Patricia Winterberg James Winterberg, Individually and as Husband and Wife v. Transportation Insurance Company T/a Cna Insurance CompanyPatricia Winterberg James Winterberg, Individually and as Husband and Wife v. Transportation Insurance Company T/a Cna Insurance Company
OPINION OF THE COURT
The Pennsylvania state legislature, in 1915, enacted its first Workmen’s Compensation Act (“the Act”) in response to strong public sentiment. It was a humanitarian measure providing no-fault compensation to substantially all workers for injuries sustained during the course of employment. The primary purpose of the legislation was to substitute a method of accident insurance in place of com
Thus, the Act provided compensation on a no-fault basis for work-related injury “as a fair exchange for relinquishing every other right of action against the employer.”
Rudy v. McCloskey and Co.,
This case requires us to predict whether the Supreme Court of Pennsylvania would permit an injured employee to disregard the state statutory workmen’s compensation scheme and bring a common law action in court if an employer’s insurance company behaves egregiously in handling the underlying workmen’s compensation claim. Because we hold that it would not, but would honor the exclusivity provisions of the Act, we affirm the order of the district court dismissing plaintiffs’ suit.
I.
Patricia Winterberg 1 (Winterberg) worked for a T.J. Maxx department store in Pennsylvania. In 1991, during the course of her employment, a clothing rack weighing several hundred pounds fell on her foot, causing a “severe contusion of bones.” Winterberg received medical treatment, paid for by the T.J. Maxx compensation carrier, Transportation Insurance Company (hereafter “TIC” or “carrier”), trading as CNA Insurance.
Winterberg’s injury and pain became progressively worse, and the doctors diagnosed her as having Reflex Sympathy Dystrophy (“RSD”). She claims that she suffers extraordinary pain and the loss of use of her left foot; that it has intensified, causing her to fall down frequently. These falls, she asserts, caused her to sustain other injuries, such as damage to the tendons of her ankle, and a fracture of her elbow, which also needed medical attention. A doctor prescribed a wheelchair because the elbow fracture made it impossible for her to use crutches. In addition, Winterberg states she underwent psychological counseling for pain management and depression.
In 1992, TIC stopped paying Winterberg’s medical bills. It took the position that the only compensable injury she had suffered was her original foot injury, and refused to authorize the other prescribed medications, therapies, and rehabilitative services. TIC also attempted to terminate her workmen’s compensation benefits on the grounds that T.J. Maxx had offered her a position she could perform even with her symptoms. Winterberg disputes that the job offered conforms to the “bona fide” requirements of the Compensation Act.
According to plaintiff, 2 defendant continued to deny her claims and refuse to pay her bills despite admonitions by the Workmen’s Compensation Referee, approval of the expenses by two separate independent reviews, and numerous letters from plaintiffs counsel detailing the harmful impact of defendant’s conduct on her. Apparently, plaintiff was terminated from some of her prescribed therapy because of her financial inability to pay for it, and this lack of therapy also aggravated her injury.
Winterberg and her husband filed this lawsuit in the Philadelphia Court of Common Pleas. They alleged that TIC had violated Pennsylvania’s “bad faith” insurance statute,
Defendants then filed a motion to dismiss based on the exclusivity jurisdiction of Pennsylvania Workmen’s Compensation Act, 77 Pa.S. § 481(a). Under that Act, an employee may not sue an employer (or its insurer) at common law for an injury arising in the course of employment. TIC argues that all of plaintiffs claims have their fundament in the treatment of her workmen’s compensation claim, and, therefore, the district court has no jurisdiction of this proceeding. On the other hand, plaintiff contends that the “bad faith” insurance statute superseded Pennsylvania’s Workmen’s Compensation Act and provides a concurrent action at common law in cases of a carrier’s flagrant misconduct. Noting that the state Supreme Court had not spoken directly on the issue, the district court determined that plaintiffs claims were all within the scope of the Act, and dismissed all claims against the insurance company. 3 The court held. that the exclusivity provision of the Compensation Act barred the tort claims and that the “bad faith” statute, though enacted later, did not repeal the Act’s exclusivity provision. Further, the court dismissed plaintiffs claim under the “bad faith” statute for lack of jurisdiction. Although the statute created a separate cause of action, the court determined that it could not be brought in a court which did not have jurisdiction of the underlying insurance claim.
The court did, however, allow plaintiffs claims arising from the tortious conduct that allegedly occurred during the medical examination conducted by Dr. Bennett. The court concluded that Dr. Bennett’s alleged actions during that examination, if proven, would constitute a common-law tort such as battery. Such conduct constituted activity wholly separate from the handling of the compensation claim, and was not subsumed under the Compensation Act.
Plaintiff petitioned the court to certify the partial dismissal under
II.
In the absence of any precedent of the Pennsylvania Supreme Court, we must predict how that court would decide this
Pennsylvania’s Workmen’s Compensation scheme provides that it is the exclusive remedy available to employees against employers for work-related injuries:
The liability of an employer under this act shall be exclusive and in the place of any and all other liability to such employes [sic] ... or anyone otherwise entitled to damages in any action at law or otherwise on account of any injury or death as defined in section 301(c)(1) and (2) or occupational disease as defined in section 108.
77 Pa.S. § 481(a). The same exclusivity of remedy is applied in cases against an employer’s insurer. See, 77 Pa.S. § 501 (“Such insurer shall assume the employer’s liability hereunder and shall be entitled to all of the employer’s immunities and protection hereunder ...”).
This exclusivity of remedy has been described as a “historical
quid pro quo
employers received for being subjected to a no-fault system of compensation for worker injuries. That is, while the employer assumes liability without fault for a work-related injury, he is relieved of the possibility of a larger damage verdict in a common law action.”
Kuney v. PMA Insurance Co., 525
Pa. 171,
Recently, however, the Pennsylvania Supreme Court carved out a narrow exception to this exclusivity provision. In
Martin v. Lancaster Battery Co., Inc.,
The Pennsylvania Supreme Court held that the plaintiff could bring his action in the state courts, regardless of the exclusivity provisions of the Workmen’s Compensation Act. In so holding, the court concluded that the Pennsylvania legislature “could not have intended to insulate employers from liability for the type of flagrant misconduct at issue herein by limiting liability to coverage provided by the Workmen’s Compensation Act.”
Martin,
Plaintiff here has tried to characterize
Martin
as carving out an exception to the
Plaintiff also contends that
Martin
creates an exception to the exclusivity provision whenever misconduct aggravates a pre-exist-ing injury. There is language in
Martin
that might support such an interpretation. The court noted, “[t]he employee herein has alleged fraudulent misrepresentation on the part of his employer as causing the delay which aggravated a work-related injury. He is not seeking compensation for the work-related injury itself in this action.”
Martin,
This reading of
Martin
is reinforced by the opinion in
Santiago v. Pennsylvania Nat’l Mutual Casualty Ins. Co.,
We interpret our supreme court’s holding in Martin ... as allowing a limited exception to the application of the exclusivity provisions of the Act. We are reluctant, however to extend that exception to the circumstances of this case. [In Martin ], the employer concealed, altered or intentionally misrepresented information related to the work-related injury which resulted in aggravation of that injury. [The case did not] coneern[] the improper handling of the claim on the part of the employer’s carrier, as was the case here and in Alston [v. St. Paul Ins. Companies,389 Pa.Super. 396 , 401,567 A.2d 663 , 666 (1989) ], supra. This too, was the case in Kuney ...
Santiago, at 1241.
We note the plaintiff in Santiago predicated his claim on an isolated incident in connection with negotiations for a lump sum settlement. In contrast, the claim in the present case is based on what plaintiff characterizes as a long pattern of “brutal deprivation.” However, this does not distinguish Santiago. Both cases center on a compensation carrier’s discharge of a workman’s compensation claim. The level of misconduct in the payment of that claim is relevant to the amount of damages a workman’s compensation judge may assess.
Santiago
is a recent case from the Pennsylvania intermediate appellate court. In predicting how the state supreme court would rule on the issue, this court should give the intermediate appellate court decisions “substantial weight in the absence of an indication that the highest state court would rule otherwise ” City
of Philadelphia v. Lead Industries Ass’n.,
III.
We next address plaintiffs claims under Pennsylvania’s “bad faith” Act,
In 1990, the Pennsylvania legislature enacted
Accordingly, Winterberg included a claim for bad faith in this action. In dismissing this claim, the district court held that
In Pennsylvania, conflicting provisions of statutes should be construed so as to give effect to both, if possible. If the two are irreconcilable, however, the specific provisions shall prevail over general provisions. This is true unless the general provision was (1) enacted later, and (2) manifestly intended to prevail over the earlier specific provision. See,
In
Okkerse by Okkerse v. Prudential Property & Casualty Ins. Co.,
In this case, the damages are different under the two statutes. In addition the conflict here is not merely between inconsistent remedies but more importantly, involves a function of jurisdiction. Under the Compensation Act, referees appointed by the State Secretary of Labor, 71 Pa.S. § 152 are empowered to hear workmen’s compensation claims, 71 Pa.S. § 152. They have no authority to hear actions brought under the “bad faith” statute, which plainly refers to actions “arising under an insurance policy [when] the court finds the insurer has acted in bad faith toward the insured.” The language of the statute focuses on suits in courts of law based on insurance policies, not workmen’s compensation claims. Therefore, Okkerse is not an apt precedent. The conflict here is greater than inconsistent remedies. The entire basis of the workmen’s compensation scheme is the immunity of the employer and its insurer from tort suits. The two statutes are logically and pragmatically irreconcilable.
Moreover, the “specific over general” rule, that determines which of two inconsistent statutory provisions should take precedence, supports our view. Specific provisions prevail over general in most cases.
Legislative intent to supersede or alter the exclusivity provision of Pennsylvania’s workmen’s compensation scheme should be more clearly manifested than the boilerplate re-pealer language of
Our holding that
However,
IV.
Nor does
The bad faith statute has been held to permit a number of actions in cases where the policy claim was not or could not be brought. In
March v. Paradise Mutual Ins. Co.,
However, disregarding these procedural limitations to underlying claims is quite different than disregarding jurisdictional limitations. Our court has recently faced a similar issue in
Gemini Physical Therapy v. State Farm Mut. Auto. Ins. Co.,
V.
In summary, the district court committed no error in dismissing plaintiffs complaint against the defendant. The claims asserted are within the exclusive jurisdiction of the workmen’s compensation scheme. Accordingly, the district court’s order of dismissal will be affirmed.
Notes
. Winterberg's husband is also a plaintiff in this suit. His claims are all tangential to Winter-berg's. He is suing for loss of consortium and companionship on the grounds of the separate tortious acts that Winterberg alleges. As he alleges no independent facts relevant to his causes of action, his claims are not discussed. Refer-enees to "plaintiff” in this opinion include the husband's claims as well.
. As this case comes to us on appeal from an order granting a motion to dismiss, the record is scant. For the purposes of review, we take all factual allegations of the plaintiff as true.
. The court also dismissed the count of the complaint for punitive damages, noting that it was a remedy and not a cause of action. However, the court gave the plaintiff leave to amend so that she might incorporate a punitive damages claim into her other causes of action.
. A workmen's compensation claim is not "based on an insurance policy” within the meaning of
. Some commentators believe that
. Appellants argue that
Romano
is controlling on the issue of jurisdiction. In that case, an insured brought suit to enforce a judgment by an umpire. It included in this suit a claim for attorney's fees under