K. Benedict v. Hard Chrome Specialists, Inc. (WCAB)
746 C.D. 2023
Pa. Commw. Ct.Sep 20, 2024Background
- Kevin Benedict suffered a work-related injury on October 22, 2013, adjudicated as a herniated nucleus pulposus (HNP) at L4-5, for which his employer was responsible for medical expenses causally related to that injury.
- In 2021, Benedict filed a Penalty Petition alleging his employer failed to pay for specific prescribed medications (Oxycodone/Oxycontin, Lyrica, and Diclofenac Sodium) he claimed were related to his work injury.
- The employer denied responsibility, asserting the prescriptions were for conditions (arthritis and spinal stenosis) not included in the accepted work injury description.
- The Workers’ Compensation Judge (WCJ) denied Benedict’s Penalty Petition, finding the medications were not causally related to the adjudicated work injury (HNP at L4-5), a decision affirmed by the Workers’ Compensation Appeal Board.
- Benedict appealed to the Commonwealth Court, challenging whether the WCJ properly evaluated the Letters of Medical Necessity linking the medications to his work injury.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether WCJ erred in not crediting the Letters of Medical Necessity | Letters showed medications were for accepted injury | Letters referenced unrelated conditions; injury description binding | WCJ properly explained and rejected Letters; no error |
| Whether WCJ's decision was sufficiently reasoned | Letters were not adequately discussed or explained | Decision met statutory requirements for reasoned adjudication under Section 422 | WCJ properly explained findings and evidentiary weight |
| Whether failure to pay justified 50% penalties | Since employer denied payment, penalties apply | Employer can decline payment for non-causally related expenses; no penalty if WCJ agrees | No penalties owed since WCJ found no causation to work injury |
| Scope of prior work injury description | All related symptoms should be covered | Only expressly adjudicated conditions (not arthritis/spinal stenosis) are employer’s burden | Employer liability limited to specific adjudicated injury description (HNP at L4-5) |
Key Cases Cited
- Hershgordon v. Workers’ Comp. Appeal Bd. (Pepboys, Manny, Moe & Jack), 14 A.3d 922 (Pa. Cmwlth. 2011) (WCJ is ultimate factfinder, may accept or reject any testimony)
- Griffiths v. Workers’ Comp. Appeal Bd. (Red Lobster), 760 A.2d 72 (Pa. Cmwlth. 2000) (reliance on WCJ credibility and evidentiary decisions is appropriate)
- Sadler v. Phila. Coca-Cola (Workers’ Comp. Appeal Bd.), 269 A.3d 690 (Pa. Cmwlth. 2022) (WCJ’s findings as factfinder are entitled to deference)
- Listino v. Workmen’s Comp. Appeal Bd. (INA Life Ins. Co.), 659 A.2d 45 (Pa. Cmwlth. 1995) (employer not liable for penalties if denial for causation is upheld)