Description of Work Injury in Claim Petition Matters in PA Workers’ Comp

When a person is injured at work in Pennsylvania, and the injury is not accepted by the workers’ compensation insurance carrier, the injured worker must file a Claim Petition to seek benefits.  Once the Claim Petition is filed, the insurance carrier has 20 days to file an Answer, responding to the allegations of the Claim Petition.  If the workers’ comp insurance company does not file an Answer within those 20 days, the injured worker can file what is (informally) called a “Yellow Freight Motion.”

If this Motion is granted, all well-pled facts in the Claim Petition are deemed admitted.  The appellate courts in PA have told us that this Motion is not the same as a default judgement.  Ongoing disability can still be challenged by the insurance carrier, and proofs by the injured worker can be required by the WCJ.

A recent case decided by the Commonwealth Court of Pennsylvania, Hollis v. C&R Laundry Services LLC (Workers’ Compensation Appeal Board), addressed what constitutes a “well-pled fact” when it comes to the description of injury.  Here, the employee was a truck driver who was involved in a motor vehicle accident while working.  When the injury was denied, a Claim Petition was filed.  The injury was alleged to be “left rotator cuff pathology/cervical left side radiculopathy, [Cervical, Thoracic, Lumbar] sprain/strain.”

After hearing the evidence, including a medical expert presented by each side, a Workers’ Compensation Judge (WCJ) granted the Claim Petition, but also ordered the benefits terminated as of the date of a Defense Medical Examination (DME) [sometimes humorously called an “Independent” Medical Examination, or IME, even when nothing about it is remotely “independent”].  In so doing, the WCJ found the doctor offered by the workers’ comp insurance company to be more credible than the treating physician.

Importantly, the doctor offered by the workers’ comp insurer (a neurologist) testified that the radiculopathy, and the strains and sprains, had all fully recovered.  Since that doctor was not an expert in orthopedics, he could not give an opinion on whether the left rotator cuff pathology remained.  The WCJ did not find the work injury to include “left rotator cuff pathology.”

On appeal to the Workers’ Compensation Appeal Board (WCAB), this decision was affirmed.  Upon further appeal, the Commonwealth Court of PA also affirmed.

The primary issue on appeal was whether the WCJ erred by granting the “Yellow Freight” Motion, but finding the allegation of “left rotator cuff pathology” to not be a proper fact or description of an “injury.”  The WCJ, as well as the appellate courts, found “left rotator cuff pathology” to be too vague and “not a medical diagnosis.”

The Commonwealth Court of Pennsylvania further explained, “Claimant merely described his condition as ‘pathology,’ which ‘deals with all aspects of disease, but with special reference to the essential nature, the causes, and development of abnormal conditions, as well as the structural and functional changes that result from the disease processes.’”  This, said the Court, could be any number of conditions.

Since the WCJ found the workers’ compensation insurer’s doctor more credible, and that doctor testified that the work-related injury had fully recovered, the Termination was properly granted.

What do we take out of this decision?  Late Answer situations are fairly rare in the world of PA workers’ compensation.  However, whenever we draft a Claim Petition, we consider the possibility that we will have a late Answer.  Accordingly, we are careful what is in the Claim Petition, including the nature of the injury we allege.  Looking ahead to the possibility of a late Answer can drastically increase the value of the late Answer, in those rare situations when it takes place.