Opinion
No. 267 C.D. 2014
10-14-2014
City of Pittsburgh (Public Works) and UPMC Benefits Management Services, Inc., Petitioners v. Workers' Compensation Appeal Board (Runco), Respondent
BEFORE: HONORABLE RENÉE COHN JUBELIRER, Judge HONORABLE ROBERT SIMPSON, Judge HONORABLE JAMES GARDNER COLINS, Senior Judge
OPINION NOT REPORTED
MEMORANDUM OPINION BY JUDGE COHN JUBELIRER
City of Pittsburgh (Public Works) and UPMC Benefits Management Services, Inc. (hereinafter "Employer") petition this Court for review of the January 24, 2014, Order of the Workers' Compensation Appeal Board (Board) affirming the Decision of the Workers' Compensation Judge (WCJ) to dismiss Employer's Petitions to Suspend and Review Compensation for John Runco (Claimant). On appeal, Employer argues that: (1) the WCJ erred as a matter of law by concluding that she lacked statutory authority to address the issue of whether Claimant's medical benefits should be suspended for failure to undergo reasonable medical treatment; (2) the WCJ erred as a matter of law when holding that the utilization review procedures of the Workers' Compensation Act (Act) provide the sole recourse for Employer; and (3) the Board erred in determining that Employer's Petitions to Suspend and Review Compensation were barred by res judicata and collateral estoppel. Discerning no error, we affirm.
Act of June 2, 1915, P.L. 736, as amended, 77 P.S. §§ 1 - 1041.4, 2501-2708.
I. BACKGROUND
Claimant sustained two work-related injuries while employed by Employer as a laborer. Claimant's first injury occurred on August 20, 1998, when he was unloading a dump truck, slipped off the tailgate, and jammed his right big toe. (WCJ August 13, 2010 Decision (2010 Decision), Findings of Fact (FOF 2010) ¶ 2, R.R. at 5.) Employer issued a medical-only Notice of Compensation Payable (NCP) recognizing the injury as an "exacerbation of pre-existing MTP joint arthritis" of the right big toe. (2010 Decision at 1, R.R. at 5.) Claimant was injured a second time on January 15, 2008, while he was exiting a dump truck and twisted his right knee and back. (FOF 2010 ¶ 2, R.R. at 5.) Claimant began receiving weekly disability benefits for this injury pursuant to a NCP, which described the injury as "a right knee medial meniscus tear." (2010 Decision at 1, R.R. at 5 (internal quotation marks omitted).)
Employer subsequently filed, in 2009, separate Petitions to Suspend and Review Compensation (2009 Petitions) requesting that Claimant's "compensation" be suspended because he refused reasonable medical treatment for his work-related injuries. (2010 Decision at 1, R.R. at 5.) Employer alleged that Claimant refused to undergo a surgical procedure on his right knee and refused medical treatment on his big right toe in the form of a fusion or cheilectomy. (FOF 2010 ¶¶ 3, 5, R.R. at 6.)
In a Decision circulated on August 13, 2010, WCJ Linda Tobin granted Employer's 2009 Petitions. (2010 Decision at 3, R.R. at 7.) WCJ Tobin found credible the testimony of Employer's medical expert, Trenton Gause, M.D., who testified that the recommended medical procedures would allow Claimant to resume his pre-injury job functions. (FOF 2010 ¶ 3, R.R. at 6.) Therefore, WCJ Tobin found that Claimant had refused reasonable medical treatment. (FOF 2010 ¶ 5, R.R. at 6.) WCJ Tobin's Conclusions of Law stated that, due to Claimant's refusal to undergo treatment, "weekly benefits must be suspended." (2010 Decision, Conclusions of Law (COL 2010) ¶ 1, R.R. at 7.) WCJ Tobin's Order stated that "[c]ompensation is suspended," but that Claimant's compensation would be reinstated if he were to undergo the recommended treatment. (2010 Decision Order, R.R. at 7.) Neither Claimant nor Employer appealed WCJ Tobin's 2010 Decision.
Claimant later filed a penalty petition alleging that Employer had failed to pay medical expenses related to his work-related injuries. The penalty petition was assigned to WCJ Tobin for adjudication and, upon receipt, WCJ Tobin sent an April 22, 2011, letter to Employer and Claimant explaining that the August 13, 2010, "order issued is clear, compensation was 'suspended,' not terminated or forfeited. Hence related medical expenses, if reasonable and necessary, must be paid." (WCJ Tobin's Letter (April 22, 2011), R.R. at 98.) WCJ Tobin also explained that she was inclined to issue an order "denying penalties because the bills [were] now being paid, and reiterating that compensation having been suspended, medical bills must, of course, still be paid in accordance with the Act." (WCJ Tobin's Letter (April 22, 2011), R.R. at 98.) WCJ Tobin stated that such an order would give Employer an opportunity to appeal and, if an appeal was taken, the Board could address whether the August 13, 2010, order was definitive. (WCJ Tobin's Letter (April 22, 2011), R.R. at 98.) Finally, WCJ Tobin provided Employer and Claimant the opportunity to discuss the matter with her via conference call before she issued an order disposing of the penalty petition. (WCJ Tobin's Letter (April 22, 2011), R.R. at 98.) The penalty petition was then withdrawn without WCJ Tobin issuing an order. (Board Op. at 3.)
Thereafter, on August 1, 2011, Employer filed the Petitions to Suspend and Review Compensation (2011 Petitions) at issue in this appeal. (WCJ March 23, 2012 Decision (2012 Decision), Findings of Fact (FOF 2012) ¶ 1.) Therein, Employer alleged that Claimant continued to refuse to undergo the recommended medical treatment and requested a forfeiture of medical benefits. (FOF 2012 ¶¶ 6-7.) The 2011 Petitions were, in part, based upon an updated Independent Medical Examination of Dr. Gause, which occurred on June 29, 2011. (FOF 2012 ¶ 7.) Dr. Gause again recommended that Claimant undergo the same surgical procedures. (FOF 2012 ¶ 7.)
The 2011 Petitions were assigned to WCJ Rosalia Parker. During the initial hearing, counsel for Claimant moved to dismiss the 2011 Petitions. (FOF 2012 ¶ 1.) After the receipt of position statements, WCJ Parker found that she lacked statutory authority to provide the requested relief. (FOF 2012 ¶ 11.) Specifically, WCJ Parker ruled that Employer's 2011 Petitions should be dismissed based upon (i) Employer's failure to follow the statutory utilization review procedures of the Act; and (ii) the absence of authority for stopping Claimant's medical benefits under Section 306(f.1)(8) of the Act. (FOF 2012 ¶ 11.) Accordingly, WCJ Parker dismissed Employer's 2011 Petitions. (2012 Decision Order.) WCJ Parker did not address the merits of Employer's 2011 Petitions or the evidence in support thereof.
Section 306(f.1)(8) of the Act states:
If the employe shall refuse reasonable services of health care providers, surgical, medical and hospital services, treatment, medicines and supplies, he shall forfeit all rights to compensation for any injury or increase in his incapacity shown to have resulted from such refusal.77 P.S. § 531(8).
On appeal to the Board, Employer requested a remand of the matter to WCJ Parker for appropriate findings of fact and conclusions of law regarding whether Claimant's continued refusal to undergo treatment should result in forfeiture of Claimant's medical benefits. Upon review the Board held that, under the doctrines of res judicata and collateral estoppel, the issue of forfeiture of medical benefits should have been litigated in the initial litigation before WCJ Tobin. (Board Op. at 5-7.) Thus, the Board determined that because Employer "was essentially attempting to relitigate [a] matter already decided by WCJ Tobin," Employer was precluded from pursuing a forfeiture of Claimant's medical expenses in the instant litigation. (Board Op. at 5-7.) Accordingly, the Board affirmed WCJ Parker's Decision without addressing whether she lacked the statutory authority to grant the requested relief or whether Employer should have followed the utilization review procedures set forth in the Act.
II. DISCUSSION
Employer now petitions this Court for review. In support of its appeal, Employer raises several issues.
"Our scope of review in a workers' compensation appeal is limited to determining whether necessary findings of fact are supported by substantial evidence, whether an error of law was committed, or whether constitutional rights were violated." Elberson v. Workers' Compensation Appeal Board (Elwyn, Inc.), 936 A.2d 1195, 1198 n.2 (Pa. Cmwlth. 2007).
Employer argues that the Board erred in determining that res judicata and collateral estoppel preclude Employer from relitigating whether Claimant's medical benefits should be suspended based on his refusal to undergo reasonable medical treatment. Employer maintains that Claimant's ongoing refusal to undergo reasonable medical treatment presents further grounds for WCJ Parker, in the exercise of her discretion, to suspend the medical portion of Claimant's compensation benefits. Employer argues that it could not have appealed the previous 2010 Decision because WCJ Tobin did not abuse her discretion in not granting a suspension of medical benefits. Employer now contends, however, that changed circumstances, based on Dr. Gause's updated medical opinion, may result in a different outcome if WCJ Parker exercises her discretion vis-à-vis the suspension of medical benefits.
While Employer presents several compelling arguments, due to the prior litigation before WCJ Tobin we hold that the Board did not err in determining that Employer is precluded by the doctrines of res judicata and collateral estoppel from pursuing the instant litigation.
The doctrine of res judicata actually "encompasses two related, yet distinct, principles: technical res judicata and collateral estoppel." Maranc v. Workers' Compensation Appeal Board (Bienenfeld), 751 A.2d 1196, 1199 (Pa. Cmwlth. 2000). Technical res judicata "provides that when a final judgment on the merits exists, a future suit between the parties on the same cause of action is precluded." Id. "Collateral estoppel, on the other hand, acts to foreclose litigation in a later action of issues of law or fact that were actually litigated and necessary to a previous final judgment." Id.
For technical res judicata to apply, four factors must be "present: (1) identity of the thing sued upon or for; (2) identity of the cause of action; (3) identity of the persons and parties to the action; and (4) identity of the quality or capacity of the parties suing or sued." Henion v. Workers' Compensation Appeal Board (Firpo & Sons, Inc.), 776 A.2d 362, 366 (Pa. Cmwlth. 2001). In general, causes of action are considered identical "when the subject matter and ultimate issues are the same in both the old and new proceedings." Id. Technical res judicata "applies not only to matters that were actually litigated in the old proceeding, but also to matters that could have been, or should have been, litigated in the old proceeding." Merkel v. Workers' Compensation Appeal Board (Hofmann Industries), 918 A.2d 190, 193 (Pa. Cmwlth. 2007). Thus, "res judicata applies to issues that were, in effect, waived in the old proceeding." Id. at 193 n.5.
In regards to collateral estoppel, the doctrine "is designed to prevent relitigation of an issue in a later action, despite the fact that the later action is based on a cause of action different from the one previously litigated." Pucci v. Workers' Compensation Appeal Board (Woodville State Hospital), 707 A.2d 646, 647-48 (Pa. Cmwlth. 1998). Collateral estoppel applies where:
1) the issue decided in the prior case is identical to the one presented in the later case; 2) there was a final judgment on the merits; 3) the party against whom the doctrine is asserted was a party or in privity with a party in the prior case and had a full and fair opportunity to litigate the issue; and 4) the determination in the prior proceeding was essential to the judgment.
In this matter we conclude that, under the doctrine of technical res judicata, Employer has waived its right in the current litigation to seek a suspension or forfeiture of Claimant's medical benefits. Here, the subject matter for both the 2009 Petitions and 2011 Petitions was Claimant's refusal to undergo reasonable medical treatment and the ultimate issue in both proceedings was whether Claimant forfeited his right to compensation for the two work-related injuries. Cf. Merkel, 918 A.2d at 193 (concluding that the subject matter in both the old and new proceedings was the employer's calculation of the average weekly wage (AWW) in connection with the claimant's injury and the ultimate issue in both proceedings was whether the employer erred in calculating the AWW). While it is unclear from the record whether Employer argued for a forfeiture of medical benefits in the 2009 Petitions, Employer clearly could have litigated that issue in the earlier proceeding. In fact, given that Claimant only received medical benefits for his right toe injury, Employer was aware in the previous proceeding that it could not suspend wage loss benefits for that injury and, thus, had an incentive to seek a suspension of Claimant's medical benefits. (2010 Decision at 1, R.R. at 5.) Moreover, Employer does not allege in the 2011 Petitions that there has been any change in Claimant's condition since the initial litigation before WCJ Tobin, but states that the treatment previously found to be reasonable by WCJ Tobin remains reasonable. As the Board correctly stated, "[t]he issue of whether Claimant forfeited his right to medical benefits should have been litigated before WCJ Tobin." (Board Op. at 6.) Therefore, Employer's 2011 Petitions are barred by technical res judicata. See also Weney v. Workers' Compensation Appeal Board (Mac Sprinkler Systems, Inc.), 960 A.2d 949, 955-56 (Pa. Cmwlth. 2008) (holding that the claimant's failure to litigate his neck and cervical injuries in a previous petition to review compensation benefits precluded him from raising the issue in a subsequent petition).
In addition, since WCJ Tobin's 2010 Decision only suspended "weekly benefits," (2010 COL ¶ 1), and did not specifically suspend medical benefits or address whether the suspension applied to medical benefits, Employer could have appealed that decision in order to obtain a determination as to whether the suspension included medical benefits. Due to Employer's failure to pay Claimant's medical expenses following WCJ Tobin's 2010 Decision, it appears that Employer believed that the 2010 Decision suspended medical benefits. As stated previously, to clarify that her 2010 Decision did not suspend medical benefits, WCJ Tobin wrote a letter to the parties, offering to issue a new, appealable order specifying that the original 2010 order only suspended wage loss benefits. (WCJ Tobin's Letter (April 22, 2011), R.R. at 98.) However, rather than attempting to appeal WCJ Tobin's 2010 Decision or requesting a new order that would be appealable, Employer chose to file the new 2011 Petitions several months later. Because Employer chose to pursue a suspension of medical benefits by commencing new proceedings rather than appealing WCJ Tobin's 2010 Decision suspending weekly benefits, Employer is now barred by technical res judicata from continuing the current litigation.
Accordingly, the Board's Order is affirmed.
Due to our disposition, we need not address the other issues raised by Employer in this appeal. --------
/s/ _________
RENÉE COHN JUBELIRER, Judge ORDER
NOW, October 14, 2014, the Order of the Workers' Compensation Appeal Board, entered in the above-captioned matter, is AFFIRMED.
/s/ _________
RENÉE COHN JUBELIRER, Judge
Id. at 648.