A workers’ compensation claimant whose benefits were suspended and have resumed may seek a modification of benefits within three years of the date of the last payment received as long as the payment falls within the 500-week eligibility period for post-suspension benefits under Section 413(a) of the state Workers’ Compensation Act, the Pennsylvania Supreme Court has ruled.
The decision addressed ambiguity as to whether the three-year provision of the act was nullified by the 500-week provision. The court said it was not and that the two provisions must be read concurrently.
In Cozzone v. Workers’ Compensation Appeal Board (East Goshen Township), the justices unanimously ruled to uphold a Commonwealth Court ruling that East Goshen Township did not violate the act by discontinuing disability payments to its employee, plaintiffs-decedent Andrew Cozzone, that were no longer obligatory under the act because they were made pursuant to a supplemental agreement after the 500-week period had expired.
But in so ruling, the justices did not entirely agree with the lower court’s reasoning and invalidated a line of other Commonwealth Court cases from the 1990s — Edgewater Steel v. WCAB (Beers), Deppenbrook v. WCAB (Republic Steel) and Roussos v. WCAB (St. Vincent Health Center) — that interpreted the expiration of the 500-week post-suspension eligibility period as a bar to total disability claims.
“We now hold that the Commonwealth Court’s interpretation of Section 413(a) as automatically barring all post-500-week/post-suspension claims for total disability is mistaken, as the limitation periods set forth in Section 413(a) are to be construed and considered concurrently,” Chief Justice Ronald D. Castille wrote for the court. “The provisions of Section 413(a) stand together, not in opposition to one another, and effect must be given to both as far as possible.”
Castille said Section 413(a) allows claimants who resume collecting benefit payments following a suspension to seek a modification of benefits within three years of the last payment received, provided that payment was made within the 500-week post-suspension eligibility period.
Therefore, Castille said, total disability claims are, in some cases, permitted beyond the expiration of the 500 weeks.
In Cozzone, according to Castille, Cozzone injured his back when he fell from a roof while working for the township and began collecting total disability benefits on February 6, 1989.
Cozzone received those benefits until September 20, 1989, when he returned to his work in his pre-injury position with no loss of earnings, Castille said.
Over 13 years later, on May 19, 2003, the township agreed to reinstate Cozzone’s total disability benefits from February 24, 2003, until March 17, 2003. Cozzone’s benefits were reinstated again from June 17, 2005, until August 29, 2005, and again on June 20, 2007, according to Castille.
On November 27, 2007, Cozzone began working in a modified-duty position for another employer and reached an agreement with the township on January 7, 2008, to reduce his payments to partial disability benefits, Castille said.
Cozzone worked at his new job until January 24, 2008, and petitioned for reinstatement of total disability payments from the township on September 26, 2008, but the township discontinued payments to Cozzone in January 2009 pursuant to the January 2008 agreement, according to Castille.
Cozzone then filed a penalty petition arguing that the township violated the act by stopping payments, Castille said.
In February 2010, a workers’ compensation judge granted Cozzone’s restatement petition as well as the penalty petition, finding that the township had violated the act, but the Workers’ Compensation Appeal Board reversed the decision, according to Castille.
The Commonwealth Court affirmed the WCAB’s decision 2-1, finding that Cozzone’s reinstatement was untimely because it was filed beyond the 500-week post-suspension eligibility period, Castille said.
But Castille said that while he agreed with the result the Commonwealth Court reached, he did not entirely agree with its reasoning.
Instead, Castille said the 500-week provision does not cancel out the three-year provision.
“The statute is silent as to the effect of resumed payments on a claimant’s right to petition for a modification following a suspension after an attempted return to work,” Castille said. “On its face, then, the statute provides for the possibility of modification as long as ‘a petition is filed with the department within three years after the date of the most recent payment,’ whenever that payment may be (assuming compensation is in order in the first place). By its plain terms, this right to petition within three years remains in effect even where the right to petition has been extended by operation of the 500-week provision, unless the township is correct that the 500-week provision somehow operates to nullify, exclude or cancel the operation of the three-year provision. The plain language of the statute, however, contains no such restriction.”
Therefore, Castille said, any payment made within the 500-week period extends the claimant’s right to seek a modification by three years, but any payment made beyond the 500-week period does not.
According to Castille, while Cozzone filed his petition to reinstate benefits from the date of his last payment, that payment was received pursuant to a supplemental agreement with the township to continue receiving benefits beyond the expiration of the 500-week eligibility period and therefore did not extend his right to seek a modification.
“In this case, appellant received payments pursuant to supplemental agreements which were executed subsequent to the expiration of his statutory right to compensation,” Castille said. “Those payments did not resurrect appellant’s expired claims.”
Castille said Cozzone “failed to prove that the township violated the act by refusing to continue payments under the final supplemental agreement, which was not enforceable under the act since appellant’s right to compensation expired prior to the execution of that agreement.”
“Because no payments were then properly payable to appellant, the township was not ‘an employer who is obligated to pay’ at that time, and its refusal to pay appellant could not constitute a violation of the act,” Castille said. “Certainly, if an employer unilaterally ceases payments where payment is obligatory under the act, that employer is properly subject to penalty. Where, however, payment actually ceased to be obligatory under the act, as in this case, there is no violation in refusing to make payments which, for purposes of the act, are not required, but gratuitous.”
Counsel for Gina Cozzone, the executor of Andrew Cozzone’s estate, Quintes D. Taglioli of Markowitz & Richman in Allentown, Pa., could not be reached for comment.
Counsel for the township, Sharolyn L. Murphy of Doman & Murphy in Ottsville, Pa., also could not be reached.
(Copies of the 28-page opinion in Cozzone v. Workers’ Compensation Appeal Board, PICS No. 13-2465, are available from Pennsylvania Law Weekly. Please call the Pennsylvania Instant Case Service at 800-276-PICS to order or for information.) •