Injured Worker Cannot “Reinstate” Disability Benefits Never Granted in PA Workers’ Comp

Sometimes odd facts in a Pennsylvania workers’ compensation case make for an odd decision.  Yet, even then, we can often find something of use in that decision.  Seeing how appellate courts approach different situations helps us understand how that may translate to other fact patterns and enable us to better represent injured workers in PA.

Recently, the Commonwealth Court of Pennsylvania issued a decision in Dorvilus v. Workers’ Compensation Appeal Board (Cardone Industries).  Here, the injured worker hurt his low back in 2009.  A Claim Petition was filed, and a Workers’ Compensation Judge (WCJ) granted the Petition, awarding both disability and medical benefits.

On appeal, the Workers’ Compensation Appeal Board (WCAB) reversed the decision of the WCJ as to the award of disability benefits (though the injured worker received disability payments until this reversal in 2013).  Though the injured worker did prove that a work injury took place, said the WCAB, he failed to prove that he was “disabled” as a result of that injury.  This was affirmed by the Commonwealth Court of Pennsylvania (not the decision we are discussing here).  Though requested, an appeal to the Supreme Court of Pennsylvania was not accepted (unlike the WCAB and Commonwealth Court of PA, the Supreme Court of PA has the discretion to accept or decline an appeal).

In 2015, the injured worker filed a Petition for Reinstatement, alleging that his disability recurred, in total, in 2013.  Upon a Motion made by the workers’ compensation insurance carrier, the WCJ dismissed the Petition for Reinstatement, since it was not filed within three years since the date of the last payment.  The WCAB affirmed the dismissal of the petition.

Upon further appeal, the Commonwealth Court of Pennsylvania also affirmed.  The injured worker did try a novel argument – prior to the reversal of the original Claim Petition, he did receive disability benefits until 2013.  The Reinstatement Petition was filed within three years of that last payment.  The workers’ compensation insurance carrier, of course, argued that the disability benefits were then reversed, so no “disability” benefits were ever actually to be paid.  The Court agreed with that assessment.

The Court drew a distinction between a case where disability benefits were awarded, and then suspended, and the situation here, where the injured worker was never found entitled to disability benefits at all.  Here, there was nothing to reinstate, since there had never been disability benefits awarded.

The Court concluded that the injured worker could not come back to prove disability more than three years after the injury (given the passage of the statute of limitations).  [Even if the Petition for Reinstatement was filed within three years of the date of the injury, it appears likely the petition would have been dismissed on other grounds, since the injured worker already litigated whether he was entitled to disability benefits for that injury, a situation known as “collateral estoppel” or “res judicata.”].