Saturday, August 13, 2005

Commonwealth Court Upholds Grant Of Attorneys Fees Where Employer Presented Some Quantum Of Evidence The Injury Did Not Occur

In Northwest Medical Center v. WCAB (Cornmesser) benefits were granted for a back injury. The Commonwealth Court dismissed the Employer's bases for appeal as follows:

"In cases where the causal connection is obvious, medical evidence of causation is not necessary. Kensington Manufacturing Company v. Workers' Compensation Appeal Board (Walker), 780 A.2d 820 (Pa. Cmwlth. 2001). A causal connection is obvious where an individual is doing an act that requires force or strain and pain is immediately experienced at the point of force or strain. Gartner v. Workers' Compensation Appeal Board (Kmart Corporation), 796 A.2d 1056 (Pa. Cmwlth. 2002), petition for allowance of appeal denied, 572 Pa. 713, 813 A.2d 846 (2002)."

The WCJ has the power to accept the Claimant's testimony as credible. The WCJ thereby rejected the inference that the injury did not occur as the Claimant stated. To support this inference, the Employer relied on the fact the Claimant presented no medical evidence and testimony indicating the Claimant initially forgot a prior injury and altered a medical form (the WCJ accepted the Claimant's explanations).

The Court nevertheless upheld the grant of attorneys fees for unreasonable contest. The Court stated: "As stated in Bells Repair, absent some evidence to contradict or challenge the claimant's allegations that he suffered a work-related injury, a bald credibility challenge to an unwitnessed work related injury is insufficient to show a reasonable contest."

The Court could only have reached this conclusion by concluding the evidence the Employer relied on to establish the inference the injury did not occur was not sufficient evidence upon which a reasonable person could base a finding of fact. The Employer should lean toward clear and convincing evidence (whether or not found credible) to support a finding of reasonable contest.

Another important holding:

Where, as here, medical bills have not been submitted in the proper form, the remedy is to remand the matter to the WCJ. AT&T v. Workers' Compensation Appeal Board (DiNapoli), 728 A.2d 381 (Pa. Cmwlth. 1999).

Sooner or later the adjuster must investigate and respond to the unpaid bill information the Claimant provides.

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