Lindemuth v. Workers' Compensation Appeal Board
134 A.3d 111
Pa. Commw. Ct.2016Background
- Claimant (Lindemuth) was injured at work on October 10, 2005; Employer accepted specific-loss claims for facial/eye injuries and paid total disability benefits.
- In 2009 the WCJ found Claimant sustained headaches causally related to the work injury (attributing them to trigeminal nerve injury) but concluded those headaches did not produce a disability separate and apart from the right-eye specific loss; that decision was affirmed on appeal.
- Claimant filed petitions in 2011 seeking reinstatement/modification of benefits, alleging his headaches worsened and now cause disabling loss of earning power; he also sought review of a Utilization Review (UR) determination denying certain prescriptions.
- At hearing Claimant, his wife, treating physicians (Drs. Kratz and Wirths), and Employer’s IME (Dr. Kasdan) testified; Dr. Kasdan disputed a trigeminal etiology and found no objective evidence of disabling headaches.
- The WCJ found Claimant’s headaches had not worsened since 2009, accepted Dr. Kasdan’s opinions over Claimant’s doctors on worsening/disability, awarded reimbursement for costs related to successful UR review only, and denied attorney’s fees.
- The Board affirmed; Claimant appealed. The Commonwealth Court affirmed the Board, addressing collateral estoppel, substantial-evidence, reasoned-decision, and attorney-fee issues.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether collateral estoppel/res judicata barred relitigation of trigeminal injury and causation | Lindemuth: 2009 WCJ accepted trigeminal injury; WCJ/Board cannot relitigate or deny trigeminal causation now | Employer: earlier decision limited to finding of injury but not to a new disability; WCJ may determine worsening under §413(a) | Court: collateral estoppel establishes trigeminal injury was decided in 2009, but that fact did not bar Claimant from seeking reinstatement for alleged worsening; not precluded from showing disability worsening since 2009 |
| Whether WCJ improperly contradicted his 2009 findings | Lindemuth: WCJ improperly rejected prior factual finding that trigeminal injury caused headaches | Employer: WCJ may reassess disability/worsening even if underlying injury was previously found | Held: WCJ erred to the extent he denied the previously decided trigeminal injury, but that error was harmless because the dispositive question was whether headaches worsened into a separate disabling condition since 2009 |
| Whether WCJ’s credibility and factfinding were supported by substantial evidence | Lindemuth: doctors’ and lay testimony show worsening and disability; WCJ’s rejection unsupported | Employer: IME (Dr. Kasdan) provided objective contrary evidence | Held: Substantial evidence (Dr. Kasdan’s IME and inconsistencies in treating physicians’ evidence) supports WCJ’s findings that headaches did not worsen to a disabling level |
| Whether WCJ issued a reasoned decision under §422(a) | Lindemuth: WCJ failed adequately to explain crediting Kasdan over Kratz/Wirths | Employer: WCJ gave objective reasons (consistency with prior exams, subjective basis of change, inconsistencies among treating docs) | Held: WCJ provided sufficient explanation for appellate review; reasoned-decision requirement satisfied |
| Whether Claimant entitled to attorney’s fees under §440(a) | Lindemuth: won UR petition; entitled to fees (at least for UR success) | Employer: Employer initiated UR reasonably and did not continue contest on UR; other contested issues resolved for Employer | Held: No attorney’s fees; Employer had reasonable basis to contest most issues and did not continue contest on UR evidence, so fees not warranted |
Key Cases Cited
- Pocono Mountain School District v. Workers’ Compensation Appeal Board (Easterling), 113 A.3d 909 (Pa. Cmwlth. 2015) (standard for reviewing substantial evidence and drawing inferences for prevailing party)
- Schemmer v. Workers’ Compensation Appeal Board (U.S. Steel), 833 A.2d 276 (Pa. Cmwlth. 2003) (definition/meaning of specific loss under §306(c))
- Sharon Steel Corp. v. Workers’ Compensation Appeal Board (Frantz), 790 A.2d 1084 (Pa. Cmwlth. 2002) (specific-loss benefits limit recovery even if claimant is totally disabled)
- Faulkner Cadillac v. Workers’ Compensation Appeal Board (Tinari), 831 A.2d 1248 (Pa. Cmwlth. 2003) (specific loss benefits payable without regard to earning capacity)
- Guthrie v. Workers’ Compensation Appeal Board (Keystone Coal Co.), 767 A.2d 634 (Pa. Cmwlth. 2001) (meaning of "disability" under §306(c) differs from earning-capacity standard)
- Bufford v. Workers’ Compensation Appeal Board (North American Telecom), 2 A.3d 548 (Pa. 2010) (requirements to reinstate benefits under §413(a): claimant must show disability recurred or worsened and continues from original injury)
- Stiles v. Workers’ Compensation Appeal Board (Department of Public Welfare), 853 A.2d 1119 (Pa. Cmwlth. 2004) (elements for collateral estoppel in workers’ compensation context)
- LTV Steel Co. v. Workers’ Compensation Appeal Board (Mozena), 754 A.2d 666 (Pa. 2000) (WCJ is exclusive arbiter of credibility; findings must be supported by substantial evidence)
- Daniels v. Workers’ Compensation Appeal Board (Tristate Transport), 828 A.2d 1043 (Pa. 2003) (reasoned decision requirement and need to explain rejection of competent evidence)
- Tatano v. Workers’ Compensation Appeal Board (Copyworld of Pittsburgh), 698 A.2d 123 (Pa. Cmwlth. 1997) (WCJ may credit an expert who did not perform complete physical exam)
- United States Steel Corp. v. Workers’ Compensation Appeal Board (Luczki), 887 A.2d 817 (Pa. Cmwlth. 2005) (application of §440(a) attorney-fee analysis to UR proceedings and when employer’s contest is "reasonable")