at least every six months)
- City of Pittsburgh v. Workers’ Compensation Appeal Board (Wright), 90 A.3d 801 (Pa. Cmwlth.) (WCJ may structure recoupment but no automatic presumption of prejudice)
- City of Philadelphia v. Workers’ Compensation Appeal Board (Grevy), 968 A.2d 830 (Pa. Cmwlth.) (employer entitled to offset for pension benefits it funded)
- Costa v. Workers’ Compensation Appeal Board (Carlisle Corporation), 958 A.2d 596 (Pa. Cmwlth.) (regulation allows unilateral employer offset)