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What's Hot in Workers' Comp

Injuries sustained by claimant in a motor vehicle accident that occurred on the drive home from work were compensable through the employment contract exception to the “going and coming rule.”

John Bark v. Sooner Steel LLC (WCAB); 540 C.D. 2021; filed March 21, 2022; by Judge Ceisler

May 1, 2022

by Francis X. Wickersham

In this case, the claimant had worked for four years as a seasonal laborer for the employer, installing rebar for in-ground swimming pools. The employer was the sole owner of the business. In March of 2018, while returning home from the employer’s job site in Rio Grande, New Jersey, the claimant sustained injuries in a motor vehicle accident. Later, the claimant filed a claim petition, and the employer denied the allegations raised in the petition. 

At the Workers’ Compensation Judge level, the parties entered into a Stipulation wherein they agreed to the nature of the injuries sustained by the claimant and agreed that, if it was found the claimant was in the course and scope of his employment at the time of the accident, the injuries would be compensable and the claimant would be entitled to payment of benefits.

According to the claimant’s testimony, he was picked up from his house in Pennsylvania by the owner’s son and then driven to the job site in New Jersey in one of the employer’s trucks. After work, they drove back to Pennsylvania in the employer’s truck. The claimant said they were stopped by a police officer on the Atlantic City Expressway and cited for having an obstructed rearview mirror. A very short time thereafter, the motor vehicle accident occurred, and the claimant woke up in the hospital. The claimant said that he did not have a written employment contract with the employer. He further said that he did not personally drive an employer-owned vehicle and was not promised a ride to work. The claimant received a percentage of the amount for each job as his pay. 

The owner’s son testified that he drove to Pennsylvania to pick up the claimant at the owner’s direction because they needed additional help for the New Jersey job. He typically picked the claimant up at his home in one of the employer’s trucks and then drove to the employer’s work site. He did not drive anyone else to the employer’s job sites and did not operate the employer’s vehicles outside of work. The owner testified that the claimant’s pay for the work he performed at the New Jersey job site included additional pay for travel time and advised that employees were regularly paid for travel time, depending on the “zone” of the job site. Payment would not be made for travel to a job site in Zone 1. However, the New Jersey job was in Zone 4 or Zone 5. 

The Workers’ Compensation Judge dismissed the claim petition, finding the claimant had no contract, written or oral, promising him transportation to and from work. He further found the claimant had a fixed place of employment and did not find that the claimant was on a special assignment. He concluded the claimant was not in the course of employment at the time of the accident. The claimant appealed to the Workers’ Compensation Appeal Board, which affirmed. 

On appeal to the Commonwealth Court, the claimant argued that he was in the course of employment at the time of the accident because he had “an oral employment contract” that included transportation to and from job sites; he had no fixed place of employment; and he was on a special mission. The Commonwealth Court concurred, specifically with respect to the contract including transportation to and from work, and reversed the Board. Noting that an oral agreement could be considered when making the determination, the court said that to satisfy this exception to the “going and coming rule,” the claimant must prove that any travel allowance paid by the employer is related to the actual expense and time involved in the claimant’s commute and must prove that the employer provided or controlled the means of his commute. The court said that, although the claimant did not have a written employment contract, this was not a dispositive fact. The claimant was in an employer-owned vehicle at the time of the motor vehicle accident and the owner testified that employees received extra compensation for travel to any job located outside Zone 1. The zones were based on the distance in miles from the owner’s home. The testimony of the owner and his son established that the employer provided the means for the claimant’s commute when the owner directed his son to pick up the claimant at his home and drive him to the New Jersey job site in the employer’s truck.
 

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Thought Leadership

Commonwealth Court Reaffirms the Constitutionality of Act 111's IRE Provisions

In this case, the claimant sustained a work injury of January 6, 1994, which was acknowledged by Notice of Compensation Payable (NCP). After the claimant’s receipt of 104 weeks of temporary total disability benefits, the employer filed a Request for an Impairment Rating Examination (IRE). The IRE was performed in May 2023 and the IRE physician found that the claimant had a 5% whole person impairment, under the AMA Guides. The employer filed a Petition based on the IRE results, and the Petition was granted by the WCJ. During litigation, the claimant argued that the IRE provisions of Act 111 (Section 306(a.3) of the Act) were not applicable to her injury, since it predated June 24, 1996, the date Act 57 went into effect, and that the IRE provisions were unconstitutional. The Workers’ Compensation Judge (WCJ)) granted the Petition and the Board affirmed. On appeal to the Commonwealth Court, the claimant argued that Act 111 violated the nondelegation doctrine and that its retroactive application to the claimant’s injury was unconstitutional. The court rejected the arguments on the basis that they had already found the same arguments without merit in multiple, prior cases. The court also addressed an argument made by the claimant that Act 111 was procedurally defective under the Pennsylvania Constitution because it was only considered on two days in each House after having undergone amendments and reassignments. The court noted that the Pennsylvania Constitution requires every bill to be considered on three different days in each House. The claimant maintained that, according to the legislative history, the bill did not receive three separate days of consideration from each House when it was assigned a new bill number. The court pointed out, however, that the bill number, H.B. 1840 remained constant and was considered on three occasions by the House. Further, the court concluded that minor amendments to the bill were germane to its original subject, which was to modify the Act’s IRE process, in accordance with Protz II.

Thought Leadership

Florida Supreme Court Rules Florida Statute §627.70152 Does not Apply Retroactively

In a decision that resolves years of appellate uncertainty and confirms that insurers and insureds alike can rely on the legal framework in place when a policy is issued, the Supreme Court of Florida last week found that Florida Statute §627.70152, which involves an insured’s requirement to provide an insurer with pre-suit notice before filing a suit, cannot be applied retroactively. In Universal Property & Casualty Insurance Company v. Hughes, the Court was presented with the issue of whether the statutory pre-suit notice requirement applied retroactively and whether it would apply to a breach of contract of an insurance policy that was issued before the statute went into effect. Before the Court was an appeal from a homeowner, Ms. Hughes, who sued her insurance carrier, Universal Property & Casualty Insurance Company (Universal) for breach of contract under an insurance policy that was in effect from April 24, 2019 through April 24, 2020. During the policy period, Ms. Hughes suffered a loss and, on May 29, 2019, made a claim for water damage. The carrier investigated the loss and issued payment; Ms. Hughes disputed the payment, finding the amount insufficient for repairs. On July 1, 2021, Florida Statute §627.70152 went into effect, which required insureds to provide notice of intent to initiate litigation against the carrier prior to filing a lawsuit; if an insured filed the lawsuit without complying with §627.70152, a court must dismiss the case without prejudice. On August 4, 2021, Ms. Hughes filed her lawsuit against Universal for breach of contract. Universal moved to dismiss based on her failure to comply with §627.70152. Ms. Hughes contended the notice requirement could not be applied retroactively. The trial court disagreed and dismissed the lawsuit without prejudice, and Ms. Hughes appealed. During the appeal, the Fourth District Court of Appeal, in Cole v. Universal Property & Casualty, 363 So. 3d 1089 (Fla. 4th DCA 2023), ruled that Florida Statute §627.70152 did apply retroactively to policies issued before the effective date of §627.70152. However, the Sixth District Court agreed with Ms. Hughes and overturned the trial court’s ruling, finding the statute could not retroactively apply to policies issued prior to the statute effective date. Thereafter, the other district courts weighed in, with the Third District Court agreeing with the Fourth District Court, and the First, Second and Fifth District Courts agreeing with the Sixth District Court. In resolving the conflict amongst the district courts, the Supreme Court advised “as a general rule, ‘the statute in effect at the time an insurance contract is executed governs substantive issues arising in connection with that contract.’ Hassen v. State Farm Mut. Auto. Ins. Co., 674 So. 2d 106, 108 (Fla. 1996). The Court applied the two-step test when deciding whether a statute has retroactive application: “First, the Court must ascertain whether the Legislature intended for the statute to apply retroactively. Second, if such an intent is clearly expressed, the Court must determine whether retroactive application would violate any constitutional principles.” Menendez v. Progressive Exp. Ins. Co., 35 So. 3d 873, 877 (Fla. 2010). In analyzing the Legislature’s intent, the Court must determine whether the Legislature has manifested a clear command for retroactivity in the statutory text.  In review of the statutory text, the Court found nothing in the language of the statute to indicate that the phrase “all suits” was serving another purpose of expanding its reach to suits based on policies that both predate and postdate the enactment of the statute. Buis v. Universal Prop. & Cas. Ins. Co., 394 So. 3d 738, 741 (Fla. 2d DCA 2024). Further, the Court noted the statute has an effective date, which has long been considered to be evidence against retroactive application of a statute. The Court concluded that, on its face, no provision of §627.70152 speaks to application of the statute to insurance policies issued before the statute’s effective date and therefore, the Legislature did not clearly command retroactivity of the statute to include insurance policies issued prior to the enactment of the statute. The Court briefly reviewed Universal’s argument that the presuit notice requirement was procedural, not substantive, and therefore should be applied retroactively; however, the Court agreed with the Sixth District Court’s finding that, in its entirety, §627.70152 transformed an insured’s ability to sue an insurance company under a property insurance policy and an insurer’s obligations to respond to and pay insurance claims, thus making the requirement a substantive change. The Court thereby upheld the decision of the Sixth District and disapproved the decision of the Fourth District in Cole.

Thought Leadership

WCJ Improperly Refused to Conduct C&R Hearing and Erroneously Required Settlement of All Pending Petitions

In this case, the claimant sustained injuries in the course and scope of her employment as a registered nurse. The employer acknowledged the injury by a Notice of Compensation Payable (NCP).  Subsequently, a Workers’ Compensation Judge (WCJ) expanded the description of injury. The employer then filed a Termination Petition, alleging the claimant was fully recovered from the injuries. Providers filed Utilization Review (UR) Petitions, challenging UR determinations finding their chiropractic treatment to be not reasonable and necessary. A settlement of the claim was eventually reached, and the employer filed a Petition to Seek Approval of a Compromise and Release (C&R) Agreement. The C&R outlined that the agreement fully resolved all future workers’ compensation claims except for the termination and UR Petitions. Briefs were filed and one day later, the WCJ issued an Interlocutory Order which stated if instructions were not followed regarding filing of a C&R, a settlement hearing date would not be given. The employer complied with the order, and filed the C&R. Subsequently, the WCJ notified the parties that the C&R must resolve all issues in the petitions, or would not be entertained. A settlement hearing was never held, and the WCJ then issued a decision, granting the Termination Petition and dismissing the UR Petitions. The WCJ also said that the Petition for Approval of a C&R was dismissed without prejudice, as the issues in the Termination and UR Petitions went to a decision. The claimant appealed to the Workers’ Compensation Appeal Board (Board). The Board granted the claimant’s appeal, finding that the WCJ violated the requirement of Section 449 that an expedited hearing be held when a Petition for Approval of a C&R is filed.  The Board further held that it was legally incorrect for the WCJ to insist that the C&R resolve all issues raised by the pending Petitions. The Board remanded the case to a new WCJ, and Employer appealed to the Commonwealth Court. The court affirmed the Board and held that the WCJ erred, as a matter of law, by refusing to hold an expedited hearing within 30 days, once the Petition for Approval of a C&R was filed.  The court noted that the language of Section 449(b) is mandatory, and a settlement hearing is not discretionary or dependent on a party’s separate request for a stay, or whether the record has been closed. The court further rejected Employer’s argument that the case should not be remanded to a new WCJ for a new decision on the termination and and UR Petitions, as the Board passed no judgment on whether the C&R Agreement resolved the termination and UR Petitions, and left it for the WCJ to decide in connection with the Petition for Approval of a C&R.