Grimm Ex Rel. Grimm v. Workers' Compensation Appeal Board
176 A.3d 1045
| Pa. Commw. Ct. | 2018Background
- Gerard Grimm (Claimant) filed a workers’ compensation fatal-claim petition after his estranged wife, Katherine Grimm (Decedent), died of a work-related heart attack while employed by Federal Express.
- Claimant and Decedent had separated in 2010; Claimant moved out, rented a townhouse, paid his own rent and utilities, and continued to pay many household expenses for the marital residence and children.
- Employer accepted Decedent’s work-related death and agreed to pay dependency benefits to the children and up to $3,000 for burial; the only unresolved issue was Claimant’s entitlement as a widower under Section 307(7).
- Evidence at the WCJ hearing included Claimant’s testimony, joint tax returns (2009–2013), and proof that Decedent provided health insurance through her employer that covered Claimant and the children.
- The WCJ found Claimant and Decedent lived separately at the time of death, that Claimant provided the majority of financial support for the household, and that Decedent’s provision of health insurance alone did not make Claimant actually dependent or receiving a substantial portion of support.
- The Board affirmed; the Commonwealth Court likewise affirmed, holding the WCJ’s findings were supported by substantial evidence and did not capriciously disregard competing evidence.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Claimant was "living with" Decedent for Section 307(7) presumption of dependency | Grimm: "living with" should be liberally construed; continuing joint financial/legal ties (joint tax returns, home ownership, no final divorce) show marital relationship preserved | Employer/WCJ: parties lived in separate residences after divorce filing; their lives were separate in fact despite joint filings | Held: Not living together; presumption inapplicable. WCJ findings supported by substantial evidence. |
| Whether Decedent’s provision of employer-sponsored health insurance made Claimant actually dependent or receiving a substantial portion of support | Grimm: Health insurance (and Decedent’s contribution to family expenses) amounted to a substantial portion of support—comparable to cases allowing small periodic support to satisfy the statute | Employer/WCJ: The only benefit to Grimm was health insurance; Grimm did not show he could not afford any insurance on his own; gravamen is support to claimant personally, not to family generally | Held: Health insurance alone did not establish actual dependency or substantial portion of support. WCJ properly weighed and rejected it as insufficient. |
| Whether joint tax returns and Claimant’s business losses established actual dependency | Grimm: Tax returns and business losses show he relied on Decedent for 25–40% of family income; small contributions can be "substantial" under precedent | Employer/WCJ: 2011 returns show Claimant earned substantially more than Decedent; Claimant paid most household expenses after separation; tax filings benefitted both and do not prove personal dependency | Held: WCJ did not capriciously disregard tax evidence; overall record shows Claimant provided substantial support to Decedent and children, not vice versa. |
Key Cases Cited
- American Mut. Ins. Co. v. Workmen's Comp. Appeal Bd., 530 A.2d 121 (Pa. Cmwlth. 1987) ("living with" language must be liberally construed in appropriate circumstances)
- Canton Plumbing & Heating v. Workmen's Comp. Appeal Bd., 582 A.2d 90 (Pa. Cmwlth. 1990) (small periodic payments can constitute "substantial portion of support" when they fund necessities)
- Urso v. Workmen's Comp. Appeal Bd., 394 A.2d 1322 (Pa. Cmwlth. 1978) (dependency is a factual question for compensation authorities)
- Oknefski v. Workmen's Comp. Appeal Bd. (Louisiana Pac. Co.), 439 A.2d 846 (Pa. Cmwlth. 1981) (statutory presumption for spouses "living with" applies equally to widows and widowers)