CINRAM MANUFACTURING, INC. and PMA Group, Appellants v. WORKERS’ COMPENSATION APPEAL BOARD (HILL), Appellees.
Supreme Court of Pennsylvania.
July 21, 2009
975 A.2d 577
SAYLOR, J.
Argued Oct. 21, 2008.
Chief Justice CASTILLE joins this dissenting opinion.
Amber Marie Kenger, Esq., Richard C. Lengler, Esq., for Workers’ Compensation Appeal Board.
Edward F. Pietrowski, Esq., Pietrowski & Pietrowski, P.C., Scranton, for Brian Hill.
OPINION
Justice SAYLOR.
Appeal was allowed primarily to address whether, during a termination proceeding, a workers’ compensation judge may correct a notice of compensation payable to subsume injuries not specifically contemplated by the original notice. The question arises because, on the one hand, governing statutory provisions plainly direct that a notice of compensation payable may be corrected at any time and in the context of any petition filed by either of the parties. See
In March 2004, the appellee, Brian Hill (“Claimant“), sustained a work-related injury, or, more precisely, an aggravation of a pre-existing medical condition, while in the employ of appellee, Cinram Manufacturing, Inc. (“Employer“). Employer issued a notice of compensation payable (the “NCP“) identifying the injury as “lumbar strain/sprain,” and Claimant received workers’ compensation benefits. In August 2004, Employer filed a petition to terminate these benefits alleging a full recovery, which Claimant disputed.
The parties presented conflicting evidence to a workers’ compensation judge (the “WCJ“). Significantly, Claimant‘s evidence supported the finding of an aggravation of a pre-existing disc herniation resulting in nerve impingement, medical conditions beyond the lumbar strain and/or sprain which was the subject of the notice of compensation payable. The WCJ credited Claimant‘s evidence, denied termination, and directed amendments to the NCP to conform it to his findings. In this effort, the WCJ did not reference Jeanes Hospital.
Employer lodged an appeal in the Workers’ Compensation Appeal Board. Included among its claims was the argument that the WCJ lacked authority to amend the NCP, because
A workers’ compensation judge may, at any time, review and modify or set aside a notice of compensation payable and an original or supplemental agreement or upon petition filed by either party with the department, or in the course of the proceedings under any petition pending before such workers’ compensation judge, if it be proved that such notice of compensation payable or agreement was in any material respect incorrect.
On further appeal, a divided three-judge panel of the Commonwealth Court affirmed. See Cinram Mfr‘g, Inc. v. WCAB (Hill), 932 A.2d 346 (Pa.Cmwlth.2007). The majority applied the plain language of Section 413(a), see id. at 348-49; whereas, the dissent invoked the review-petition requirement, as supported by the pertinent language in Jeanes Hospital. See Cinram Mfr‘g, 932 A.2d at 349 (Pellegrini, J., dissenting).
We allowed appeal primarily to address the correctness of Jeanes Hospital‘s directive as applied to corrective amendments. Our present, plenary review of this legal issue is encompassed within the appellate standard of review pertaining to administrative adjudications. See Griffiths v. WCAB (Seven Stars Farm, Inc.), 596 Pa. 317, 328-29, 943 A.2d 242, 248-49 (2008).
I.
Employer relies on Jeanes Hospital and Commercial Credit Claims v. WCAB (Lancaster), 556 Pa. 325, 728 A.2d 902 (1999), to support the requirement of a review petition. Employer highlights the concern, attributed to Commercial Credit, that, if a workers’ compensation judge is permitted to amend a notice of compensation payable to add injuries in the course of any proceeding, then a claimant will remain perpetually eligible to receive compensation by serially and belatedly alleging new injuries. See id. at 332-33, 728 A.2d at 905. Employer develops this line of argument as follows:
Increasingly, defense counsel is seeing claimants defending against termination by presenting medical testimony of injury to a completely different body part. As a result, employers are put in the untenable position of attempting to “‘prove a negative’ by establishing that the [new injury] bore no causal relationship to the work-related accident“, which is not only “fundamentally unfair“, but also effectively reverses the claimant‘s long-settled burden to prove all elements of a claim. As a practical matter, the employer may have no choice but to withdraw the termination petition and petition the [j]udge to compel the claimant‘s attendance at another independent medical examination which addresses the newly implicated body part. Such Order is discretionary with the judge regardless of the time which has elapsed since the previous examination, so, at a minimum, alleging a new injury in termination proceedings indefinitely prolongs the claimant‘s receipt of benefits.
Brief for Employer at 16 (quoting Commercial Credit, 556 Pa. at 332, 728 A.2d at 905 (citations omitted)).
Claimant‘s response centers on the plain language of Section 413(a). He distinguishes Jeanes Hospital factually, on the ground that the claimant there had filed a petition to review a notice of compensation payable describing injuries to the lower back to subsume a shoulder injury, a thoracic
Apparently in the alternative, Claimant advances a line of reasoning found in Sears Logistic Services v. WCAB (Preston), 937 A.2d 1151 (Pa.Cmwlth.2007). There, the Commonwealth Court indicated that Section 413(a) permits a WCJ to amend a notice of compensation payable in the context of any proceeding initiated by either party if it is proven that the mistake in the notice relates to a fact or condition existing at the time of the notice‘s issuance. See id. at 1155 (citing Samson Paper Co. & Fidelity Engraving v. WCAB (Digiannantonio), 834 A.2d 1221 (Pa.Cmwlth.2003)). According to Claimant, a claimant may be deprived of relief under Section
This Court‘s opinion in Jeanes Hospital addressed Commonwealth Court precedent which had required claimants to file a claim petition when seeking to expand the scope of a notice of compensation payable to subsume additional injuries. See, e.g., Jeanes Hosp. v. WCAB (Hass), 819 A.2d 131 (Pa.Cmwlth.2003); Zippo Mfr‘g Co. v. WCAB (Louser), 792 A.2d 29, 33 (Pa.Cmwlth.2002); AT & T v. WCAB (Hernandez), 707 A.2d 649, 650 n. 2 (Pa.Cmwlth.1998). The difficulty with these cases was that they departed from the express statutory provisions of Section 413(a), which permit modification to be accomplished via review petition. See Jeanes Hosp., 582 Pa. at 421, 872 A.2d at 169.3 Accordingly, Jeanes Hospital clarified that a review petition, and not a claim petition, was the appropriate mechanism to secure modification of the notice.
Jeanes Hospital, however, was not focused on the distinction between corrective amendments and amendments addressing subsequently-arising medical or psychiatric conditions related to the original injury (or consequential conditions). Thus, unfortunately, language in the decision blurs this difference. Corrective amendments and amendments to address consequential conditions require independent consideration, since the Legislature treated them in separate and distinct passages of Section 413(a). Corrective amendments are covered by the first paragraph, codified at Section 771 of Title 77 of the Pennsylvania Statutes,
Importantly, Section 771 specifies that amendments under its terms may be made “in the course of the proceedings under any petition pending before [the] workers’ compensation judge.”
We are cognizant of the general requirement to adhere to precedent. There are material differences between the legal issues presented in Jeanes Hospital and in the present case, however. In the first instance, in Jeanes Hospital, at least some of the injuries sought to be subsumed within the notice of compensation payable, such as fibromyalgia and depression, appear to be consequential conditions as opposed to injuries
We also recognize the importance of the policy considerations raised by Employer, as well as the difficulties confronting employers defending against belated efforts by claimants to avoid compensation adjustments. Again, however, we are not free to override the procedural scheme expressly prescribed by the Legislature. This Court has exclusive supervisory power over procedural matters in the courts, see
For the above reasons, we hold that Claimant was not required to file a review petition to support a corrective amendment to the NCP.10
II.
In a separate challenge, Employer contends the WCJ‘s finding of work-relatedness, which was also affirmed by the Commonwealth Court, lacks support in substantial evidence. Employer asserts that all of the objective, diagnostic testing confirmed that Claimant‘s disc herniation and any related nerve impingement predated the work incident giving rise to compensation. In particular, Employer points to a post-
Under the appellate standard of review pertaining to administrative agency adjudications, agency findings are subject to judicial review to assure that they are supported by substantial evidence. See
At the termination hearing, Claimant presented deposition testimony from board-certified orthopedic surgeon Alan P. Gillick, M.D., who was a treating physician. Dr. Gillick explained that he conducted his first examination in 2000, when Claimant complained of numbness in his left foot but presented no pain or disability. See Deposition of Alan P. Gillick, M.D., N.T., April 15, 2005, at 9-10. Dr. Gillick did not initially recommend any treatment, but, in mid-2001, authorized a series of epidural injections. He explained that the symptoms, at that time, “were certainly not severe enough to warrant anything surgical.” Id. at 11-12. In 2002, Dr. Gillick reviewed a magnetic resonance imaging study reporting a “small, broad posterior disc herniation at L5-S1 mildly indenting the ventral thecal sac but not resulting in significant narrowing of the spinal canal.” Id. at 17. In light of the minimal symptoms, in Dr. Gillick‘s judgment, surgery still was not implicated. See id.
all of the information that I can ascertain would suggest that this was a new injury, or at least, let‘s say, it was a worsening of an underlying degenerative problem in the sense that he developed pain down his leg which he did not have before. He developed a change on his MRI, as well as his myelogram, confirming that the disc had truly herniated and was compressing his nerve.
Id. at 23. The opinions were couched in terms of a reasonable degree of medical certainty. See, e.g., id. at 21.
Dr. Gillick also discussed the electromyelographic studies highlighted by Employer, indicating that he rarely relies on them, because of their subjective nature. See Gillick Dep. at 26-27 (“An EMG is a very subjective study; and when I do use an EMG, I tend to use it to help distinguish between different diagnoses.“). Based upon his examination and review, Dr. Gillick recommended a surgical discectomy, which Claimant subsequently underwent. Id. at 22-23.
This appeal presents a common fact pattern in which an employer asserts that a work-related back injury is a short-term soft tissue injury; whereas, the claimant with a history of congenital or degenerative abnormalities, claims a longer-term structural aggravation. In this arena, employers are
In this case, the Commonwealth Court correctly held that substantial evidence, in the form of Dr. Gillick‘s testimony as discussed above, supported a finding of work-related aggravation. Employer‘s rejoinder focuses largely on its own evidence, which we recognize also is substantial.11 However, the main focus of substantial evidence review is on the evidence presented by the prevailing party. Cf. Sell, 565 Pa. at 122-23, 771 A.2d at 1250-51. Generally, arguments centered on the weight of countervailing evidence are framed as claims of capricious disregard of evidence by the fact finder. See generally Leon E. Wintermyer, Inc. v. WCAB (Marlowe), 571 Pa. 189, 203-04, 812 A.2d 478, 487-88 (2002). In this vein, we
As noted, relying on Newcomer, Employer also advances the proposition that a medical expert‘s testimony is incompetent in workers’ compensation proceedings where it does not specifically address the injury on the terms on which it was couched in a notice of compensation payable. However, this simply is not supported by Newcomer, the sole authority Employer invokes. Newcomer‘s holding is that an expert‘s opinion concerning work-relatedness is incompetent as a matter of law where it is based solely on a false medical history supplied by the claimant. See Newcomer, 547 Pa. at 647-48, 692 A.2d at 1066. The opinion does not suggest a bright-line rule precluding claimants from pursuing corrective amendments to notices of compensation payable by establishing a contemporaneous mistake.
In the present case, the material conflict in this case was among medical opinions concerning work-relatedness, none of which was shown to have been grounded solely in a fabricated account of events. Thus, it is apparent that Newcomer does not control the outcome. Moreover, and coming full circle, the WCJ possessed authority, under the express terms of Section 413(a), to entertain corrective amendments in the context of “any petition,” even one filed by the employer seeking termination.
The order of the Commonwealth Court is affirmed.
Chief Justice CASTILLE, Justice BAER, Justice TODD, Justice McCAFFERY and Justice GREENSPAN join the opinion.
Justice EAKIN files a concurring opinion.
I concur with the majority because I believe a workers’ compensation judge may correct materially incorrect information in a notice of compensation payable pursuant to
This is the law of this Commonwealth; I do not believe it is prudent or necessary to allow a WCJ to amend an NCP in all circumstances.
Here, medical evidence showed Claimant‘s disc herniation worsened after his work-related injury. Amending the NCP to include the aggravation of Claimant‘s disc herniation—a diagnosis more accurately and fully reflecting Claimant‘s original injury—remedied the materially incorrect NCP. Because the original NCP was materially incorrect in omitting the disc herniation, the WCJ properly amended the NCP to correct the omission of the aggravation of Claimant‘s disc herniation. See, e.g.,
Furthermore, I agree with the majority that due process is not implicated here, because Employer was able to present ample medical evidence. See Majority Op., at 533 n. 8, 975 A.2d at 582. Additionally, Employer failed to raise a due process claim, and “[i]ssues not raised in the lower court are waived and cannot be raised for the first time on appeal.”
975 A.2d 586
COMMONWEALTH of Pennsylvania, Appellee v. Ray D. McCOY, Jr., Appellant.
Supreme Court of Pennsylvania.
Argued Dec. 2, 2008.
Decided July 21, 2009.
