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LifeQuest Nursing Center v. Workers' Compensation Appeal Board (Tisdale)

Commonwealth Court of Pennsylvania

July 19, 2018

LifeQuest Nursing Center, Petitioner
v.
Workers' Compensation Appeal Board (Tisdale), Respondent

          Submitted: February 23, 2018

          BEFORE: HONORABLE P. KEVIN BROBSON, ANNE E. COVEY, ELLEN CEISLER, Judges.

          OPINION

          ANNE E. COVEY, JUDGE.

         LifeQuest Nursing Center (Employer) petitions this Court for review of the Workers' Compensation (WC) Appeal Board's (Board) August 24, 2016 order modifying the Workers' Compensation Judge's (WCJ) decision to include left sacroiliitis sprain and left leg sprain in the description of Elizabeth Tisdale's (Claimant) work injury, reversing the WCJ's denial of Claimant's penalty petition and termination of Claimant's benefits, and remanding for the WCJ to determine the penalty amount. Employer presents three issues for this Court's review: (1) whether the Board erred by concluding that the issuance of Supplemental Agreements during a period in which Employer was paying WC benefits pursuant to a Notice of Temporary Compensation Payable (NTCP) acts as an admission of liability for the alleged work-related injury; (2) whether the Board erred by failing to conclude that Employer's timely filing of a Notice Stopping Temporary Compensation Payable (NSTCP) and a Notice of WC Denial (NCD) act to preserve all of Employer's rights, defenses and obligations with respect to the underlying claim; and (3) whether the Board erred by concluding that the credible testimony of Robert Mauthe, M.D. (Dr. Mauthe)[1] was not substantial, competent evidence to support the termination of Claimant's WC benefits.

         On April 23, 2014, Claimant sustained a left leg sprain when she tripped and fell over a patient's wheelchair at work. On May 9, 2014, Employer issued an NTCP in order to properly investigate the reported work-related injury. On June 27, 2014, Employer filed two Supplemental Agreements[2] with the WC Bureau (Bureau) because Claimant was released to work and Employer made hours available to her. See Reproduced Record (R.R.) at 214a-217a. On July 11, 2014, Claimant stopped working and Employer filed an NSTCP and an NCD. See R.R. at 160a-163a.

         On July 24, 2014, Claimant filed a Claim Petition averring that she sustained a work injury on April 23, 2014, and a penalty petition alleging that Employer violated the WC Act (Act)[3] by using Bureau documents in an inappropriate manner and discontinuing her partial benefits in light of the Supplemental Agreements. WCJ hearings were held on September 3 and December 3, 2014 and March 4, 2015. On July 28, 2015, the WCJ granted the Claim Petition, in part, and terminated Claimant's benefits as of October 9, 2014. The WCJ determined that Employer was not bound by the Supplemental Agreements because the NSTCP properly stopped benefits. Specifically, the WCJ concluded:

This [WCJ] finds the issuance of the Supplemental Agreements does not bind [Employer] to the acceptance of the work injury. [Employer] issued [an NTCP] on May 9, 2014 indicating the 90-day period begins on 4/25/14 and ends 7/23/14. Two Supplemental Agreements were issued modifying Claimant's benefits as of June 13 and June 20, 2014. The [NSTCP] and [NCD] were both issued on July 11, 2014. The [NSTCP] and [NCD] were timely issued within the 90-day period. By utilizing Supplemental Agreements, [Employer] was attempting to document the benefits it paid to Claimant upon her return to work while the [NTCP] was in effect. There is no document known as a 'Temporary Supplemental Agreement', and by issuing the [Supplemental] Agreements[, ] [Employer] reflected the benefits it was paying to Claimant during her return to work during the initial 90-day period. This [WCJ] finds the issuance of the [NSTCP] and [NCD] nullifies the Supplemental Agreements and [Employer] had no responsibility to pay ongoing benefits after issuing the [NSTCP] and [NCD].

WCJ July 28, 2015 Dec. at 6-7.

         Claimant appealed to the Board which, on August 24, 2016, modified the WCJ's decision to include left sacroiliitis sprain and left leg sprain in the description of Claimant's work injury, reversed the WCJ's denial of Claimant's penalty petition and termination of Claimant's benefits, and remanded for the WCJ to determine the penalty. On December 16, 2016, the WCJ issued a decision and awarded no penalties to Claimant. Employer appealed from the WCJ's decision to the Board, asking the Board to reconsider its August 24, 2016 decision or make it final pursuant to Shuster v. Workers' Compensation Appeal Board (Pennsylvania Human Relations Commission), 745 A.2d 1282 (Pa. Cmwlth. 2000).[4] On August 17, 2017, the Board made its August 24, 2016 decision final and appealable. Employer appealed to this Court.[5]

         Initially, Section 406.1 of the Act[6] provides, in relevant part:

(a) The employer and insurer shall promptly investigate each injury reported or known to the employer and shall proceed promptly to commence the payment of compensation due either pursuant to an agreement upon the compensation payable or a notice of compensation payable [(NCP)] as provided in [S]ection 407 of the Act[7]or pursuant to [an NTCP] as set forth in subsection (d), on forms prescribed by the [D]epartment [of Labor and Industry (Department)] and furnished by the insurer. The first installment of compensation shall be paid not later than the twenty-first day after the employer has notice or knowledge of the employe's disability. Interest shall accrue on all due and unpaid compensation at the rate of ten per centum per annum. Any payment of compensation prior or subsequent to an agreement or [NCP] or [] [NTCP] or greater in amount than provided therein shall, to the extent of the amount of such payment or payments, discharge the liability of the employer with respect to such case.
. . . .
(d)(1) In any instance where an employer is uncertain whether a claim is compensable under [the Act] or is uncertain of the extent of its liability under [the Act], the employer may initiate compensation payments without prejudice and without admitting liability pursuant to [an NTCP] as prescribed by the [D]epartment.
(2) The [NTCP] shall be sent to the claimant and a copy filed with the [D]epartment and shall notify the claimant that the payment of temporary compensation is not an admission of liability of the employer with respect to the injury which is the subject of the [NTCP]. The
[D]epartment shall, upon receipt of [an NTCP], send a notice to the claimant informing the claimant that:
(i) the payment of temporary compensation and the claimant's acceptance of that compensation does not mean the claimant's employer is accepting responsibility for the injury or that a compensation claim has been filed or commenced;
(ii) the payment of temporary compensation entitles the claimant to a maximum of ninety (90) days of compensation; and
(iii) the claimant may need to file a claim petition in a timely fashion under [S]ection 315 [of the Act], enter into an agreement with his employer or receive [an NCP] from his employer to ensure continuation of compensation payments.
(3) Payments of temporary compensation shall commence and the [NTCP] shall be sent within the time set forth in clause (a).
(4)Payments of temporary compensation may continue until such time as the employer decides to controvert the claim.
. . . .
(6) If the employer does not file a notice under paragraph (5)[8] within the ninety-day period during which temporary compensation is paid or payable, the employer shall be deemed to have admitted ...

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