Welliver McGuire, Inc. v. Workers' Compensation Appeal Board
Welliver McGuire, Inc. v. Workers' Compensation Appeal Board
Opinion of the Court
Welliver McGuire, Inc. (Employer) petitions for review from an order of the Workers’ Compensation Appeal Board (Board) which affirmed the decision of a Workers’ Compensation Judge (WCJ) granting the petition to review compensation benefits and penalty petition filed by Richard Padgett (Claimant). We reverse and remand in part and affirm in part.
Claimant thereafter filed a review petition alleging that Employer was not entitled to an offset and also filed a penalty petition claiming that Employer unilaterally modified his benefits in violation of the Workers’ Compensation Act (Act).
At the WCJ’s hearing, the parties stipulated that 46.3% of the money in Claimant’s pension plan is the result of contributions made by Employer. The parties also stipulated that although Employer is insured by Travelers Insurance Company (Travelers) for purposes of claimants workers’ compensation wage loss indemnity benefits, Employer has a $250,000.00 aggregate deductible for such benefits. As such, the first $250,000.00 of workers’ compensation benefits paid to Claimant and other employees is paid directly by Employer. Between February 4,1998 and June 1, 2000, all workers’ compensation benefits paid to Claimant were monies paid by Employer. All benefits after June 1, 2000 were paid by Travelers inasmuch as the $250,000.00 aggregate limit had been exceeded.
Claimant also testified at the hearing that his workers’ compensation benefits were reduced four days before being notified by Employer of the reduction. The LIBC Form 761 sent by Employer informing Claimant of the reduction stated that “this form is to provide you with at least 20 calendar days notice of this offset prior to a change in your workers’ compensation benefits.”
Based on the above, the WCJ granted Claimant’s review and penalty petitions. The WCJ concluded that based on this court’s recent decision in Kramer v. Workers’ Compensation Appeal Board (Rite Aid Corporation), 794 A.2d 953 (Pa. Cmwlth. 2002), petition for allowance of appeal granted, 573 Pa. 32, 820 A.2d 700 (2003), Employer was not entitled to an offset for pension benefits issued to Claimant because Claimant’s workers’ compensation benefits were paid by Employer’s insurance carrier and not by Employer. On appeal the Board affirmed.
Initially, we observe that the set-off provisions of the Act, set forth in Section 204(a), 77 P.S. § 71(a), provide in pertinent part:
The severance benefits paid by the employer directly liable for the payment of compensation and the benefits from a pension plan to the extent funded by the employer directly liable for the payment of compensation which are received by an employee shall also be credited against the amount of the award made under section 108 and 306, except for benefits payable under section 306(c).
In Kramer, the claimant incurred a work-related injury and received benefits until
The claimant filed an offset review petition alleging that the employer’s offset was unconstitutional and contrary to the Act. The claimant argued that because the employer’s insurance carrier, Travelers and not the employer was liable for the payment of the claimant’s workers’ compensation, the employer could not take a credit for those payments. This court agreed with the claimant.
We observed that the plain language of Section 204(a) of the Act provides that “the severance benefits paid by the employer directly liable for the payment of compensation and the benefits from a pension plan to the extent funded by the employer directly liable for the payment of the compensation ... which are received by an employee shall also be credited against the amount of the award made....” In interpreting the above, we stated that the plain language dictated that an offset is afforded to an employer only if the employer is directly liable to a claimant for compensation. Because Travelers was responsible for the payment of the claimant’s workers’ compensation, and not the employer, we determined that the employer was not entitled to a credit.
In this case, Employer argues that, in contrast to the employer in Kramer, Employer here was self-insured up to an aggregate of $250,000.00.
In Hulmes, similar to Kramer, the claimant incurred a work-related injury, returned to a light-duty job and then was laid-off when the employer relocated its facility. Employer sent a severance check to the claimant and also reinstated her total disability benefits. However, the employer suspended the claimant’s workers’ compensation benefits for two months claiming that the Act authorized a credit in the amount of the severance against the disability benefits owed the claimant.
This court observed that in Kramer, the employer was not entitled to a credit under Section 204(a) because its insurance company was the party directly responsible for the payment of compensation. In Hulmes, however, we determined that the
Should it be determined that the arrangement by which Claimant’s workers compensation benefits was, in effect a fully-insured one, then the Board should on the basis of Kramer, reverse. If the Board finds that Employer funded the benefits, then the Board may enter an appropriate award.
Hulmes, 811 A.2d at 1130.
Here, the parties stipulated that 46.3% of the money in Claimant’s pension plan is the result of contributions made by Employer. Additionally, the parties stipulated that Employer was required to exhaust an aggregate $250,000.00 deductible before Travelers assumed liability for workers’ compensation benefits and that Employer, not Travelers, directly paid workers’ compensation benefits to Claimant from February 4,1998 to June 1, 2000. As of June 1, 2000, the aggregate deductible of $250,000.00 was met and workers’ compensation benefits paid thereafter were paid by money from Travelers.
In accordance with 77 P.S. § 71(a), an injured employee who subsequently receives “benefits from a pension plan to the extent funded by the employer directly liable for the payment of compensation” in effect forfeits workers’ compensation disability benefits in an amount corresponding to the pension benefits funded by the employer. In this case, Claimant received pension benefits of which 46.3% was funded by Employer and Employer was directly responsible for the payment of Claimant’s workers’ compensation benefits from February 4,1998 to June 1, 2000. Accordingly, we must remand this case to the Board for the proper calculation of credit owed to Employer. Namely, from February 4, 1998 to June 1, 2000, Claimant’s monthly wage loss benefits should have been reduced by 46.3% of Claimant’s monthly pension.
Next, we will address Employer’s argument that the WCJ and Board erred in granting Claimant’s penalty petition, contending that its violation of the Act was de minimis. We disagree.
In accordance with 34 Pa.Code § 123.4(b), before an employer can offset workers’ compensation benefits, the employer must notify the employee “[a]t least 20 days prior to taking the offset.” In this case, Employer reduced Claimant’s workers compensation benefits four days before Employer even notified Claimant that there would be a reduction.
For imposition of penalties to be appropriate against an employer or carrier, a violation of the Act or the rules and regulations must appear on the record. Farance v. Workers’ Compensation Appeal Board (Marino Brothers, Inc.), 774 A.2d 785, 789 (Pa.Cmwlth. 2001), petition for allowance of appeal denied, 567 Pa. 748, 788 A.2d 380 (2001). Whether to impose penalties against an employer is within the sound discretion of the WCJ. Id. Here, there is no dispute that Employer failed to comply with the 20-day notice provision contained in 34 Pa.Code § 123.4(b) and, as such, it was within the discretion of the WCJ to impose penalties.
In accordance with the above, the decision of the Board is reversed and remanded for the Board to determine the credit due Employer. The decision of the Board is affirmed in all other respects.
ORDER
Now, October 22, 2003, that portion of the Workers’ Compensation Appeal Board
Jurisdiction relinquished.
. Act of June 2, 1915, P.L. 736, as amended, 77 P.S. §§ 1-1041.4, 2501-2626.
. Employer also argues that this court should not follow Kramer because it is presently on appeal to the Supreme Court and as claimed by Employer, it is likely to be reversed. The Supreme Court, however, has yet to issue a decision and as such we will follow the holding in Kramer.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.