Reinstatement to Total Workers’ Compensation Denied Past Statute

When an employee in Pennsylvania is injured on the job, and disabled from work as a result of the injury, workers’ compensation benefits should start. These benefits usually stop either when the injured worker is fully recovered or goes back to work (they can be stopped for other reasons, such as incarceration or refusal to undergo reasonable and necessary medical treatment, but that’s for another blog entry).

An injured worker who goes back to work has a period during which he or she may file to reinstate workers’ comp total disability benefits, if the disability recurs. The Pennsylvania Workers’ Compensation Act was a bit unclear on whether this period was three years from the date of the most recent payment of compensation, or 500 weeks from the date of the reduction or stoppage of benefits. Recently, the Supreme Court of Pennsylvania clarified this answer for us all, in the decision of Cozzone v. Workers’ Compensation Appeal Board (East Goshen Township).

In this case, Mr. Cozzone, the injured worker (claimant), suffered a serious injury to his back in 1989. Despite the severity of his injury, claimant went back to work in 1989 and his benefits were stopped. Claimant then continued to work, with no loss of wages, for over 13 years. In 2003, claimant and the workers’ comp insurance carrier entered into a Supplemental Agreement, reinstating total disability benefits (Additional Supplemental Agreements were also entered into between the parties, reinstating benefits again, in 2005 and 2007).

When claimant finally went out of work for the last time, in 2008, the workers’ compensation insurance carrier refused to voluntarily reinstate total disability benefits. Claimant filed a Petition for Reinstatement and litigated the matter before a Workers’ Compensation Judge (WCJ), who granted such Petition. This was reversed by the Workers’ Compensation Appeal Board (WCAB). The Commonwealth Court of Pennsylvania affirmed the decision of the WCAB.

Upon appeal to the Supreme Court of Pennsylvania, the decision was again affirmed. In interpreting Section 413(a) of the PA Workers’ Compensation Act, the Court found that an injured worker has the entire 500 week “permanent partial entitlement period” within which to file a Petition for Reinstatement to total disability. In addition, if payments of compensation were made within the last three years of that 500 weeks, then the injured worker actually has three years after the date of the last payment to file. So, at a maximum, if the injured worker is receiving a partial disability benefit at the time the 500 weeks expire, the injured worker has 500 weeks plus three years to file a timely Reinstatement Petition.
Though the result here was against the injured worker, and the Petition for Reinstatement was ultimately unsuccessful, the findings by the Supreme Court were actually beneficial to injured workers in general. The Court found that an injured worker should have no less than the 500 weeks within which to request reinstatement (whereas the insurance carrier argued that the period should be only three from the date of the last payment). Additionally, the Court found that, when payments of compensation are continuing, the three years is in addition to the 500 week period (rejecting an argument that the 500 week period and the three year period should be mutually exclusive, and should not each be used).

Unfortunately for Mr. Cozzone, his first Supplemental Agreement came in 2003. Since this was well beyond the permitted 500 weeks (no additional three years for Mr. Cozzone, since he was not receiving ongoing payments of workers’ compensation benefits; though the additional three years would not have saved Mr. Cozzone’s case anyway), the Supplemental Agreement had no real legal meaning and was not enforceable (the parties could not voluntarily extend the statute of limitations). So, The Court said, Mr. Cozzone did not have three years from the date of the most recent payment in this case, because the payment could not resurrect the statute of limitations. Mr. Cozzone would have had, at a maximum, 500 weeks plus three years, and the Petition for Reinstatement was beyond that time period.

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