Justia Pennsylvania Supreme Court Opinion SummariesArticles Posted in Public Benefits
Rehabilitation & Community Providers Association, et al. v. Dept. Human Svcs
The underlying dispute before the Pennsylvania Supreme Court in this case involved the adequacy of state funding for community participation support ("CPS") services, which were designed to help individuals with autism or intellectual disabilities live independently. The primary issue on appeal related to the exhaustion requirement. The Pennsylvania Department of Human Services ("DHS") issued ODP Announcement 19-024, indicating it intended to change the rate structure for CPS services provided under the Home and Community Based Services (“HCBS”) waivers. Petitioners filed an action for declaratory and injunctive relief, challenging the legality of the new fee schedule and alleged the new reimbursement rates were too low to sustain the provision of CPS services to eligible recipients. Pertinent here, the Commonwealth Court agreed with one of DHS' preliminary objections that Petitioners failed to exhaust their administrative remedies, as required by case precedent, before seeking judicial review. The court acknowledged a narrow exception to the exhaustion requirement whereby a court may consider the merits of a claim for declaratory or injunctive relief if a substantial constitutional question is raised and the administrative remedy is inadequate. It clarified, however, that the exception only applied where the plaintiff raises a facial constitutional challenge to the statute or regulation in question, as opposed to its application in a particular case. Here, the court concluded, the Petitioners were attacking the fee schedule in the Final Notice, which was produced by application of the legal authority cited in that notice, and not advancing a facial constitutional challenge. The court also found Petitioners failed to demonstrate the administrative remedy was inadequate. The Supreme Court affirmed the Commonwealth Court’s order insofar as it sustained the preliminary objection asserting that the Petitioners failed to exhaust their administrative remedies, and dismissed the Petition as to those parties. The order was vacated in all other respects, and the matter was remanded for further proceedings. View "Rehabilitation & Community Providers Association, et al. v. Dept. Human Svcs" on Justia Law
Weeks v. DHS
Changes to the Pennsylvania Human Services Code terminated a cash assistance program for certain low-income individuals administered by the Department of Human Services ("DHS"). Appellants, being aggrieved by the termination of Cash Assistance, filed in the Commonwealth Court’s original jurisdiction, a Class Action Petition for Review on behalf of themselves and others similarly situated, seeking a preliminary injunction to prevent that aspect of the law from taking effect until a final merits determination as to the constitutionality of the act as a whole could be reached. The Commonwealth Court denied the request. After review, the Pennsylvania Supreme Court concluded the Commonwealth Court did not abuse its discretion in determining Appellants failed to carry their burden with regard to the likelihood-of-success-on-the-merits aspect of the standard for preliminary injunctive relief. That being the case, the Supreme Court did not not address whether the court erred in finding that Appellants failed to demonstrate irreparable harm. View "Weeks v. DHS" on Justia Law
Harmon v. UCBR
The Pennsylvania Supreme Court granted discretionary review to determine whether the Commonwealth Court erred in holding appellant Daniel Harmon was disqualified from receiving unemployment compensation benefits pursuant to Section 402.6 of the Unemployment Compensation Law. Appellant was a part-time employee at Brown’s Shop Rite beginning February 14, 2013. By December, he was convicted of driving with a suspended license and sentenced to a term of 60 days’ imprisonment to be served on 30 consecutive weekends, beginning March 14, 2014 and ending August 7, 2014. Appellant’s employment with Brown’s Shop Rite was terminated on March 24, 2014 due to a violation of company policy, which was unrelated to his incarceration. He then filed for benefits and received them for the week ending March 29, 2014 through the week ending July 26, 2014. This period included weeks when appellant was serving his sentence of weekend incarceration. The Supreme Court held appellant was not disqualified from receiving unemployment compensation benefits, and therefore reversed the order of the Commonwealth Court. View "Harmon v. UCBR" on Justia Law
Washington, et al. v. Dept. of Pub. Welfare
Three disabled individuals who formerly received cash general assistance benefits from the Pennsylvania Department of Public Welfare filed a complaint alleging that the manner in which the Pennsylvania General Assembly enacted Act 80 of 2012, a piece of legislation which, inter alia, made sweeping changes to the administration of the state's human services programs, violated Article III, Sections 1, 3 and 4 of the Pennsylvania Constitution. The Pennsylvania Supreme Court determined the Act was in violation of Section 4. The provisions of H.B 1261, P.N. 1385 were entirely removed from the bill by the Senate, inasmuch as they had been enacted by another piece of legislation, Act 22 of 2011. Since the original provisions were gone when the new provisions were added by the Senate, it was factually and legally impossible for the new provisions to work together with the deleted provisions to accomplish a single purpose. The Court held the amendments "to such enfeebled legislation" were not germane as a matter of law. Consequently, the Senate amendments were not germane to the provisions of H.B. 1261, P.N. 1385, and, accordingly, the three times that H.B. 1261, P.N. 1385 was passed by the House in 2011 could not count towards the requirements of Article III, Section 4. View "Washington, et al. v. Dept. of Pub. Welfare" on Justia Law
Penn. State Police v. WCAB (Bushta)
In this discretionary appeal, we consider whether Appellant, the Pennsylvania State Police (“PSP”), is entitled to subrogation of benefits that a trooper – who was injured in a motor vehicle accident – was eligible to receive under the Workers’ Compensation Act (“WCA”) against the trooper’s recovery from a third-party tortfeasor pursuant to the Motor Vehicle Financial Responsibility Law (“MVFRL”). In 2011, Pennsylvania State Trooper Joseph Bushta (“Claimant”) was on duty when his police vehicle was hit by a tractor-trailer. As a result of the collision, Claimant suffered various cervical, thoracic, and lumbar injuries which required medical treatment and physical therapy, and which resulted in Claimant’s inability to perform his job duties for approximately 16 months. PSP, a self-insured public employer, issued a notice of compensation payable (“NCP”) indicating a weekly compensation rate of $858.08 under the WCA. The Pennsylvania Supreme Court determined that all of the benefits Claimant received were Heart and Lung benefits, not WCA benefits. Thus, pursuant to the MVFRL, PSP does not have a right of subrogation against Claimant’s settlement with the third-party tortfeasors. View "Penn. State Police v. WCAB (Bushta)" on Justia Law
Kinney-Lindstrom v. MCARE Fund
Mother and Appellant/Cross-Appellee Lisa Kinney Lindstrom sought a ruling as to the number of "occurrences" for which the MCARE Fund is liable based on allegations that her physician failed to diagnose discrete in utero infections suffered by her twins, which caused severe injuries to both children. The Commonwealth Court granted summary judgment in favor of the MCARE Fund, holding that the physician's failure to diagnose Mother's infection constituted the single cause of the children's injuries, and, therefore, there was a single occurrence, limiting MCARE coverage to the statutory limit of one payment of $1 million. Upon review, the Supreme Court reversed, holding that the Commonwealth Court erred by granting summary judgment because there was a genuine issue of material fact as to whether the children's injuries arose from the physician's failure to diagnose a single infection, or whether the children's injuries resulted from the physician's failure to diagnose multiple infections from different organisms that infected each child in utero at different times. View "Kinney-Lindstrom v. MCARE Fund" on Justia Law
Pennsylvania v. Abraham
The Commonwealth appealed a superior court order that reversed an order denying appellee's petition for post conviction relief and for remanding for an evidentiary hearing. Appellee Joseph Abraham was accused of soliciting a former student for sex, and for allegedly sexually assaulting her. When the allegations surfaced, the then 67-year-old Appellee retired from teaching and began receiving pension payments. Pursuant to a negotiated agreement, appellee pled guilty to corruption of a minor and indecent assault of a person less than 16 years of age. He was sentenced to probation; no direct appeal was filed. Because the crime of indecent assault of a person less than 16 years of age is one of the enumerated offenses in the Public Employee Pension Forfeiture Act (PEPFA), appellee forfeited his pension when he pled guilty to this charge. He filed a motion to withdraw his plea nunc pro tunc, alleging he was not informed of his right to seek withdrawal of his plea or of the possible sentences he faced. The trial court denied the motion. Appellee filed a timely PCRA petition alleging plea counsel was ineffective for failing to inform him he would forfeit his pension upon pleading guilty. The PCRA court dismissed the petition without a hearing. On appeal, the Superior Court reversed. "Because counsel cannot be deemed ineffective for failing to advise a defendant regarding the collateral consequences of a plea, appellee's ineffectiveness claim fails." Therefore, the Supreme Court reversed the order of the Superior Court granting appellee a PCRA hearing on the issue of prejudice, and remanded the case to reinstate the PCRA court's order denying appellee relief. View "Pennsylvania v. Abraham" on Justia Law
Gentex Corp v. Workers’ Compensation Appeals Bd.
Appellant Anne Marie Morack worked for Appellee Gentex Corporation for over thirty years. In 2005, she left when swelling and pain in her hands were too overwhelming for her to continue work. She sought medical help, and notified her employer of the pain. In early 2005, Appellant applied for short-term disability, noting on her application for benefits that she did not believe her injury was work-related. After consultation with a specialist, Appellee learned that her injury was work-related. Gentex ultimately appealed the Workers' Compensation Appeal Board's decision granting Appellant's claim to the Commonwealth Court, contending that Appellant did not timely notify her supervisor of the injury nor aptly describe the injury to comply with the state workers' compensation act. The Commonwealth Court reversed, finding Appellant did not aptly describe her injury nor give Gentex adequate notice. The Supreme Court granted allocatur to determine what constitutes sufficient notice under the Act, and to "speak to" an employer's duty to conduct reasonable investigations into the circumstances surrounding a work-related injury. Under the Act, notice is a prerequisite to receive workers' compensation benefits, and the claimant bears the burden of demonstrating that proper notice was given. Upon review of the applicable case law in this instance, the Court found that, "consistent with the humanitarian purposes of the Act, [the Court] made it clear that even imperfect notice can satisfy" its strictures. The Court employed a "totality of the circumstances" approach to determining whether Appellant in this case both satisfied the notice and description of the injury in making her claim for benefits. In reversing the Commonwealth Court, the Supreme Court found that Appellant's collective communications with Gentex satisfied the notification requirements of the Act. View "Gentex Corp v. Workers' Compensation Appeals Bd." on Justia Law
Bur. of Workers’ Comp., Aplt v. WCAB
Claimant Kevin Ressler suffered a work-related injury in 1995. He received Workers' Compensation benefits. In 2004, Claimant submitted to an independent medical evaluation (IME). The sequence of events since the IME make up the heart of this appeal. In June 2004, Claimant had surgery related with his work-related injury. In July 2004, his employer petitioned to terminate benefits as of the date of the IME. The employer also requested a supersedeas. The Workers' Compensation Judge (WCJ) denied the superseadas in August 2004. In October of that year, the insurer received the invoice for the June surgery and paid the amount by the end of January, 2005. In June 2005, the WCJ granted the employer's petition to terminate benefits. The Workers' Compensation Appeal Bard (WCAB) affirmed that decision. The insurer then requested reimbursement for the 2004 surgery from the Supersedeas Fund. The Bureau of Workers' Compensation challenged the request because Claimant's surgery predated the supersedeas request. The WCJ found that no obligation to pay arose until the bill was submitted to the insurer in October 2004. Because the obligation to pay arose after the denial of supersedeas, reimbursement was appropriate. The WCAB affirmed. The issue of whether the Supersedeas Fund may deny reimbursement of treatment rendered before the insurer requested supersedeas came before the Supreme Court. Upon review of the trial record and the Workers' Compensation Act, the Court concluded that the lower courts appropriately ordered reimbursement to the insurer for undue payments made after the supersedeas request and in direct response to the earlier denial. The Court affirmed the lower court's decision. View "Bur. of Workers' Comp., Aplt v. WCAB" on Justia Law
Crozer Chester Med. Ctr. v. Dept. of Labor & Ind.
The Commonwealth Court declined to issue a writ of mandamus to Appellant Crozer Chester Medical Center (Crozer) in its attempt to force the Department of Labor and Industry (Department) to reimburse it for medical fees. Claimant William Radel suffered a work-related injury while lifting a bundle of rebar for his employer. The claimant underwent surgery at Crozer, and Crozer sent claimant's records and the bill to claimant's insurance company, Zurich North American Insurance (Zurich). Zurich did not pay, nor did it deny the claim. Crozer then turned to the State for reimbursement. The Department rejected the application as "premature," because Zurich's non-payment made an "outstanding issue of liability/compensability for the alleged injury." Crozer then petitioned the Commonwealth Court to force the Department to pay. The Supreme Court agreed that Crozer's application for reimbursement was premature. The Court found that Crozer did not try to resolve Zurich's nonpayment before petitioning the State or the Commonwealth Court. The Court affirmed the decision of the Department and the lower court, and dismissed Crozer's petition for a writ of mandamus.