Workers' Compensation Defense

1.    Pennsylvania Supreme Court holds that the compensation rate for specific loss benefits is controlled by Section 306(c) of the Act, not Section 306(a)
Jennifer Jackiw v. Soft Pretzel Franchise, 329 A.3d 1152 (Pa. Cmwlth. 2025) 

The claimant crushed her arm in a pretzel machine at work and needed it amputated. She and her employer agreed that this injury was a specific loss of the forearm, entitling her to compensation benefits for 390 weeks total: 370 weeks paired with 20 weeks of a healing period. The parties disagreed on how to calculate the weekly benefit amount. The claimant claimed that the employer’s position on her compensation rate, rooted in Section 306(a) of the Act, was too low. She argued that Section(c)(25) for specific loss benefits should apply. The workers’ compensation judge found that Section 306(a) should apply, and the Appeal Board and the Commonwealth Court affirmed. However, the Supreme Court reversed, finding that Section 306(c) was the proper formula for calculating the compensation rate for loss of use of a forearm. The court held that the General Assembly intended for the Act to utilize one formula for calculating total disability benefits and another for calculating specific loss benefits. 

 

2.    Pennsylvania Supreme Court: Treatment plan items, including cannabinoid oil, count as “medicines and supplies”; cost rules apply to providers, not claimants
Mark R. Schmidt v. Schmidt, Kirifides & Rassias, P.C., 333 A.3d 310 (Pa. 2025)

The claimant sustained a lower back injury while loading files into a trial bag. The workers’ compensation judge found that this aggravated the claimant’s pre-existing degenerative disc disease. The claimant filed a Penalty Petition against the employer for not covering his out-of-pocket expenses for CBD products to treat pain. The judge granted the petition, deeming CBD oil a “supply” under Section 306(f1)(1)(i) of the Act. Upon the employer’s appeal, the Appeal Board held that CBD oil is not a “supply” without FDA approval and the claimant did not provide necessary bills and records for payment. The Supreme Court affirmed what the Commonwealth Court held on appeal, that CBD oil is a “medicine” and “supply” under the Act, and said Act mandates providers to submit bills on specified forms for payment, not employees. Further, the Act does not require FDA approval for a “supply.” Thus, the claimant was entitled to full reimbursement from the employer for his out-of-pocket expenses. 

 

3.    Pennsylvania Supreme Court holds that a specific loss award is survivable and payable to claimant’s estate, even though claimant’s death was related to work injury 
Kristina Steets v. Celebration Fireworks, Inc., 335 A.3d 1076 (Pa. 2025)

The workers’ compensation judge granted the claimant’s Claim and Review Petitions that requested specific loss benefits, and the Appeal Board and Commonwealth Court affirmed. However, the claimant died from her injuries while the decision from the Commonwealth Court was pending. The claimant’s estate filed petitions seeking payment of the specific loss award by the judge that was under appellate review when the claimant died. The judge denied the estate’s petitions, notwithstanding the claimant’s funeral expenses. The Board and Commonwealth Court affirmed, but the Supreme Court reversed, holding that the decedent’s pending benefits were survivable and payable to her estate. Per Sections 306, 307 and, in particular, the plain language in 410 of the Act, specific loss benefits may be awarded after a death caused by a work-related injury where benefits are pending at the time of the claimant’s death. 

 

4.    Commonwealth Court upholds employer’s full subrogation lien; refusal to negotiate not bad faith
Martha Garduno Mondragon v. Jo Jo Pizza, 329 A.3d 790 (Pa. Cmwlth. 2025) 

The claimant sustained slip and fall injuries on ice in the employer’s parking lot. Her Claim Petition was granted, and the workers’ compensation case was settled by a Compromise and Release Agreement (C&R), which recognized the employer’s right to subrogation against the property owner to the extent of the employer’s lien. Claimant’s counsel then began negotiations with the employer to voluntarily release its lien. However, the employer declined and filed a petition to recover its full lien. The employer also filed a petition in civil court to enforce a judge’s subpoena for the claimant to produce all copies of checks, releases and distribution sheets, which the claimant refused to do. The trial court held claimant’s counsel in civil contempt for willful noncompliance with the subpoena, and the Commonwealth Court rejected the claimant’s appeal, remanding the case to the workers’ compensation judge. The judge granted the employer’s petition, and the Appeal Board affirmed. The Commonwealth Court affirmed, holding that the employer’s refusal to reduce or negotiate its subrogation lien does not constitute bad faith, emphasizing that the claimant agreed in the C&R that the employer’s subrogation lien was intact.

 

5.    In seeking to add a distinct, consequential injury to NCP and to reinstate indemnity payments for related disability, petitions must be filed within three years of the date of most recent compensation payment, per Section 413(a) of the Act
Matthew Grow v. PECO Energy Company (WCAB), 329 A.3d 819 (Pa. Cmwlth. 2025) 

The claimant sustained a neck injury at work in 2013, and the employer suspended his benefits upon his return to work in 2014. The claimant underwent cervical surgery in 2021 and filed Reinstatement and Review Petitions in 2022. The workers’ compensation judge granted the petitions, and upon the employer’s appeal, the Appeal Board reversed. The claimant appealed, and the Commonwealth Court affirmed the Board’s decision, concluding that the claimant was untimely in filing the petitions. The court held that the 2021 surgery, while related to the accepted work injury of contusions and fractures at the C3-C4 level, was a distinct and consequential injury. Thus, the claimant had to file his petitions within three years of the date of the most recent compensation payment, which he did not file.

 

6.    Claimant’s receipt of administrative time while out on leave for COVID-19 is not payment in lieu of workers’ compensation benefits 
Jaime Brown v. City of Philadelphia (WCAB), 330 A.3d 12 (Pa. Cmwlth. 2025) 

The claimant, a police officer, was out of work for a work-related physical injury. The day after his November 3, 2020, return to work, he claimed that he contracted COVID-19 while in the office. He was off from work from November 4, 2020, until April 1, 2022; and at no point did he file a Claim Petition for COVID-19. While on leave, he received full pay without depleting sick or vacation time and was under the impression that his time off equated “E-time” (“excused time”/ET), which ended on March 5, 2022; from March 5 to April 1, 2022, the claimant received his normal salary through accrued vacation time. The employer then filed a Notice of Compensation Denial for the alleged COVID-19 exposure. The workers’ compensation judge dismissed the claimant’s Reinstatement and Penalty Petitions, finding that the ET payroll designation did not constitute payment of wages in lieu of workers’ compensation, that the employer did not intend to use ET pay as an agreement to pay workers’ compensation benefit and that discontinuation of ET did not constitute a unilateral cessation of benefits. The claimant appealed, and the Appeal Board and the Commonwealth Court affirmed, stating COVID-19 counts as E-time, regardless of whether the exposure is work-related. 

 

7.    Payments made by an employer to a claimant for a COVID-19 diagnosis were not in lieu of workers’ compensation’ therefore, unilaterally stopping them does not violate the Workers’ Compensation Act 
William Bolds v. City of Philadelphia, 333 A.3d 765 (Pa. Cmwlth. 2025) 

The claimant alleged that he contracted COVID-19 while working as a police officer in May 2020. He designated his time off from work due to COVID-19 as “E-Time” (“excused time”/ET), and he received full salary, with no loss of sick or vacation time. Payments continued through March 5, 2022, at which point the claimant began using accrued sick/vacation time. He did not return to work. On January 31, 2022, the claimant filed Reinstatement and Penalty Petitions, alleging the employer unilaterally terminated benefits in January 2022 and paid wages in lieu of workers’ compensation benefits. The employer filed a Notice of Workers’ Compensation Denial, denying liability for work-related COVID-19. The workers’ compensation judge denied the claimant’s petition, holding that payments made under E-Time do not constitute the employer’s agreement that the claimant had a work-related COVID-19 diagnosis. On appeal, the Appeal Board affirmed, as did the Commonwealth Court, which held that the employer’s signing off on E-Time was intended to protect workers as an emergent response to COVID-19 in 2020, regardless of whether the disability was work-related.

 

8.    Commonwealth Court: no reimbursement mechanism for insurers’ overpayments to pharmacies under Workers’ Compensation Act
Pioneer Construction Company, Inc., Eastern Alliance Insurance Company, and Employers Alliance, Inc. v. Insight Pharmaceuticals, LLC d/b/a Insight Pharmacy, 338 A.3d 234 (Pa. Cmwlth. 2025) 

A workers’ compensation carrier (the insurer) filed a Petition to Review Medical Treatment and/or Billing (Billing Review Petition), seeking reimbursement for an overpayment they made to a pharmacy for compound pain creams previously found to be not reasonable or necessary for treatment of the claimant’s work injury in a prior Utilization Review (UR) Determination. The insurer argued that the workers’ compensation judge had equitable powers under the Act to order the reimbursement. The pharmacy argued the judge lacked jurisdiction to order the reimbursement as the pharmacy could not be a party to the UR and that the Act contained no reimbursement provision for insurers who overpay providers. The judge granted the petition. The insurer then filed an enforcement action in the Court of Common Pleas, and the pharmacy’s motion to dismiss the action was denied. The pharmacy appealed to the Commonwealth Court, which held that because the pharmacy was not, and could not be, a party to the UR and the judge’s proceedings, the trial court erred by not striking the judgment against the pharmacy. The court further held that the reimbursement awarded by the judge was not contemplated by the Act, even as a matter of equity. The court said there was no mechanism in the Act, either expressly or by implication, for an employer/insurer to recoup monies it mistakenly paid or overpaid to a pharmacy.

 

9.    Commonwealth Court affirms claimant’s electrocution injury; employer received timely and adequate notice under Sections 311 and 312 of the Act
Kimberly-Clark Mill v. William Moss, Jr. (WCAB), 344 A.3d 443 (Pa. Cmwlth. 2025) 

The claimant worked for the employer for 17 years as a machine operator and firefighter. He filed a Claim Petition alleging he was electrocuted in 2018 while vacuuming at work, causing severe tremors and worsening tremors from a prior work-related electrocution in 2013. The workers’ compensation judge granted the Claim Petition, and the Appeal Board affirmed. The employer then appealed to the Commonwealth Court, primarily arguing that the claimant failed to establish that he gave timely notice of his work injury. The court, however, rejected this argument and dismissed the appeal, holding that under Sections 311 and 312 of the Act, which work together as to the timing and content of notice, the employer was provided with information concerning the time and place of injury, that it occurred at work and that a reasonable description of the injury was given.

 
10.    Commonwealth Court recognizes firefighter’s PTSD claim; infant CPR incidents were a singular, extraordinary event and deemed an abnormal working condition
Brian Ganley v. Upper Darby Township (WCAB), --- A.3d ---, (Pa. Cmwlth. 2025)

In his job as a firefighter, the claimant experienced two events within a period of roughly two and a half years in which he performed cardiac pulmonary resuscitation (CPR) on infants, both of whom were not resuscitated. The first event involved a two-week-old infant, and the claimant suffered mental issues related to the incident but continued working for the employer. The second incident involved a nine-month-old infant brought to the fire station who was not breathing. The claimant’s mental health symptoms from the first incident worsened after the second, and the claimant filed a Claim Petition, alleging he sustained post-traumatic stress disorder (PTSD). The workers’ compensation judge dismissed the petition, finding that administering CPR was not an abnormal working condition. The Appeal Board affirmed, but the Commonwealth Court reversed, holding that the incidents collectively were a singular, extraordinary event and, thus, constituted an abnormal working condition. 

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_{What’s Hot in Workers’ Comp, Vol. 29, No. 12, December 2025 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 © 2023 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.}