No. 1110 C.D. 2022
OPINION BY: Judge Ceisler / FILED: August 11, 2023
In a Nutshell: Employer Has No Obligation to Notify Claimant of an Approaching Expiration of the Three-Year Statute of Repose in Section 413(a).
Claimant unsuccessfully challenged the above-mentioned precept through a case specific approach by showing that Employer had arranged for an IME within the three-year period and failed to inform him that this filing mandate was soon approaching. Claimant also failed to prevail in arguing that temporary total disability benefits and medical benefits paid to him under a Supplemental Agreement dated April 23, 2018 served to toll the statute of repose set forth in Section 413(a) in that the execution of the agreement took place more than three years from the last payment of compensation.
Claimant, who had sustained a compensable back injury on December 14, 2014, received indemnity and medical benefits under the terms of a Notice of Temporary Compensation Payable (NTCP). On March 12, 2015, Employer issued a Notice Stopping Temporary Compensation (NSTC).
In 2017, Claimant reported to Employer that his lower back symptoms recurred, and back surgery was recommended. Employer made arrangements for Claimant to undergo an Independent Medical Examination (IME) on January 16, 2018.
The Employer issued a Supplemental Agreement for Compensation (Supplemental Agreement) on April 23, 2018, acknowledging that Claimant‘s disability had recurred, and he would receive total disability benefits effective April 11, 2018. A second Supplemental Agreement was executed on June 29, 2018, after Claimant returned to work with no further loss of wages.
On May 14, 2021, Claimant filed a petition seeking reinstatement of his total disability benefits and a Review Petition seeking review of his medical treatment and medical bills, and an amendment to the description of his work injury to include L5-S1 disc herniation. Employer denied the allegations and argued that Claimant‘s petitions were time-barred in that they had not been filed within three years of Claimant’s last payment of compensation as mandated under Section 413(a) of the Act.
Claimant advanced the argument that the Employer had an obligation to notify him prior to the expiration of the three-year statute of repose in Section 413(a). The Court noted that Claimant did not cite any legal authority to support his argument. However, as noted by the Court, Claimant chose to rely on the specific facts of his case.
Claimant testified that he notified Employer in 2017 that his lower back symptoms had recurred and that his treating physician recommended surgery. Employer’s claim adjuster scheduled an IME for January 16, 2018, a date which Claimant maintained fell outside the three-year limitations period set forth in Section 413(a). Claimant asserted that Employer did not advise Claimant of this fact, and Claimant “had no reason to seek legal advice” or know that he should take action “to protect his” compensation rights. Claimant contends that he relied on Employer for medical treatment related to his work injury and given the humanitarian purposes of the Act, Employer should have notified him that the three-year limitation period would expire on December 18, 2017.
The Court rejected Claimant’s argument for several reasons. The Court ruled that Claimant was under the misimpression that the statute of repose under section 413(a) expired on December 18, 2017. The Court noted that Claimant received wage loss benefits pursuant to the January 14, 2015 NTCP until March 12, 2015 when Employer issued the NSTC and medical-only NCP petitions were time-barred as of March 12, 2018, not December 18, 2017. Accordingly, the January 16, 2018 IME occurred prior to expiration of the three-year statute of repose. Under the circumstances, Employer had no reason to believe that the January 16, 2018 IME would run afoul of the statute of repose in Section 413(a).
The Court further held that the WCJ correctly held that the April 23, 2018 Supplemental Agreement, under which additional wage loss and medical benefits were paid to Claimant, was clearly beyond March 12, 2018 expiration date (emphasis by writer). Further, the Court stressed that the Supplemental Agreement did not toll the statute of repose, in that the Pennsylvania Supreme Court has held that “no payment, whether by agreement or misconstruction of the Act, or commendable compassion, can operate to resurrect an expired claim….”
Claimant conceded there was no evidence that Employer intentionally deceived him regarding the statute of repose in Section 413(a). He argued that Employer by its silence and inaction unintentionally lured him into a false sense of security in that he had no way of knowing that he must file a review petition to amend the description of his injury. Claimant also pointed out that Employer had logs entered by the claim adjuster documenting that Claimant’s workers’ compensation claim had been closed but would be reopened. However, the Court found there to be substantial evidence supporting the WCJ’s finding that Employer did not engage in concealment, misrepresentation, or other inequitable conduct that would implicate the doctrine of equitable estoppel.
If you would like further information or have any questions regarding the information contained in this article, please contact, Kelly M. Davis, Esquire, at kdavis@vaughanbaio.com or by phone at (717)-980-3700.
