Lynch v. Commonwealth

275 A.3d 1130

John LYNCH, Petitioner

v.COMMONWEALTH of Pennsylvania (Workers’ Compensation Appeal Board), Respondent

No. 1202 C.D. 2021

Commonwealth Court of Pennsylvania.

Submitted on Briefs March 18, 2022

Decided April 29, 2022

Michael G. Dryden, Philadelphia, for Petitioner.

Richard D. Hollingworth, Jr., Camp Hill, for Respondent.

BEFORE: HONORABLE ANNE E. COVEY, Judge, HONORABLE MICHAEL H. WOJCIK, Judge, HONORABLE MARY HANNAH LEAVITT, Senior Judge

OPINION BY JUDGE WOJCIK

John Lynch (Claimant) petitions for review of an order of the Workers’ Compensation Appeal Board (Board) that affirmed a decision of a Workers’ Compensation Judge (WCJ) granting the Commonwealth of Pennsylvania's (Employer or Commonwealth) Modification Petition based on an Impairment Rating Evaluation (IRE), and modifying Claimant's disability benefits from total to partial disability pursuant to Act 111 of 2018 (Act 111), which added Section 306(a.3) of the Workers’ Compensation Act (WC Act).¹ Claimant argues that his full salary benefits under Act 534² do not constitute workers’ compensation benefits necessary to trigger the IRE process under Section 306(a.3) of the WC Act. Upon review, we affirm.

I. Background

The facts are not in dispute. Claimant sustained two injuries while working for Employer in a state mental hospital run by the Department of Public Welfare.³ On December 29, 2012, Claimant sustained the first work-related injury (2012 Injury). Employer accepted liability for the 2012 Injury by issuing a Notice of Compensation Payable (NCP), which initially described the injury as a left knee and right shoulder strain and was later amended to include an exacerbation of preexisting degenerative arthritis, which eventually required left knee replacement surgery.

On September 9, 2014, Claimant sustained a second work-related injury (2014 Injury). The parties entered into a March 1, 2016 Supplemental Agreement (2016 Supplemental Agreement), in which Employer agreed to reinstate temporary total disability (TTD) benefits effective January 27, 2016, for the 2014 Injury, which was described as a right shoulder rotator cuff tear. The 2016 Supplemental Agreement noted that Act 534 benefits were being paid in lieu of TTD benefits. WCJ Op., 4/16/21, Finding of Fact (F.F.) No. 4; Certified Record (C.R.) at 19-20.⁴

On August 12, 2020, Employer filed two Modification Petitions under Act 111 -- one regarding the 2012 Injury and the other regarding the 2014 Injury -- seeking to change Claimant's disability status from total to partial based on the results of an IRE performed on June 2, 2020, which yielded a whole-body impairment rating of less than 35%. Claimant did not file an answer.

By decision and order circulated on April 16, 2021, the WCJ denied the Modification Petition arising out of the 2012 Injury and granted the Modification Petition arising out of the 2014 Injury, which is the subject of this appeal. With regard to the 2014 Injury, the WCJ found that Claimant had received 104 weeks of TTD for the 2014 Injury prior to the June 2, 2020 IRE. F.F. No. 12. The WCJ explained:

While the Claimant does receive an amount equal to his full salary under Act 534, the Insurer^{[5 ]} pays workers’ compensation [TTD] benefits to [ ] Employer, which then adds sufficient amounts to the workers’ compensation benefits to bring the sum up to the level of the Act 534 benefits, and the total is then paid to [ ] Claimant. Accordingly, Claimant receives workers’ compensation [TTD] benefits plus additional amounts added to equal his Act 534 rate.

F.F. No. 13; C.R. at 21. The WCJ found that Act 111 permits a credit for TTD benefits paid prior to the effective date of Act 111 for purposes of calculating the 104 weeks. F.F. No. 14; C.R. at 21. Based on the results of the IRE, the WCJ determined that Employer established entitlement to a modification of benefits as set forth in the 2016 Supplemental Agreement from total to partial disability status as of June 2, 2020, the date of the IRE.⁶

Claimant appealed to the Board. Claimant argued, in relevant part, that the WCJ erred in modifying his benefit status because he had not received 104 weeks of TTD as of the time of the IRE because he was receiving wage continuation benefits under Act 534, not TTD benefits under the WC Act.

The Board rejected Claimant's argument. The Board opined that Act 534 benefits are intended to supplement, not replace, workers’ compensation and occupational disease benefits. Act 534 does not prevent an employer from initiating proceedings under Act 111. The Board ultimately concluded that Act 534 benefits count towards the 104 weeks of total disability benefits under Act 111. Because Claimant had received over 104 weeks of benefits as of June 2, 2020, Claimant met the prerequisites for an IRE. Based on the IRE results, which yielded a whole-body impairment rating of less than 35%, Employer was entitled to a modification of benefits from total to partial. Thus, the Board affirmed. Claimant's appeal to this Court now follows.⁷

II. Issue

Claimant argues that the WCJ and Board committed clear errors of law by determining that he was subject to an IRE under Act 111 and modifying his benefits based on the results. Claimant maintains that he was not subject to an IRE on June 2, 2020, because he had not yet received 104 weeks of total disability benefits under Section 306(a.3) of the WC Act, 77 P.S. § 511.3. Section 306(a.3) of the WC Act clearly provides that an employee must receive 104 weeks of total disability benefits under Section 306(a) of the Act, 77 P.S. § 511, before those benefits may be modified based upon an IRE. Section 306(a) specifically and exclusively relates to workers’ compensation benefits, not Act 534 benefits. Under Act 534, an employee receives his full salary, not workers’ compensation benefits. Nothing in Act 534 allows for the modification of an employee's benefits based on an IRE. Because Claimant received only Act 534 benefits and had not received any workers’ compensation benefits for his 2014 Injury, let alone the 104 weeks necessary, Claimant was not subject to an IRE under Act 111. On this basis, Claimant maintains that the modification of his benefits must be reversed.

III. Discussion

Section 306(a.3) of the WC Act provides for IREs to evaluate the degree of permanent impairment caused by a work injury and for the change of a claimant's disability status from total disability to partial disability based on the degree of impairment determined by the IRE. 77 P.S. § 511.3. Section 306(a.3)(1) of the WC Act provides, in relevant part:

When an employe has received total disability compensation pursuant to [Section 306(a) of the WC Act, 77 P.S. § 511,] for a period of one hundred and four weeks , unless otherwise agreed to, the employe shall be required to submit to a medical examination which shall be requested by the insurer within sixty days upon the expiration of the one hundred and four weeks to determine the degree of impairment due to the compensable injury, if any. ...

77 P.S. § 511.3(1) (emphasis added). If a valid IRE results in an impairment rating of less than 35%, the claimant is entitled only to partial workers’ compensation disability benefits. Section 306(a.3)(2) of the WC Act, 77 P.S. § 511.3(2). Under Section 306(b)(1) of the WC Act, a claimant's receipt of partial disability benefits is limited to 500 weeks. 77 P.S. § 512(b)(1).

Section 306(a) of the WC Act provides:

The following schedule of compensation is hereby established:

(1) For total disability, sixty-six and two-thirds per centum of the wages of the injured employe as defined in section 309 beginning after the seventh day of total disability, and payable for the duration of total disability, but the compensation shall not be more than the maximum compensation payable as defined in section 105.2. Nothing in this clause shall require payment of compensation after disability shall cease. If the benefit so calculated is less than fifty per centum of the Statewide average weekly wage, then the benefit payable shall be the lower of fifty per centum of the Statewide average weekly wage or ninety per centum of the worker's average weekly wage.

(2) Nothing in this act shall require payment of total disability compensation benefits under this clause for any period during which the employe is employed or receiving wages.

77 P.S. § 511.

The question before us is whether Claimant's receipt of full salary benefits under Act 534 constitutes receipt of "total disability compensation" under Section 306(a) of the WC Act for purposes of triggering Act 111's IRE mechanism. We turn to Act 534.

Act 534 was passed by the General Assembly to assure that state workers in positions at institutions considered more dangerous than normal would receive full salary during periods of work-related disability. Section 1 of Act 534, 61 P.S. § 951. The applicable positions are employees of "a State penal or correctional institution under the Bureau of Correction of the Department of Justice^{[8 ]} and ... a State mental hospital or Youth Development Center under the Department of Public Welfare." Id. Pursuant to Act 534, the Commonwealth employer pays a "full salary" to any employee "injured during the course of his employment" by a person confined in one of the above-mentioned facilities "until the disability arising therefrom no longer prevents his return as an employee of such department, board or institution at a salary equal to that earned by him at the time of his injury." Id.

Significantly, Act 534 benefits are "intended to supplement, not replace, workers’ compensation and occupational disease benefits." McWreath v. Department of Public Welfare , 26 A.3d 1251, 1256 (Pa. Cmwlth. 2011). " ‘[A]n injured worker may receive workers’ compensation benefits simultaneously with Act 534 benefits.’ " YDC New Castle-PA DPW v. Workers’ Compensation Appeal Board (Hedland) , 950 A.2d 1107, 1110 n.3 (Pa. Cmwlth. 2008) (quoting Polk Center/Department of...