S. Sloane v. WCAB (Children's Hospital of Philadelphia)
124 A.3d 778
Pa. Commw. Ct.2015Background
- Claimant (Sloane), a nurse, suffered a 2004 right-elbow work injury (lateral epicondylitis) for which Employer accepted partial disability and paid benefits while she worked light duty.
- On December 3, 2006 Claimant sustained a work-related exacerbation of her right elbow and a flare-up of preexisting right-knee degenerative disease; Employer issued a medical-only NCP for 2006 (medical treatment only; no wage-loss recognized).
- Claimant stopped working November 16, 2007 and had right-knee replacement surgery in December 2007; she never returned to work and filed a petition (May 31, 2011) seeking reinstatement of total disability benefits effective November 1, 2007.
- A WCJ granted reinstatement as of November 17, 2007 based on both the 2004 and 2006 injuries and found Claimant’s treating physician (Dr. Mercora) more credible than Employer’s IME (Dr. Ruht); WCJ also required Employer to pay medical expenses including the 2007 knee surgery.
- The Board affirmed the WCJ only as to medical compensability for the 2006 knee treatment but reversed the award of total disability for the 2006 injury as time-barred under the Act; it also reversed total disability for the 2004 injury, concluding the medical proof tied disability to the 2006 knee injury.
- Commonwealth Court affirmed the Board: held Claimant could not invoke the 500-week reinstatement rule for a medical-only NCP, the 2006 wage-loss claim was untimely under three-year limits, the WCJ exceeded authority by awarding benefits on the 2004 injury after parties had stipulated it was not at issue, and Dr. Mercora’s testimony was sufficient to support medical compensability for the 2006 knee treatment.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Timeliness of petition for 2006 wage-loss benefits: which limitation governs (3-year §413(a) vs. 500-week reinstatement)? | Sloane: medical-only NCP functioned like a suspended-benefits scenario; reinstatement petition is timely within 500 weeks. | Employer: medical-only NCP did not suspend disability; three-year limitation applies; petition untimely. | Court: medical-only NCP does not suspend wage-loss; 500-week rule inapplicable; three-year limitations (§413/§315) bar Claimant’s 2006 wage-loss claim. |
| Whether payments of medical benefits toll limitations for bringing wage-loss claim for 2006 injury | Sloane: medical payments should preserve claim; reinstatement proper. | Employer: medical payments are not "compensation" under §413 and medical-only NCP expressly rejects wage-loss liability, so they do not toll. | Court: medical payments do not constitute §413 compensation; medical-only NCP shows Employer did not intend medical payments to replace wage-loss; limitations run. |
| Reinstatement based on 2004 elbow injury and WCJ credibility finding | Sloane: her testimony suffices and WCJ credibility finding should be upheld. | Employer: WCJ exceeded scope—parties had stipulated the 2004 injury was not at issue; relief on 2004 injury prejudicial. | Court: affirmed reversal—parties stipulated 2004 injury excluded at Dr. Ruht’s deposition; WCJ acted outside authority in awarding 2004-based benefits because Employer lacked notice/opportunity to defend. |
| Compensability of December 2007 knee replacement and related medical treatment (causation/competency of Dr. Mercora) | Sloane: Dr. Mercora (treating physician) credibly tied surgery to the 2006 work event. | Employer: Mercora was a litigation-hired doctor lacking competency/personal treatment connection; Dr. Booth’s records do not tie trauma to 2006. | Court: upheld medical compensability—Mercora’s opinion was competent and WCJ reasonably credited him over Employer’s IME; credibility/weight are for WCJ. |
Key Cases Cited
- Cozzone v. Workers’ Compensation Appeal Board, 73 A.3d 526 (Pa. 2013) (interaction of 500-week reinstatement rule and three-year repose explained)
- Fitzgibbons v. Workers’ Compensation Appeal Board, 999 A.2d 659 (Pa. Cmwlth. 2010) (§413(a) three-year filing rule for review/modify petitions)
- Penn Beverage Distributing Co. v. Workers’ Compensation Appeal Board, 901 A.2d 1097 (Pa. Cmwlth. 2006) (claims arising from previously recognized injury may be governed by §413)
- Westinghouse Electric Corp. v. Workers’ Compensation Appeal Board (Korach), 883 A.2d 579 (Pa. 2005) (medical payments do not constitute "compensation" under §413 unless intended to replace wage-loss)
- Schreffler v. Workers’ Compensation Appeal Board, 788 A.2d 963 (Pa. 2002) (intent of employer controls whether medical payments toll §315 limitations)