PENNSYLVANIA WORKERS’ COMPENSATION
CASE SUMMARIES
05/1/2025 – 05/31/2025

SPECIFIC LOSS BENEFITS
CLAIMANT DIES BEFORE COLLECTING

Kristina Steets, (Deceased) v. Celebration Fireworks (WCAB)
Supreme Court of Pennsylvania – Published Opinion
Decided: May 30, 2025

Issue:
Because specific loss benefits are not payable until either disability ceases or the worker dies, did the Commonwealth Court err by limiting receipt of specific loss benefits posthumously to only claimants who die because of a cause unrelated to the work injury?

Background:
In 2017, Kristina Steets (“Steets”) was very badly injured during the course of her employment with Appellee, Celebration Fireworks, Inc. (“Employer”). Employer accepted liability for Steets’ total disability under the Workers Compensation Act when it filed a Notice of Compensation Payable. In 2019, Steets filed claim and review petitions seeking to amend the description of her injuries in the NCP and requesting specific loss benefits. The WCJ amended the NCP as requested and granted Steets’ petition for specific loss benefits, decisions later affirmed by the Workers’ Compensation Appeal Board (“WCAB”) and the Commonwealth Court.  Steets died from her injuries while the Commonwealth Court’s decision was pending.  Appellant, Steets’ Estate (“the Estate”), subsequently filed claim and review petitions seeking payment of, inter alia, the specific loss benefits awarded to Steets that were still subject to appellate review when she died. The WCJ denied the Estate’s claims beyond the payment of Steets’ funeral expenses, and the WCAB affirmed that decision. The Commonwealth Court affirmed in a split en banc decision, ruling that Steets’ specific loss benefits did not survive her work-related death. In this matter of first impression, the Supreme Court reversed.  In so doing, the Court overruled precedential decisions, insofar as those decisions held that Section 306(g) of the WCA is the exclusive means by which specific loss benefits survive the death of worker. Because Steets died “before the final adjudication” of her specific loss benefits claim, Employer was required to pay those specific loss benefits to the Estate.

Holding:
Steets was awarded special loss benefits by the WCJ under Section 306(c) for injuries that were separate and distinct from the injuries for which she was already receiving temporary total disability benefits. Consequently, when payment of Steets’ total disability benefits ended, she was entitled to receive special loss benefits by operation of Section 306(d) of the WCA.   Steets’ right to specific loss benefits was established when the WCJ awarded the benefits, and her death simultaneously terminated her total disability and triggered payment of her specific loss benefits under the schedule set forth in Section 306(d).  The Commonwealth Court, in the case at bar, disregarded the plain reading of Section 410, which provision was the basis upon which the Estate argued it was entitled to Steets’ specific loss benefits.  Section 410 of the Act is a general provision which states that benefits due to a claimant who dies before final adjudication of his or her claim are payable to the claimant’s estate or dependents. The plain text of Section 410 refers to claims made by the injured worker in the first instance during their lifetime, not to fatal benefits claims made by survivors that are governed by Sections 306(g) or 307. It is true by its express terms that Section 306(g) only applies when an employee dies “from some other cause.  However, it was error for the Commonwealth Court to use Section 306(g) to exclude from Sections 307 and 410 the survivability of specific loss benefits as those are wholly distinct provisions of the WCA. Section 410 permits an employee or his dependents to “present a claim petition for compensation to the department” when “the employer or his insurer and the employe or his dependent, concerned in any injury, shall fail to agree upon the facts thereof or the compensation due under this act.” Purdon’s § 751. If “any claimant shall die before the final adjudication of his claim,” Section 410 dictates that “the amount of compensation due such claimant to the date of death shall be paid to the dependents entitled to compensation, or, if there be no dependents, then to the estate of the decedent.”  Section 410 is not itself contingent upon the manner of death or the types of benefits that are being contested.  Section 410 dictates that compensation due to Steets is to be paid to the Estate.
Affirmed.

Justice Wecht filed a dissenting opinion in which Justice Brobson joined.  The crux of the dissent was that the General Assembly conditioned payment of specific loss benefits on a death by cause other than the work injury that it intended to exclude the alternative, i.e., death by the work injury. There is a sound reason for this canon of construction; without it, the Act would have been twice as long because its drafters would have been required to couple every declarative sentence with its obverse.  The Majority holding that Section 410 provides an independent basis, apart from Subsection 306(g), for survivors and estates to receive specific loss installments that never came due before the claimant died is incorrect.  Section 410 has no application here because the 840 weeks of specific loss benefits to which Steets’ estate argues it is entitled were not “due” to Steets “to the date of death.” Steets was receiving total disability benefits when she died, and although she was also entitled to specific loss benefits, she could not receive both at the same time.  The majority decision creates an arbitrary loophole that will give some estates and dependents of deceased workers rights that go far beyond anything that the General Assembly codified. They would affirm.

Background:
Claimant worked part-time as a clerk for the Employer. In October 2019, Claimant suffered a work injury, which was later accepted by Employer as a left-foot contusion. Employer agreed to pay her medical bills for this injury.  In January 2020, Claimant filed a claim petition, expanding the description of her injuries and requesting ongoing, total disability, alleging injuries to her right knee and left ankle, as well.  The WCJ denied the petition, finding that Claimant had failed to establish any further injury or a work-related disability.  Claimant appealed to the Board, which affirmed. The Board’s decision was entered and mailed to Claimant on April 4, 2023.  It was not until June 5, 2023 that Claimant submitted a letter to the Commonwealth Court, indicating her intention to appeal, and later filed a petition for review.

Holding:
The Court held that the Claimant had untimely petitioned the Court for review. As the Court found no evidence of fraud, breakdown in court operations, or other non-negligent circumstances excusing Claimant’s untimely appeal, the Court quashed the Claimant’s petition for lack of jurisdiction.  Claimant conceded that her appeal was untimely but alleged that she never received the Board’s decision by mail because it was sent to an outdated address and that she only learned of the decision after calling the Board.  An appellant bears a heavy burden to establish the right to appeal nunc pro tunc (late) because the time limits set on appeals are mandatory. The Court will grant nunc pro tunc relief only upon a showing of fraud, an administrative breakdown, or non-negligent circumstances beyond the appellant’s control.  Here the administrative board was not negligent, nor did it act improperly or unintentionally mislead a party.  There was no evidence to support Claimant’s assertion that she informed the Board of her change in address or, in particular, that she apprised the Board promptly and prior to the issuance of its decision. To the contrary, we note that the Board certified its record to this Court in August 2023, long after Claimant says she moved, yet the Board’s record includes no change of address.
Affirmed.

MEDICAL FEE REVIEWS
REASOBLE AND CUSTOMARY CHARGES

Cannon Cochran Management v. Scomed Supply (Bur. of W. C. Fee Review Hearing Office)
Commonwealth Court of Pennsylvania – Unpublished Memorandum Opinion
Decided: May 7, 2025

Issue:
Whether the evidence presented by Insurer was sufficient to meet its burden of proving that the usual and customary charges for the items dispensed by Provider are anything other than Provider’s actual charges?

Background:
Claimant was injured in 2005, in the course of his employment with Employer.  Since his injury, Claimant has not returned to work due to chronic pain, weakness, loss of sensation, memory difficulties, and sight impairment. Based on a prescription written by Claimant’s treating physician, Provider dispensed effervescent tablets, Epsom salt, and CBD cream to Claimant.  Provider then billed insurer for reimbursement on the same dates.  Insurer issued denials and or failed to respond.  The Fee Review Hearing Officer found Provider due reimbursement at 80% of the billed charges for the effervescent tablets, Epsom salt, and CBD cream dispensed to Claimant.

Holding:
The fees allowed to a medical provider for the treatment of a compensable work injury are normally tied to the reimbursement rates authorized under the Medicare program. When a Medicare payment mechanism is unavailable, Section 306(f.1)(3)(i) of the Act provides that the amount of payment shall be no more than 80% “of the charge most often made by providers of similar training, experience and licensure for a specific treatment, accommodation, product or service in the geographic area where the treatment, accommodation, product or service is provided.”  The insurer must establish by a preponderance of the evidence that it properly reimbursed the provider.  Before the Hearing Officer, the insurer presented no evidence that it properly reimbursed the provider.  Insurer merely asserted that the amounts billed by Provider were unreasonably high, and that the items dispensed to Claimant could be purchased from various online retailers for substantially less money.  Such evidence was insufficient to support insurer’s burden of proof, since insurer failed to establish that the online retailers were in Provider’s geographic area or that the information presented was obtained concurrently with the relevant billing dates. Insurer unsuccessfully argued that Section 306(f.1)(3)(i)’s “geographic area” requirement should be amended, as most nonprescription items can be found online, and can be delivered. 
Affirmed.

MODIFICATION BASED ON JOB OFFER
REASONABLE ACCOMIDATIONS

Amazon.Com Services, et al v. Carlson (WCAB)
Commonwealth Court of Pennsylvania – Unpublished Memorandum Opinion
Decided: May 7, 2025

Issues:
1.  Whether the WCJ and the Board erred in finding that Claimant established grounds for temporary total disability benefits, as opposed to partial; 2.  Whether the Employer was obligated to accommodate Claimant’s restrictions on his regular shift?

Background:
Claimant worked as a fulfillment center associate for Employer locating items and filling boxes throughout the day.  In April 2022, he experienced a sharp pain and pulling sensation on the center-left side of his neck.  Concentra imposed sedentary-duty restrictions. When Claimant provided those restrictions to Employer, it advised him that the only available positions were on night shift. Employer terminated Claimant’s employment for job abandonment.  Even though Claimant did not return to work for Employer, he resumed working his second job with Concurrent Employer.  Claimant filed a claim petition and a penalty petition.  Employer issued a medical-only Notice of Temporary Compensation Payable. The WCJ found that Claimant provided Employer with his work restrictions but that it failed to make work available to him on his regular shift. 

Holding:
First, the WCJ did not act in accordance with the Act in determining that there was no wage loss from Concurrent Employer by comparing Claimant’s earnings there before and after the work injury, finding those amounts to be consistent, and concluding that they cancelled each other out. Wages received from all concurrent separate employments should have been used to determine the AWW and calculate the amount of compensation payable by the liable employer. The wages from Concurrent Employer entitled Claimant to an award of temporary partial disability benefits rather than temporary total disability benefits. Claimant’s concurrent employment changes the calculation and duration of benefits.  The WCJ did not conclude that Employer’s night-shift position was not within Claimant’s permitted medical restrictions or vocational abilities and the Claimant acknowledged that Concentra never took him off work completely.  Claimant’s personal reason for not accepting the night-shift position did not render it unavailable.  Having been offered a position within his physical restrictions and capabilities, the burden shifted to Claimant to show good cause for his failure to accept the offer.  The Court concluded that Claimant was entitled to temporary partial disability benefits but not temporary total disability benefits.  Therefore, the Court affirmed in part; reversed in part; and remanded for a recalculation of Claimant’s AWW to include the wages that he earned with his Concurrent Employer and a recalculation of the amount due and owing on the penalty petition.
Affirmed.

MEDICAL COSTS AND BILLING
RECOVERING OVERPAYMENT TO PROVIDER

Pioneer Construction Co., et al v. Insight Pharmacy
Commonwealth Court of Pennsylvania – Published Opinion
Decided: May 12, 2025

Issues:
(1) Whether Insurer properly served the Praecipe for Entry of Judgment (Praecipe) and, thus, the trial court had jurisdiction over Pharmacy; (2) whether the trial court violated Pharmacy’s due process rights by entering judgment against it when it was not a party to, and could not as a matter of law participate in, the utilization review (UR) and WCJ proceedings that gave rise to the trial court’s judgment; and (3) whether the trial court erred by denying the Petition where Section 428 of the WC Act (Act) authorizes only employees or dependents deprived of compensation to recover from an employer or insurer in default of payment.

Background:
Insight Pharmacy (Pharmacy) appealed from the Trial Court’s order denying its Petition to Open Judgment by Default Entered by Employer, and Insurer, based on a WCJ decision that joined Pharmacy as a party to Insurer’s Billing Review Petition, declared that Insurer overpaid Pharmacy, and granted the Billing Review Petition directing Pharmacy to reimburse Insurer.  Claimant was injured while working for Employer.  Insurer filed the Billing Review Petition, asserting that, based on a March 19, 2015 UR that determined certain compounded pain creams prescribed for Claimant and supplied by Pharmacy were neither reasonable nor necessary for treatment of Claimant’s work-related injury after December 15, 2014, Insurer no longer had to pay for them.  Notwithstanding, when Pharmacy submitted additional bills for Claimant’s compounded creams to Insurer in October 2018, Insurer processed the bills and paid Pharmacy $30,767.14.  Upon realizing its error, Insurer asked Pharmacy to refund the payments, but Pharmacy declined.  A WCJ conducted hearings on the Billing Review Petition. Insurer also filed a Petition for Joinder of the Pharmacy to the proceedings.  Insurer maintained that Pharmacy was bound by the UR determination and the WCJ had equitable powers under the Act to order Pharmacy to reimburse Insurer for its mistaken payments. Pharmacy asserted that the WCJ lacked jurisdiction to order reimbursement because Pharmacy could not be a party to the WCJ proceedings and the Act contains no reimbursement remedy for insurers who overpay providers.  The WCJ found that Insurer had overpaid Pharmacy, granted the Billing Review and Joinder Petitions, and ordered Pharmacy to reimburse Insurer $30,767.14.  Subsequently, Insurer filed the Praecipe in the trial court pursuant to Section 428 of the Act requesting that judgment be entered against Pharmacy in the amount of $31,242.55.  The Judgment Notice reflects that the prothonotary sent the Judgment Notice to Pharmacy and Counsel.  Pharmacy demanded that Insurer withdraw the Praecipe or Pharmacy would seek sanctions against Insurer on the bases that Insurer falsely identified Pharmacy as a party to the WCJ proceedings, Pharmacy could not appeal from the WCJ’s decision because it was not a party to the WC litigation, and Insurer did not properly serve the Praecipe on Pharmacy. Insurer responded that because Pharmacy participated in the WCJ proceedings and did not appeal from the WCJ’s order, Pharmacy was bound by that decision.

There was a Dissenting Opinion by President Judge Cohn Jubelirer.
Reversed.

PENNSYLVANIA LEGISLATIVE REVIEW

House Bill 183

A few months ago, the Commonwealth of Pennsylvania, House L&I Committee, voted on what is now designated as HB 183. This Bill expands access to workers compensation disfigurement benefits by increasing the duration of eligibility from up to 275 weeks to a new level of up to 400 weeks, extending the benefit to the entire body, and not just to the head, face and neck, and allowing these benefits to be paid simultaneously with indemnity benefits.  The bill was passed by the House on April 7, 2025, and has now been referred to the Senate Labor & Industry Committee.   It is worthy of note that this bill was amended, just prior to passage, to apply to injuries for which “permanent disfigurement was reached” after the effective date of the provision, whereas it was previously intended to only apply to injuries sustained on or after the effective date.   As of today, there has been no new action.

NEW JERSEY WORKERS’ COMPENSATION

CASE SUMMARIES
5/1/2025 – 5/31/2025

JOINT EMPLOYMENT AND SPECIAL MISSION DOCTRINE

Vola v. City of Northfield
Superior Court of New Jersey, Appellate Division – Unpublished Opinion
A-1627-23; 2025 WL 1392256
Decided: 5/14/2025

Background:
Petitioner filed a Claim Petition against his employer, Northfield Police Department (Northfield), and a companion Claim Petition against Asplundh Tree Experts (Asplundh) as a joint employer pursuant to the special mission doctrine. He was injured while following the Asplundh trucks to perform extra traffic duty. Asplundh denied it was a joint employer and moved to dismiss. Northfield opposed and argued Asplundh was a joint and several employer. A Judge found the petitioner was 25% partially disabled with a credit for pre-existing injuries. The petitioner then filed an application for review or modification. A Judge denied Asplundh’s motion to dismiss, finding that it was a joint and special employer and liable with Northfield under the special mission doctrine. On Appeal, Asplundh argues the Judge erred finding it was a joint special employer because no employment relationship existed.

Holding:
The court found the petitioner’s injuries are compensable under the special mission doctrine. It did not matter that the petitioner did not arrive to the place of deployment yet, but that did not alter the purpose of his travel and assignment. The Judge was correct in relying on Domanoski and determining the petitioner was employed by both Northfield and Asplundh. The petitioner served the public interest of Northfield and the private       interest of Asplundh. As such, both employers share liability.
Affirmed.

INTENTIONAL WRONGDOING EXCLUSION

Bunting, Admin. of Estate v. Emil A. Schroth, Inc.
Superior Court of New Jersey, Appellate Division – Unpublished Opinion
A-1972-23; 2025 WL 1430643
Decided: 5/16/2025

Background:
Petitioner was working for Emil A. Schroth, Inc. (Schroth) when he severely injured his foot. He filed a workers’ compensation claim and was paid by Schroth’s workers’ compensation insurance. He further filed a personal injury lawsuit against Schroth. He alleged gross negligence and intentional wrongdoing. Petitioner then entered into a consent judgment with Schroth and Schroth assigned its rights to its insurance companies. Insurers filed a motion to dismiss for failure to state a claim. They argued Petitioner was not entitled to coverage due to exclusions in their policies. Petitioner cross moved for partial summary judgment. The Judge granted the insurers’ motion to dismiss with prejudice and denied the petitioner’s cross motion for summary judgment.  In his decision, the Judge found the policy excluding intentional wrongs claims did not violate public policy. Petitioner appealed.

Holding:
The court found that based on Rodriguez, the insurers did not have to provide defense or indemnity coverage due to their policy exclusion as the petitioner alleged the injury was caused by Schroth’s intentional wrongdoing. The court further found that the exclusions do not violate public policy because intentional wrong exclusions do not violate public policy.
Affirmed.

NEW JERSEY LEGISLATIVE UPDATE

Assembly Bill 4750
Expands certain employer reporting requirements to include entities that employ or contract with individuals for financial compensation, including ridesharing and delivery technology platforms.

Last Action: January 14, 2025 – Received in the Senate, Referred to Senate Labor Committee

Assembly Bill 4371/S1943
Requires workers’ compensation, PIP, and health insurance coverage for the medical use of cannabis under certain circumstances.

Last Action: May 16, 2024 – Introduced, Referred to Assembly Financial Institutions and Insurance Committee

Assembly Bill 4283
Provides personal liability for owner, executive officer, or executive director of employer for failure to pay for workers’ compensation coverage.

Last Action: May 6, 2024 – Introduced, Referred to Assembly Labor Committee

Assembly Bill 4559
Concerns certain workers’ compensation supplemental benefits and funding method.

Last Action: June 13, 2024 – Introduced, Referred to Assembly Labor Committee

Assembly Bill 2100/S1470
Provides workers’ compensation benefits for certain public safety workers who developed illness or injury as result of responding to September 11, 2001 terrorist attacks.

Last Action: September 19, 2024 – Reported out of Asm. Comm. With Amendments, and referred to Assembly Public Safety and Preparedness Committee

Assembly Bill 5198/S3772
Concerns valuation of board and lodging with respect to workers’ compensation.

Last Action: January 23, 2025 – Reported and Referred to Assembly Appropriations Committee

Senate Bill 794
Concerns workers’ compensation insurance requirements for certain corporations and partnerships. 

Last Action: December 5, 2024 – Reported from Senate Committee as a Substitute, 2^nd Reading