Pennsylvania Uninsured Employers Guaranty Fund v. Workers' Compensation Appeal Board
85 A.3d 1109
Pa. Commw. Ct.2014Background
- On March 16, 2009 Gerald Bonner (Claimant) fell ~12 feet while tearing off a roof for employer Anthony Fitzgerald, sustaining skull fracture, seizures, left orbital injury and traumatic brain injury.
- Employer was uninsured; Claimant filed claim petitions against Employer and the Pennsylvania Uninsured Employers Guaranty Fund (Fund). Fund denied liability.
- Claimant testified he still suffered headaches, balance problems, photosensitivity and could not return to labor work; average weekly wage found to be $400.
- Claimant’s treating psychologist/neurotrauma specialist Michael W. Collins, Ph.D., diagnosed moderate traumatic brain injury, performed neuropsychological testing, reviewed imaging, treated Claimant and opined Claimant was unable to return to labor work as of his last exam (11/25/2009), though he speculated Claimant might improve with continued treatment.
- Fund’s IME (Dr. Kasdan) confirmed the 2009 injuries but opined Claimant’s exam was within normal limits, recommended no further treatment for the brain injury, and concluded Claimant could return to full-time light duty.
- WCJ credited Claimant and Dr. Collins, rejected parts of Dr. Kasdan’s opinion, awarded total disability benefits; the Board affirmed. The Commonwealth Court likewise affirmed.
Issues
| Issue | Plaintiff's Argument (Fund) | Defendant's Argument (Bonner) | Held |
|---|---|---|---|
| Whether there was substantial evidence that Claimant’s disability continued beyond Dr. Collins’s last treatment date (11/25/2009) | Dr. Collins could not opine beyond 11/25/2009; per Innovative Spaces claimant must prove ongoing disability throughout pendency, so evidence insufficient | Claimant’s own unrebutted testimony and Dr. Collins’s findings support ongoing disability; WCJ may credit claimant’s testimony and draw reasonable inferences | Court held WCJ properly credited Claimant and Dr. Collins; claimant’s testimony plus expert evidence constituted substantial evidence of ongoing disability; speculative future improvement does not defeat award |
| Whether WCJ properly weighed conflicting medical testimony (IME vs treating physician) | Fund relied on IME (Dr. Kasdan) that claimant could return to work and needed no further treatment | Claimant urged treating physician’s diagnosis and functional limitations; WCJ entitled to accept or reject testimony | Court reaffirmed WCJ’s exclusive credibility role and upheld rejection of IME where WCJ found it less persuasive |
| Whether Claimant’s testimony alone can establish chronological length of disability | Fund argued testimony insufficient absent continuous medical proof | Claimant argued he may prove ongoing disability through credible testimony and medical support | Court held claimant’s credible testimony may establish duration; WCJ free to determine chronological length |
| Whether Dr. Collins’s optimistic speculation justified suspension of benefits | Fund argued anticipated improvement supported suspending benefits | Claimant argued speculation insufficient to suspend benefits | Court held speculative testimony cannot support suspension; WCJ correctly declined to suspend benefits on speculative testimony |
Key Cases Cited
- Innovative Spaces v. Workmen’s Compensation Appeal Board (DeAngelis), 646 A.2d 51 (Pa. Cmwlth. 1994) (claimant bears burden to prove ongoing disability throughout pendency)
- Inglis House v. Workmen’s Compensation Appeal Board (Reedy), 634 A.2d 592 (Pa. 1993) (burden on claimant to prove duration and extent of disability)
- Hoang v. Workers’ Compensation Appeal Board (Howmet Aluminum Casting, Inc.), 51 A.3d 905 (Pa. Cmwlth. 2012) (WCJ is final arbiter of witness credibility)
- Vols v. Workmen’s Compensation Appeal Board (Alperin, Inc.), 637 A.2d 711 (Pa. Cmwlth. 1994) (WCJ may accept/reject testimony)
- General Electric Co. v. Workmen’s Compensation Appeal Board (Valsamaki), 593 A.2d 921 (Pa. Cmwlth. 1991) (referee/WCJ may draw reasonable inferences from evidence)
- Casne v. Workers’ Compensation Appeal Board (STAT Couriers, Inc.), 962 A.2d 14 (Pa. Cmwlth. 2008) (credibility findings binding absent arbitrary/capricious basis)
- Glass v. Workers’ Compensation Appeal Board (City of Philadelphia), 61 A.3d 318 (Pa. Cmwlth. 2013) (view evidence in light most favorable to prevailing party below)
- YDC New Castle–PA DPW v. Workers’ Compensation Appeal Board, 950 A.2d 1107 (Pa. Cmwlth. 2008) (medical expert need not be eyewitness to disability throughout pendency)
- American Contracting Enterprises, Inc. v. Workers’ Compensation Appeal Board (Hurley), 789 A.2d 391 (Pa. Cmwlth. 2001) (WCJ may rely on claimant’s testimony to determine length of disability)
- Ricks v. Workers’ Compensation Appeal Board (Parkway Corp.), 704 A.2d 716 (Pa. Cmwlth. 1997) (upholding claimant testimony establishing ongoing disability despite medical release)
- Hyman S. Captan Pavilion v. Workers’ Compensation Appeal Board (Dullebawn), 735 A.2d 147 (Pa. Cmwlth. 1999) (medical speculation insufficient to modify/suspend benefits)