Stanish v. Workers' Compensation Appeal Board
11 A.3d 569
Pa. Commw. Ct.2010Background
- Claimant Stanish, injured Aug. 5, 2005, was awarded benefits under a WCJ decision.
- An impairment rating evaluation (IRE) on Apr. 14, 2008 rated 13% impairment, prompting employer to seek self-executing relief to change from total to partial disability.
- IRE was conducted using the AMA Guides 5th edition; 6th edition published Jan. 2008; Bureau notified that both editions could be used until Aug. 31, 2008, after which only the 6th edition would be accepted.
- WCJ denied modification in Jan. 2009, finding no evidence that impairment was 50% or more and that the IRE used the 5th edition because the physician trained under 6th edition only later.
- Board affirmed the WCJ, rejecting claimant’s argument that the IRE must be calculated under the most recent AMA Guides.
- Court vacated the Board’s decision and remanded to permit a new IRE under the most recent AMA Guides, with a physician agreed by the parties or designated by the Bureau.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether impairment must be calculated under the most recent AMA Guides | Stanish argues IRE must use the most recent AMA Guides edition. | Anderson contends the Bureau’s grace-period allowing 5th edition use is permissible. | Impairment must be calculated under the most recent AMA Guides; Bureau interpretation invalid. |
| Whether the Board correctly applied self-executing relief under Section 306(a.2) | Stanish contends the IRE used the 5th edition undermines eligibility for relief. | Anderson argues the grace period allowed self-executing relief despite edition used. | Because the IRE did not use the most recent edition, the impairment rating is invalid; remand to permit a proper IRE. |
| Appropriate remedy on remand | Stanish seeks dismissal or re-evaluation under 6th edition without delay. | Anderson seeks correction via a new IRE with a mutually agreed physician or Bureau designation. | Remand to allow a new IRE consistent with Section 306(a.2)(1) using the most recent AMA Guides. |
Key Cases Cited
- Gardner v. Workers' Compensation Appeal Board (Genesis Health Ventures), 585 Pa. 366 (Pa. 2005) (mandatory use of most recent AMA Guides; self-executing relief framework)
- Gerlach (Ford Motor/Visteon Sys. v. Workers' Compensation Appeal Board), 970 A.2d 517 (Pa. Cmwlth. 2009) (limits of self-executing relief and timing considerations)
- Johnson v. Workers' Compensation Appeal Board (Sealy Components Group), 982 A.2d 1253 (Pa. Cmwlth. 2009) (regulatory provisions and invalidation of §123.105(f))
- Mercy Reg'l Health Sys. v. Department of Health, 645 A.2d 924 (Pa. Cmwlth. 1994) (administrative regulations must align with statutory intent)
- Combine v. Workers' Compensation Appeal Board (Nat'l Fuel Gas Distrib.), 954 A.2d 776 (Pa. Cmwlth. 2008) (statutory interpretation and regulatory deference principles)