Griffiths v. W.C.A.B., 148 MAP 2005.

CourtUnited States State Supreme Court of Pennsylvania
Citation943 A.2d 242
Docket NumberNo. 148 MAP 2005.,148 MAP 2005.
Decision Date19 March 2008

Matthew Lane Wilson, Esq., Mary T. Stark, Esq., Martin, Banks, Pond, Lehocky & Wilson, Coplay, for David Griffiths.

Timothy Dean McNair, Esq., Erie, for amicus curiae Pennsylvania Trial Lawyers Association.

Amber Marie Kenger, Esq., Richard C. Lengler, Esq., Workers Compensation Appeal Board, Harrisburg, for Workers' Compensation Appeal Board.

Sheri B. Friedman, Esq., Charles S. Katz, Jr., Esq., Swartz Campbell, L.L.C., Philadelphia, for Seven Stars Farm.

Michael D. Sherman, Esq., Fried, Kane, Walters, Zuschlag & Grochmal, Pittsburgh, for amicus curiae Pennsylvania Defense Institute.



Chief Justice CASTILLE.

This Court granted review to determine: (1) whether a van modified to make it wheelchair accessible for a workers' compensation claimant rendered a quadriplegic by a work-related injury is an "orthopedic appliance" under Section 306(f.1)(1)(ii) of the Workers' Compensation Act ("the Act"), 77 P.S. § 531(1)(ii); and (2) whether the cost containment provision in Section 306(f.1)(3)(i) of the Act, 77 P.S. § 531(3)(i), is applicable in this instance. We hold that the van, and not merely the wheelchair lift and modifications installed in the van, may qualify as an indispensable device necessary to accommodate this sort of catastrophic work injury, and thus, may fall within the definition of an orthopedic appliance. We also hold, however, that the extent of an employer's obligation in this regard will depend upon the specific facts of the case. We further hold that the cost containment provision of the Act does not apply in the instant case. Accordingly, we reverse and remand to the Workers' Compensation Judge for proceedings consistent with this Opinion.

On August 21, 2000, appellant David Griffiths sustained a devastating injury in the course and scope of his employment with Seven Stars Farm, Inc. (Employer) when he was struck by a bale of hay that fell from overhead, rendering him a C-5 quadriplegic and confined to a wheelchair. Following a four-month hospital stay, appellant was discharged. Appellant's wife, Edith Griffiths, testified that she needed to transport appellant not only home from the hospital, but to and from follow-up medical appointments. Mrs. Griffiths rented two different vans for one month each, thus providing an opportunity to compare model layouts, features, and comfort before buying an appropriate model and design. Employer's insurance carrier representative was advised of the van rental in advance, being told that it was necessary to transport appellant home, to take him to medical appointments, and "to get out a `little bit' and enjoy `a little quality of life after being in the hospital [for] four months.'" WCJ Decision at 1.

Mrs. Griffiths noted that she and appellant ultimately purchased a third model van, a 2000 Ford Windstar. Appellant was more comfortable in the Windstar than in the rental vans: the Windstar had no mechanical lifts and its design was very simple, as entry is made by opening the back door, folding out a ramp by hand, and driving the wheelchair straight in. The cost of the van was $28,500, consisting of $18,000 in base costs, $10,000 in conversion costs, and $500 for shipping and handling. Other models the Griffiths had considered would have cost $40,000 or more, and were more complicated. The van was purchased with funds from a family friend. Id.

Employer voluntarily accepted liability for appellant's work injury and commenced timely payment of total disability compensation. The parties stipulated that Employer reimbursed appellant for eighty percent of the van rental cost and the cost of the van conversion, but refused to pay anything for the base costs for the van itself.

On January 26, 2001, appellant filed a penalty petition alleging that Employer violated the Act by failing to pay for the entirety of the van rental and the subsequent van purchase.1 The parties stipulated that the issues before the Workers' Compensation Judge ("WCJ") were whether appellant was entitled to reimbursement for the base purchase price of the van and whether appellant was entitled to reimbursement for one hundred percent or only eighty percent of the relevant costs.

The WCJ granted the penalty petition. The WCJ first noted the undisputed point that modifications to the van to make it wheelchair accessible were an expense for "orthopedic appliances" under Section 306(f.1)(1)(ii) of the Act, which provides, in pertinent part, that the "employer shall provide payment for medicines and supplies, hospital treatment, services and supplies, and orthopedic appliances, and prostheses in accordance with this section." 77 P.S. § 531(1)(ii). The WCJ next concluded that the cost containment provision in Section 306(f.1)(3)(i) applies only to a health care provider. Because the relevant provider in this case was the employer and its insurer, and no health care provider was involved, the WCJ found that Employer was responsible to pay the full rental costs of the prior vans and the full cost of modifying the Windstar. Finally, the WCJ concluded that "a reasonable cost to purchase the van [was] recoverable under the circumstances of this case." The WCJ explained his reasoning on this point as follows:

Without a van, with retrofitting for wheelchair accessibility, this paraplegic Claimant is confined to his home due to the work injury; limited, if not totally precluded, even as to obtaining medical attention, since this family had no other vehicles to enable Claimant to get to medical appointments, and transportation was not provided by the Carrier.

[Employer's] obligation to pay for retrofitting is of no benefit unless the Claimant has a van. In turn, whether [Claimant] or any other claimant in similar circumstances, can obtain a van is dependent upon available financial resources. Here, the moneys to purchase the van were borrowed from a family friend.

Upon consideration of the specific financial circumstances presented here*, payment of a reasonable sum for purchase of a van is appropriate....

* In denying a recovery for the cost of the van, the claimant's specific financial circumstance was not discussed in Petrilla v. WCAB (People's Natural Gas, 692 A.2d 623 (Pa. Cmwlth.1997)).

WCJ Decision at 2-3 (Conclusions of Law).

Employer appealed to the Board, renewing its twin positions that it was responsible for making the van accessible by wheelchair, but not for its original purchase price, and that, in any event, its liability was capped at eighty percent of the cost. The Board affirmed in part (concerning cost containment) and reversed in part (concerning liability for the purchase price of the van). Citing the Petrilla case, the Board held that the van itself is not an orthopedic appliance under the Act, and therefore, Employer is not obliged to pay for it. The Board rejected the WCJ's distinction of Petrilla, which was based upon appellant's specific financial circumstances, noting that Petrilla did not consider the claimant's financial circumstances, "and we do not see how the source of the funds that Claimant used to purchase the van brings it within the definition of an orthopedic appliance." The Board summarily concluded, on this point, that the Petrilla Court "determined that the base price of a vehicle that is retrofitted for a claimant's use is not recoverable and we are bound by that determination." Board Op. at 3-4.

With respect to the cost containment provision, the Board acknowledged that where no governing fee schedule has been established, Section 306(f.1)(3)(i) caps a provider's obligation at no more than eighty percent of the charge most often made by providers in a given geographic area. The Board determined, however, that the term "provider" meant a "health care provider," and because no health care provider was involved here, the cost containment provision simply did not apply. The Board therefore agreed with the WCJ that Employer was required to reimburse appellant for one hundred percent of the costs of renting a van for two months and modifying the purchased van to make it wheelchair accessible. Id. at 5-6.

The parties cross-appealed the two issues. In a 5-2, en banc published opinion, the Commonwealth Court reversed in part and affirmed in part, ruling in favor of Employer on both issues. Griffiths v. Workers' Comp. Appeal Bd. (Seven Stars Farm, Inc.), 861 A.2d 424 (Pa.Cmwlth. 2004). The majority deemed Petrilla to be controlling on the question of whether Employer was responsible for the cost of the van. In Petrilla, the claimant was rendered paraplegic and confined to a wheelchair due to a work injury. Although the employer had offered to retrofit the claimant's vehicle with hand controls and other modifications, the employer maintained that it was not obligated to provide the vehicle itself. The Petrilla court agreed, finding that a vehicle is not an orthopedic appliance under the statute:

The general use of a vehicle must, of course, be distinguished from the retrofitting of that vehicle, without which the vehicle could not be operated by the claimant. It is the modifications and additional "appliances," not the vehicle itself, which are necessary to accommodate the claimant's work-related injury. Thus, the special retrofitting is an "orthopedic appliance" [citing Rieger v. Workmen's Comp. Appeal Bd. (Barnes & Tucker Co.), 104 Pa.Cmwlth. 42, 521 A.2d 84 (1987)], while a van itself is not.

Second, by analogy, while the special remodeling of an injured worker's home to make it wheelchair accessible might be analogous to the cost of retrofitting a motor vehicle so that the vehicle is accessible to a paraplegic, the cost of the...

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