AI Generated Opinion Summaries

This summary was computer-generated without any editorial revision. It is not official, has not been checked for accuracy, and is NOT citable.

Facts

• In August 2013, the Worker suffered a work-related injury when a live power line collided with his work truck. The Employer immediately took the Worker to the emergency room and began investigating the accident but did not report the accident to the Insurer or the Workers’ Compensation Administration. Instead, the Employer directly paid for the Worker’s medical care from August 2013 to March 2014. The Worker filed an initial complaint for workers’ compensation benefits in February 2014, and after mediation in April 2014, it was confirmed that the Worker was entitled to benefits. The Insurer began making payments in December 2015 but only for indemnity moving forward, not for the back-owed benefits. The Worker received a total of $225,642.52 in indemnity and medical benefits by August 2017 (paras 2-4).

Procedural History

• [Not applicable or not found]

Parties' Submissions

• Worker-Appellant: Argued that the Workers’ Compensation Judge (WCJ) misconstrued the Workers’ Compensation Act in issuing the benefit penalty and erroneously refused to assess his common law bad faith claims (para 1).
• Employer/Insurer-Appellees: The summary does not provide specific arguments made by the Employer/Insurer. However, it can be inferred that they contested the Worker's claims to some extent, given the litigation and the WCJ's findings (para 5).

Legal Issues

• Whether the WCJ misconstrued the Workers’ Compensation Act in issuing the benefit penalty against the Employer and Insurer.
• Whether the WCJ erred by declining to assess the Worker's common law bad faith claims (para 7).

Disposition

• The Workers’ Compensation Judge’s order granting in part and denying in part the Worker’s application for bad faith and unfair claims processing was affirmed. The WCJ found that the Employer and Insurer engaged in unfair claims processing and awarded the Worker a statutory benefit penalty under the Workers’ Compensation Act (para 1).

Reasons

• The Court of Appeals, per Judge Megan P. Duffy, with Judges Zachary A. Ives and Shammara H. Henderson concurring, held that:
  The Supreme Court has previously determined that the Workers’ Compensation Act provides an exclusive and adequate remedy for bad faith claims, thus the WCJ did not err in declining to assess the Worker's common law bad faith claims (para 7).
  The WCJ did not err in awarding a single benefit penalty from each party despite finding multiple counts of unfair claims processing against each party. The statute indicates that only one penalty is available for each claim affected by bad faith or unfair claims processing (paras 10-11).
  The WCJ did not err in calculating the benefit penalty based on the portion of the claim specifically affected by the acts of unfair claims processing or bad faith, rather than the total amount of benefits received by the Worker (paras 14-16).
  The WCJ did not abuse its discretion in the amount of the benefit penalty assessed against Employer and Insurer. The Court found no compelling argument or authority that a five and ten percent penalty is insufficient to deter Employer and Insurer (paras 17-19).