PA Court Confirms Workers’ Compensation Offset for SSR Benefits; Says Post-Injury Conviction Not Relevant to Job Availability

A recent case in the Commonwealth Court of Pennsylvania touched on two interesting aspects of the PA workers’ compensation system.  First, the Court dealt with the offset for Social Security Old Age benefits (personally, I find “Social Security Retirement” benefits a bit less offensive), under Section 204(a) of the Pennsylvania Workers’ Compensation Act.  Second, the role and importance of a post-injury conviction, in the context of the vocational process, was considered.

The case we are discussing is Sadler v. Philadelphia Coca-Cola (Workers’ Compensation Appeal Board).  Obviously a serious injury, the workers’ comp insurance carrier accepted “’a right pinky finger amputation,’ ‘distal radioulnar joint subluxation, ECU tendinopathy, pisotriquetral joint arthritis resulting in pisiform excision, right wrist DRUJ resection’ and ‘right transverse process fractures of L2-3 and L4, contusion to the right gluteal region/right hip, fracture of the right 6th rib and right leg radiculitis, . . . and low back sprain.’” After the injury, while receiving temporary total disability (TTD) benefits, the injured worker applied for Social Security Retirement (SSR) benefits (and, in turn, the insurance company filed a Notice of Offset, reducing the TTD payments based on 50% of the SSR benefits).  Also subsequent to the work injury, the injured worker was convicted of a Class II Felony and incarcerated for some period of time.

As frequently happens, the workers’ compensation insurance carrier had the injured worker evaluated for an “Independent Medical Examination” (IME; the word “independent” being dubious, since it is the carrier who unilaterally selects the physician).  After the IME doctor releases the injured worker to gainful employment, the insurance company retains a vocational counselor to prepare a Labor Market Survey (LMS), also known as an Earning Power Assessment (EPA).  The insurer then files a Petition for Modification, based on the jobs found in the LMS/EPA (in addition to a Petition for Termination, which is not relevant to our discussion).  Among other petitions not directly relevant, the injured worker filed a Petition to Review Benefit Offset.

After hearing all of the evidence, the Workers’ Compensation Judge (WCJ) granted the Petition for Modification and denied the Petition to Review Benefit Offset.  The decision of the WCJ was affirmed by the Workers’ Compensation Appeal Board (WCAB).

Upon further appeal, the decision was also affirmed by the Commonwealth Court of Pennsylvania.  As we previously addressed in this blog, a prior constitutional challenge to the offset for SSR benefits was unsuccessful.  Here, since the injured worker was only employed by Coca Cola for four weeks before the injury, it was alleged that such an offset was unconstitutional as it applied in this case.  Specifically, it was argued that the application of the offset here violated the equal protection clause (an argument not addressed in the prior case discussed in our blog).

Initially, the Court agreed that there was “a legislative classification for unequal distribution of benefits or burdens.” The next step in the analysis, said the Court, was to determine the standard of review; there was no dispute this would be the rational basis standard.  In a precursor to the ultimate finding, the Court observed that “Legislative classifications subject to rational basis scrutiny enjoy a strong presumption of validity.”

Finding that there was some legitimate reason for the classification, “even if its soundness or wisdom might be deemed questionable,” the Court found the offset under Section 204(a) to pass Constitutional muster.  As to the issue of the injured worker only being employed for four weeks before the injury, the Court noted that the SSR offset is 50%, not 100%.  The Court reasoned that this reduction considers the varying employment durations which could be at issue.  Though 50% “is not a perfect fit” it does reflect the differences in duration of employment from case to case.

The second aspect of this decision, the requirement that a job in a LMS/EPA be “open and available,” has also been discussed previously in our blog.  The question becomes whether the felony conviction, which occurred AFTER the work injury, should be considered in whether a job is “available” to the injured worker.  Obviously, a felony conviction may be highly relevant in whether a job available.

Analogizing to a medical condition arriving after a work-related injury, the Court agreed with the WCJ and the WCAB, that what happens after the work injury (a felony conviction or a subsequent medical condition) does NOT have to be considered with regard to whether a job is “available” to an injured worker.  As the Court noted, while discussing precedent, “for a limitation on a claimant’s ability to work generally or on the availability of a particular position to be considered by a WCJ, the limitation must be related to the work injury, particularly if the limitation arises from events occurring after the work injury.”  Otherwise, the loss in earnings is not related to the work injury, but to this subsequent issue (for which the workers’ comp insurer should not have to be responsible).

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