T. Sengle v. WCAB (Lowes Home Centers, Inc.)
T. Sengle v. WCAB (Lowes Home Centers, Inc.) - 2006 C.D. 2016
| Pa. Commw. Ct. | Aug 25, 2017Background
- Tammy Sengle injured her lower back/left hip/leg on November 15, 2010 while working at Lowe’s; Employer issued a Medical-Only Notice of Compensation Payable (medical-only NCP) for a left lumbosacral strain/sprain but later issued a Notice of Compensation Denial (NCD) as to certain alleged injuries.
- Claimant missed work 11/15–11/19/2010, returned 11/22/2010 with restrictions; Employer accommodated restrictions but discharged Claimant on December 10, 2010 for failing to timely submit to a post-accident drug test under Employer’s drug policy.
- Claimant filed a Claim Petition (disability and medical benefits), Employer filed a Termination Petition (asserting full recovery as of May 3, 2011), and Claimant filed Penalty Petitions alleging unpaid work-related medical bills.
- WCJ found Claimant not credible, credited Employer’s expert that Claimant had fully recovered from the accepted injury as of May 3, 2011, dismissed Claim and Penalty Petitions, and granted the Termination Petition; Board affirmed but remanded for specific findings on partial disability between 11/15/2010 and 12/10/2010.
- On remand the WCJ again found Claimant not disabled for that period (rejecting medical evidence tied to Claimant’s reports) and found Employer’s contest reasonable; Board affirmed.
- Commonwealth Court affirmed dismissal of Claim Petition and Termination Petition and denial of unreasonable-contest fees, but reversed in part and remanded on the Penalty Petition because some medical bills in the record were on HCFA forms and were denied by insurer and the WCJ failed to address causation for those bills.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Claimant proved work-related disability (partial or total) | Sengle: she was disabled Nov 15–Dec 10, 2010 and thereafter; entitled to at least partial ongoing benefits under Vista | Lowe’s: claimant bears burden to prove disability; her testimony and treating evidence were not credible; discharge for cause broke causal link to wage loss | WCJ/Board/Ct: WCJ credibility findings supported; claimant failed to prove disability; Claim Petition dismissed |
| Whether Employer met burden to terminate benefits | Sengle: Employer’s NCD acknowledged left-leg sciatica and Employer’s expert did not address full recovery from that condition | Lowe’s: accepted injury was the lumbosacral sprain/strain (medical-only NCP); Employer’s expert credibly opined full recovery from accepted injury | Held: Employer met termination standard; termination affirmed |
| Whether Employer violated Act by not paying certain medical bills (Penalty Petition) | Sengle: various medical bills (including HCFA 1500 forms) were submitted and denied; penalty appropriate for unpaid work-related bills | Lowe’s: many bills were not properly/timely submitted with required reports; insurer denied some bills believing them non-work-related | Held: For many bills WCJ reasonably discredited claimant’s testimony; but some bills in record showed HCFA submission and insurer denials and WCJ failed to address causation — remand required to determine whether those denied bills were work-related and whether penalties apply |
| Whether Employer’s contest was unreasonable and whether remand decision was reasoned under §422(a) | Sengle: contest unreasonable; remand decision failed to follow Board instructions and ignored evidence of restrictions/medical bills | Lowe’s: contest was reasonable given factual/medical disputes; WCJ adequately explained credibility findings and rejection of evidence | Held: Contest was reasonable; remand decision was sufficiently reasoned for appellate review |
Key Cases Cited
- Vista Int’l Hotel v. Workers’ Compensation Appeal Board (Daniels), 742 A.2d 649 (Pa. 1999) (claimant must prove work-related injury causing inability to perform time-of-injury job; partial ongoing benefits may follow discharge if prior partial loss proven)
- BJ’s Wholesale Club v. Workers’ Compensation Appeal Board (Pearson), 43 A.3d 559 (Pa. Cmwlth. 2012) (violation of employer rules, including drug policy, can show lack of good faith and preclude benefits)
- Udvari v. Workmen’s Comp. Appeal Bd. (USAir, Inc.), 705 A.2d 1290 (Pa. 1997) (employer meets termination burden when medical expert opines, to reasonable medical certainty, claimant fully recovered and no objective findings link pain to work injury)
- McLaughlin v. Workers’ Comp. Appeal Bd. (St. Francis Country House), 808 A.2d 285 (Pa. Cmwlth. 2002) (employer who accepted medical-only liability may not unilaterally stop paying related medical bills without authorization)
- Listino v. Workmen’s Comp. Appeal Bd. (INA Life Ins. Co.), 659 A.2d 45 (Pa. Cmwlth. 1995) (employer may refuse payment when disputing causation but must be correct or face liability and penalties)
- Second Breath v. Workers’ Comp. Appeal Bd. (Gurski), 799 A.2d 892 (Pa. Cmwlth. 2002) (employer bears burden to prove suitable work would have been available or that claimant lacked good faith when loss of earnings results from post-injury discharge)
- Brutico v. Workers’ Comp. Appeal Bd. (U.S. Airways, Inc.), 866 A.2d 1152 (Pa. Cmwlth. 2004) (attorney’s fees may be denied when employer had a reasonable basis to contest)
- Daniels v. Workers’ Comp. Appeal Bd. (Tristate Transp.), 828 A.2d 1043 (Pa. 2003) (when testimony is by deposition WCJ must articulate objective bases for credibility determinations)