Doors v. Workers' Compensation Appeal Board11/28/2005
Keystone Shower Doors (Employer) appeals from the order of the Workers' Compensation Appeal Board (Board) which affirmed the Workers' Compensation Judge's (WCJ) decision to grant the Penalty Petition of Christina McCloskey (Claimant).
On August 27, 1993, Claimant sustained a work-related injury when a cabinet fell and caused an injury to her left hand during the course and scope of her employment. A Notice of Compensation Payable (NCP) listed the injury as a "sprained left hand." Claimant was indemnified for all medical benefits, including all reasonable and necessary prescription medications related to the injury. Notice of Compensation Payable, (date illegible) at 1; Reproduced Record (R.R.) at 105a.
In December of 1997, Employer filed a termination petition, which was answered by Claimant. Employer's request for a Supersedeas was denied and Employer was ordered to continue to pay Claimant's weekly benefits and reasonable and necessary medical expenses incurred in connection with the August 17, 1993, injury.
On April 24, 1998, Claimant filed a petition to amend the NCP to include other injuries. Petition to Review Compensation Benefits, April 24, 1998, at 1; R.R. at 4a. On June 26, 2000, Employer and Claimant entered into a Compromise and Release Agreement (C&R Agreement) pursuant to Section 449 of the Workers' Compensation Act (Act). Paragraph 4 of the C&R Agreement delineated the injury as a "left hand and left upper extremity injury," and Paragraph 6 specifically stated that the injury described in Paragraph 4 resulted in Claimant's "total disability." Compromise and Release Agreement, June 26, 2000, at 1-2; R.R. at 25a-26a (Emphasis added). Employer agreed to pay Claimant $115,000 in settlement of her medical and wage loss claims. In Paragraph 9 of the C&R Agreement, Employer agreed to continue to pay for "all future reasonable and necessary prescription medications related to Claimant's work-related accident of August 27, 1993." Compromise and Release Agreement, June 26, 2000, at 3; R.R. at 27a (Emphasis added). After a hearing, the C&R was approved by the WCJ in a decision and order dated June 29, 2000. The WCJ dismissed the petitions for termination, review and penalties as moot.
On January 1, 2003, without notice or explanation, Employer stopped paying for Claimant's medical prescriptions without any utilization review.
On April 7, 2003, Claimant filed a penalty petition and alleged that Employer's failure to pay for her prescription medications constituted a violation of the Act. Employer answered the petition and denied that the prescription medications were reasonable, necessary or causally related to the August 27, 1993 work related injury. Answer to Penalty Petition, April 18, 2003, at 1; R.R. at 54a.
At the hearing, Claimant testified that she took medications to treat injuries to her left hand and upper extremities ever since the accident of August 27, 1993, including, among others, Oxycontin, Roxicodine, Neurontin, Depokate, Zanaflex, Chlonidine, Keppra, Zantac, Seroquel, Chlonidine, Maxalt, Wellbutrin and Chronulaz. Notes of Testimony, May 27, 2003, (N.T.) at 4-5; R.R. at 60a-61a. Her doctors prescribed those medications for the injuries she sustained to her left hand and upper extremities on August 27, 1993. She stated that Employer's insurance paid for those medications since 1996, but stopped in January 2003. N.T. at 6; R.R. at 62a.
Claimant also presented the deposition testimony of Thomas Del Giorno, Jr., M.D. (Dr. Del Giorno), board-certified in family medicine. Dr. Del Giorno took a history and clinically examined Claimant. He also had the opportunity to review voluminous me
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