Thursday, July 10, 2003

Payment of Heart and Lung Benefits Estops City From Denying WC, Section 413 Review Not Addressed

In The City of Nanticoke, et al. v. WCAB (Ziolkowski) a fireman requested Heart and Lung Act benefits for coronary artery disease via a grievance. The City did an internal review and granted the benefits, and terminated the Claimant's employment based on his total disability. The WCJ, the Board and the Commonwealth Court agreed that the Employer was estopped from denying the Claimant's workers' compensation claim even though an interim investigation by the Employer revealed there was no medical evidence supporting the award of Heart and Lung benefits.

The Employer's argument on appeal was that collateral estoppel did not apply because there was no "actual litigation". The Court said the City's internal review was litigation, and in any event the City had fifteen (15) months to investigate. The Court however found a reasonable contest on the issue of "whether or not Claimant's receipt of Heart and Lung Benefits alone with no formal award, would be enough to collaterally estop Employer from re-litigating the issue of causation."

There was no discussion of Gunter, the Supreme Court case that said even when the Employer grants benefits that are congruent, it still may contest liability under the provisions of Section 413 of the Act. In Gunter, as in this case, it was the Employer's argument that the initial award of benefits was erroneous.

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