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Pennsylvania Court Affirms Employee’s Treatment for Injuries is Compensable

In a recent case before the Pennsylvania Commonwealth Court, the court partially affirmed the lower court’s decision to compensate an employee for her injuries. Here, Sandra Sloane (Claimant) and her employer, the Children’s Hospital of Philadelphia (Employer), both appealed the order of the Workers’ Compensation Appeal Board that affirmed in part and reversed in part the decision and order of a Worker’s Compensation Judge (WCJ).  The order granted a petition for reinstatement of benefits filed by Claimant. 

Claimant sought a review of the order that reversed the WCJ’s reinstatement of benefits from work injuries in 2004 and 2006.  Employer sought a review of the Board’s order upholding the WCJ’s finding that knee surgery and treatment were related expenses to the 2006 injury.

Claimant suffered an injury to her right elbow in 2004, during the course and scope of her employment as a nurse for Employer. She received partial disability benefits and returned to work in a light duty position, with reduced wages.

In 2006, Claimant suffered a second job-related injury to her right elbow and right knee, while working to restrain a patient. She accepted a medical-only Notice of Compensation Payable. She returned to light duty work while receiving partial disability for the 2004 injury. She ceased working in anticipation of right knee replacement surgery in 2007, and she did not return to work following this surgery.

Claimant filed a Petition seeking reinstatement of total disability benefits, and Employer answered, denying her entitlement to reinstatement of benefits.  The matter was assigned to a WCJ.

The WCJ granted the Petition and concluded that Claimant was totally disabled as of 2007, due to her 2004 and 2006 work injuries.  The WCJ also held that Employer was liable for payment of medical services as a result of the 2004 and 2006 injuries.  This liability extended to the 2007 right knee replacement surgery and subsequent treatment. The WCJ also found that Dr. Mercora, Claimant’s treating physician, was more credible than Dr. Ruht.

After Employer appealed the decision and order, the Board affirmed in part and reversed in part.

The Commonwealth Court stated that the Board, in their analysis, ignored that during the deposition of Employer’s medical expert, both parties stipulated that Claimant’s right elbow injury of 2004 was not at issue in the current proceedings. Since the parties understood that only the 2006 right knee injury was at issue, Employer did not elicit testimony from Dr. Ruht related to Claimant’s 2004 injury, and whether it contributed to Claimant’s total disability.

While liberal pleading rules apply in workers’ compensation matters, any party against whom relief is sought must be on notice of the theory of relief and have had an opportunity to respond. If the parties expressly stipulated to excluding the 2004 injury from the proceedings, and Employer then relied on that agreement to not present any medical evidence concerning that injury, the WCJ erred in ordering benefits related to the 2004 injury.

Employer also appealed from the Board’s order affirming the WCJ’s holding that Employer must pay Claimant’s medical expenses related to the 2006 knee injury, including knee replacement surgery.  Employer alleged that Claimant’s medical expert, Dr. Mercora, should not have been credited as Claimant’s treating physician because he did not have personal knowledge of Claimant’s treatment.

The appellate court stated that the WCJ did not err in determining that Dr. Mercora credibly supported Employer’s liability for expenses related to the injury. Dr. Mercora did base his opinion in part on the notes of others, but it is proper for an expert to do so if he customarily relies on these notes in his practice.

The court also stated they cannot evaluate the weight and credibility of the evidence, if Employer is asking the appellate court to second-guess Dr. Mercora.  As an appellate court, the evidence and credibility of witnesses cannot be reweighed.  Instead, the court is to determine if substantial evidence supports the WCJ’s findings.

The court rejected the allegation by Employer that the WCJ erred in affording Dr. Mercora more deference than Employer’s expert, Dr. Ruht.  According to Employer, Dr. Mercora saw Claimant in connection with this litigation, and he admitted he was only going to monitor Claimant’s condition. As a rule, the court stated that a treating physician is given more credence than a physician who examines a patient for litigation purposes. In fact, Dr. Mercora testified he recommended treatment for certain conditions with other doctors, and he provided treatment for her back and discussed future treatment for her knee and elbow.  The court stated that Dr. Mercora assumed more responsibility in Claimant’s medical care than a litigation expert would have, and he was therefore entitled to greater deference.

Employer also contended that Dr. Mercora’s testimony was inconsistent with the notes of other doctors and associates who treated Claimant for her knees. But the court rejected this claim and further stated that if it were inconsistent, the WCJ’s determination to accept Dr. Mercora’s opinion about the cause of the injury was within the WCJ’s role.

In conclusion, the appellate court stated that the Board did not err in determining that Claimant’s treatment for the 2006 work injury was compensable under the Workers’ Compensation Act.

At Needle Law, we help injured workers seek workers’ compensation benefits for their job-related injuries. We provide a free, confidential consultation. Contact the office today at 570-344-1266.

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