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What's Hot in Workers' Comp

Commonwealth Court affirms denial of Claim Petition that alleged occupational disease of lead toxicity.

Jerry Mercer v. Active Radiator MPN, Inc. (WCAB); No. 1326 C.D. 2023; filed June 3, 2024; Judge Fizzano Cannon

July 1, 2024

by Francis X. Wickersham

On August 24, 2018, the claimant advised the employer that he had sustained a work-related injury due to lead exposure. The employer issued a notice of denial on September 1, 2018. On September 4, 2020, the claimant filed a Claim Petition seeking benefits as of September 21, 2017, and ongoing, with partial disability between July 1, 2018, and May 31, 2019. 

According to the underlying evidentiary record, the claimant was 60 years old and had worked 40 hours per week since 2015 as a solderer and welder, where he worked with lead solutions and wore safety gloves. The lead solution would get on his clothes, and the process created smoke. The claimant did not recall being exposed to lead in the past. He would at times get sore in his nasal membranes and have nosebleeds, which he thought were from fumes. The claimant had a history of smoking a pack of cigarettes per day. In September 2017, the claimant was told that he was being let go for performance reasons. He essentially did not work from that time due to anxiety and trust issues, which he said were related to the end of his employment with the employer. The claimant had symptoms of headaches and pressure in his face, neck, and ears. 

The claimant presented testimony from multiple medical experts—a PET scan specialist, a clinical psychologist and a psychiatrist—all of whom testified that exposure to lead at work caused the claimant to experience symptoms consisting of lack of concentration, tension, irritability, loss of balance, memory loss, and cognitive impairment and deficits. A vocational expert for the claimant further testified that the claimant’s occupational ability had been entirely eroded since working for the employer. 

The employer presented testimony from a safety manager testified that when their workers began employment, they watch videos and are given handouts regarding the dangers of lead exposure and the need for precautions. This witness also testified that the claimant’s workspace had exhaust fans and a ventilation system, and that uniforms provided to workers are left at the workplace each day and sent out for cleaning. The safety manager also testified that workers are tested for lead every six months. After the claimant’s November 2016 test, an occupational health doctor recommended further testing and removal from the workplace. The safety manager testified that the claimant was laid off in September 2017, along with a work partner, due to an industry slowdown, not due to the claimant’s high test results. The employer also presented a number of experts—infectious disease specialist, psychologist, toxicologist and neurologist—who testified that the claimant had a low level of lead exposure at work, and that the studies performed on the claimant’s brain—and relied on by the claimant’s experts for their opinions on causation—were not fully diagnostic of high exposures to lead. Ultimately, the workers’ compensation judge issued a decision denying the Claim Petition. The claimant appealed to the Appeal Board, which affirmed.

On appeal to the Commonwealth Court, the claimant raised multiple issues, including that the judge capriciously disregarded evidence, failed to issue a reasoned decision, the decision was not supported by the substantial evidence of record, and the judge erred in finding that the occupational disease rebuttable presumption did not apply. 

Relative to the capricious disregard argument, the court stated that, while the claimant was exposed to lead at work, and clearly believed that his current issues were related, his evidence failed to establish either lead toxicity or that his current deficiencies were due to his exposure. The fact that the workers’ compensation judge did not find the claimant’s testimony on this issue trustworthy did not amount to capricious disregard of the evidence. 

As for the claimant’s reasoned decision argument, the court concluded that the claimant failed to establish that the judge insufficiently explained the credibility determinations he made or that they were based on wholly erroneous or incompetent evidence. The court also found that the judge’s decision was based on substantial competent evidence, even though the employer’s experts testified to one degree or another that lead toxicity can result in varied, and even diffuse, manifestations and can be difficult to diagnose or definitively rule out in the absence of baseline lead testing before the claimant worked for the employer. 

Finally, the court found that in order for the occupational disability presumption under Section 301(e) of the Act to apply, the claimant must first establish that he has actually sustained and been disabled by the claimed occupational disease. If the question of whether an occupational disease has been sustained is in dispute and the workers’ compensation judge concludes that, based on the preponderance of the evidence, the answer is negative, the presumption will not apply. The judge rightly found that the claimant failed to meet his burden. 


 

What’s Hot in Workers’ Comp, Vol. 28, No. 7, July 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.

Firm Highlights

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.