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Subcontractor is employer directly liable to pay compensation and entitled to pension offset under §204(a), claimant voluntarily withdrew from workforce, entitled subcontractor to suspension of wage loss benefits.

Thomas A. England v. Merion Construction, M. Schnoll & Sons, Schnoll Painting, Seabright Insurance and New Hampshire Insurance (WCAB); No. 304 C.D. 2021, No. 305 C.D. 2021; filed August 7, 2024; Judge Wallace

September 1, 2024

by Francis X. Wickersham

This case involved multiple petitions, two separate decisions from a workers’ compensation judge, and appeals to the Workers’ Compensation Appeal Board and the Commonwealth Court. The claimant suffered a work injury to his left knee in 2010 while working as a union painter for M. Schnoll & Sons. The general contractor was Merion Construction. Schnoll issued a Notice of Compensation Payable (NCP), accepting liability for a torn meniscus, and the claimant began receiving total disability benefits. Later, the judge expanded the knee injury by granting the claimant’s review petition.
    
Schnoll then filed a modification petition, alleging the claimant had an earning power of $520.00 per week based on a Labor Market Survey (LMS). The claimant filed a review petition, seeking to expand the injury to the low back and groin. The judge granted the modification petition, and the claimant’s compensation was reduced to a partial rate. The judge also partially granted the claimant’s review petition, finding that he had a lumbar sprain and strain as a result of his altered gait from the left knee injury. Both Schnoll and the claimant appealed to the Board. The Board affirmed, but remanded to the judge to award costs limited to the claimant’s partially successful review petition.

Meanwhile, Schnoll filed another modification/suspension petition based on the claimant’s receipt of a union disability pension. The claimant contested the petition, maintaining that the employer directly liable for payment of compensation was not Schnoll but Merion, since they agreed to serve as the statutory employer. Schnoll also filed a modification petition, alleging an earning power of $1,346.00 per week based on an LMS, and a suspension petition, alleging the claimant voluntarily removed himself from the workforce based on prior deposition testimony he gave that he did not intend to return to work. The claimant filed a petition joining Merion and New Hampshire Insurance into the litigation. The judge issued a decision granting Schnoll’s petitions and finding that Schnoll was entitled to a pension offset, the claimant had an earning power of $1,346.00 per week, and the claimant voluntarily withdrew from the workforce as of January 9, 2018, (the date of claimant’s prior deposition), entitling Schnoll to a suspension of wage loss benefits. The claimant appealed to the Appeal Board, which affirmed, and the claimant then appealed to the Commonwealth Court. 

The claimant argued to the Commonwealth Court that Merion, not Schnoll, was the employer directly liable for payment of compensation; therefore, Schnoll was not entitled to an offset under Section 204(a) of the Act. The claimant further argued that the amount of the pension offset found by the judge was wrong. According to the claimant, he did not voluntarily remove himself from the workforce, noting he received Social Security Disability Benefits and a disability pension, and he was stranded into disability by his work injury. He further maintained he did not have an earning power as found by the judge because he was unable to perform the jobs listed in the LMS due to physical limitations and a past felony conviction. 

The Commonwealth Court dismissed the claimant’s appeal and affirmed the judge and the Board on all counts. According to the court, the record supported the conclusion that Schnoll, not Merion, was the employer directly liable for the payment of compensation due to Schnoll’s purchase of workers’ compensation insurance per the terms of the subcontract. The court further rejected the claimant’s argument that the pension contribution made by Schnoll of $54,860.99 was not accurate since he worked for two entities, Schnoll and Schnoll Painting, both of which contributed to his pension. The court affirmed the workers’ compensation judge’s finding as to the amount of the pension contribution made by Schnoll, and Schnoll was entitled to a pension offset. 

Concerning the voluntary withdrawal from the workforce issue, the court held the record supported the judge’s findings that there was a lack of medical evidence the claimant was totally disabled and that the claimant had a lack of effort in returning to work, despite having the ability to do so. Further, the record supported the judge’s finding that there was no evidence that returning to work would endanger the claimant’s union benefits, so long as he did not work for a business competing with the union. The court also said the record supported the judge’s finding that the claimant was capable of performing the jobs listed in the LMS and agreed with the judge that it appeared the claimant was sabotaging his job search by calling potential employers and telling them he was a “convicted felon,” with no indication the crimes were in the past and he has had a clean record. 


 

What’s Hot in Workers’ Comp, Vol. 28, No. 9, September 2024, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2024 Marshall Dennehey, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.

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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

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

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.