Pocono Mountain School District v. Workers' Compensation Appeal Board
113 A.3d 909
| Pa. Commw. Ct. | 2015Background
- Claimant (Rick Easterling) slipped at work on Jan 20, 2010 and received NTCP/NCP for left shoulder and lumbosacral sprains; later filed a Review Petition to add CRPS of left upper extremity, cubital tunnel syndrome, head injury, and loss of use of his left hand.
- Employer (Pocono Mountain School District + insurer) initially paid total disability benefits; parties later stipulated to CRPS and status post left ulnar nerve release but disputed specific loss of the left hand.
- WCJ (Sept. 7, 2012) granted Review Petition as to specific loss of the left hand (335 weeks after disability ends), denied head injury, and dismissed Employer’s Modification Petition seeking a Social Security offset.
- Board (Mar. 21, 2014) affirmed the WCJ on the specific-loss finding but reversed the WCJ on the Modification Petition, allowing an offset for Social Security retirement benefits.
- Claimant had applied for SSA retirement benefits pre-injury and SSA’s Notice of Award reflected entitlement as of January 2010; first SSA payment was Feb 10, 2010 (after the Jan 20 injury).
- On appeal, the court affirmed the specific-loss finding (WCJ credibility credited treating physician Dr. Barnes) and reversed the Board’s reversal on the Social Security offset, holding Employer is not entitled to the offset because Claimant was entitled to SSA benefits before his work injury.
Issues
| Issue | Easterling's Argument | Employer's Argument | Held |
|---|---|---|---|
| Whether substantial evidence supports specific loss of left hand | Dr. Barnes’ testimony and Claimant’s credible functional limitations show permanent loss of use of left hand | Medical testimony allegedly references left upper extremity generally and not a permanent loss of the hand; also contends hand injury is not a separate injury permitting both specific-loss and disability benefits | Affirmed: substantial evidence supports specific loss of left hand; WCJ credited Dr. Barnes and Claimant testimony |
| Whether Claimant’s hand condition is permanent | Permanent, functionless hand due to CRPS, scarring/fibrosis, and atrophy; no expectation of improvement | Argues insufficient competent medical evidence of permanency | Denied: both Drs. Barnes and Bozentka concluded claimant reached MMI and restrictions were permanent |
| Whether Claimant may receive both total disability and specific-loss benefits (separate and distinct disabilities) | Hand loss is separate and distinct from CRPS-related disability; specific loss payable in addition to disability for other separate injuries | Employer contends injuries are not separate such that only specific-loss benefits apply | Affirmed: record shows destruction/derangement beyond hand and separate disability; specific-loss and disability both permissible under Section 306(d) framework |
| Whether Employer may offset workers’ comp by 50% of Claimant’s SSA retirement benefits | SSA payments commenced after injury so offset should apply | Claimant: entitlement date pre-injury (approved to start Jan 2010) — offset not allowed under regulation | Reversed Board: no offset. Court holds entitlement (not first payment) is controlling; Claimant was entitled to SSA benefits before his Jan 20, 2010 injury, so Employer not entitled to credit |
Key Cases Cited
- Harrison v. Workers’ Comp. Appeal Bd. (Auto Truck Transp. Corp.), 78 A.3d 699 (Pa. Cmwlth.) (corrective amendment and burden to prove NCP materially incorrect)
- Miller v. Workers’ Comp. Appeal Bd. (Wal-Mart), 44 A.3d 726 (Pa. Cmwlth.) (standard for proving specific loss: permanent loss of use for all practical intents and purposes)
- Schemmer v. Workers’ Comp. Appeal Bd. (U.S. Steel), 833 A.2d 276 (Pa. Cmwlth.) (definition of specific loss under Section 306(c))
- Killian v. Heintz Div. Kelsey Hayes, 360 A.2d 620 (Pa. 1976) (standard for when injuries other than specific loss are separate and compensable)
- Sharon Steel Corp. v. Workers’ Comp. Appeal Bd. (Frantz), 790 A.2d 1084 (Pa. Cmwlth.) (separate-and-distinct injury analysis under Section 306(d))
- Pittsburgh Bd. of Educ. v. Workers’ Comp. Appeal Bd. (Davis), 878 A.2d 173 (Pa. Cmwlth.) (entitlement to SSA benefits occurs when claimant meets SSA entitlement requirements, not merely date of first payment)
- Caputo v. Workers’ Comp. Appeal Bd. (Commonwealth), 34 A.3d 908 (Pa. Cmwlth.) (employer’s statutory right to credit for SSA benefits and interaction with workers’ comp)
- Faulkner Cadillac v. Workers’ Comp. Appeal Bd. (Tinari), 831 A.2d 1248 (Pa. Cmwlth.) (distinction between disability and specific-loss benefits)