Background
Gail Smith, a licensed practical nurse, suffered a disabling lower back injury in December 2016 while lifting a patient at her employer’s assisted living facility. After years of litigation, Workers’ Compensation Judge (WCJ) Joseph Hakun expanded the injury description in a 2022 decision to include “work-related post-laminectomy pain syndrome and lumbar radiculopathy.” WCJ Hakun credited the testimony of both parties’ medical experts and wrote that their opinions “inter alia, include work-related post-laminectomy pain syndrome and lumbar radiculopathy.”
In September 2022, Employer Atria Management requested an impairment rating evaluation (IRE) under Section 306(a.3) of the Workers’ Compensation Act, which requires claimants who have received total disability benefits for 104 weeks to submit to a medical examination using the 6th Edition, second printing of the AMA’s Guides to the Evaluation of Permanent Impairment. Dr. Vinit Pande conducted the IRE, reviewing Smith’s lumbar radiculopathy and chronic pain, and assigned a 31% whole-person impairment rating—below the 35% statutory threshold. An impairment rating below 35% permits modification from total to partial disability, capping future benefits at 500 weeks. Employer filed a modification petition. Claimant countered with her own IRE expert, Dr. James Bonner, who gave her a 36% rating, but acknowledged that the applicable injury class had a 33% ceiling and that he awarded extra points for pain complaints—a methodology unsupported by the AMA Guides. WCJ McCormick credited Dr. Pande and modified benefits to partial disability.
Claimant appealed, arguing that WCJ Hakun’s use of “inter alia” meant that her injury description encompassed unspecified additional ailments beyond the two named, and that Dr. Pande’s IRE was therefore inadequate for failing to evaluate those unnamed conditions. The Workers’ Compensation Appeal Board affirmed by unanimous vote.
The Court’s Holding
The Commonwealth Court (Judge Wolf, writing) affirmed. On the threshold textual question, the court rejected Claimant’s reading of WCJ Hakun’s decision. Claimant argued that the phrase “inter alia”—meaning “among other things”—signaled that her compensable injuries extended beyond post-laminectomy pain syndrome and lumbar radiculopathy. The court disagreed, noting that a grammatical analysis of WCJ Hakun’s sentence compelled a different reading: the antecedent of the relative pronoun “which” was the doctors’ opinions, not Claimant’s ailments. The phrase “inter alia” meant that the doctors opined on topics other than the specific diagnoses listed—not that Claimant suffered from additional unlisted conditions. WCJ Hakun had found no ailments beyond the two named, and nothing in the record suggested otherwise.
Having resolved the injury-description question, the court disposed of the IRE adequacy challenge as a corollary. Under Duffey v. Workers’ Comp. Appeal Bd., 152 A.3d 984 (Pa. 2017), an IRE physician must evaluate “additional injuries” that arose from the work incident and were known at the time of the IRE. But that rule presupposes that such additional injuries were actually established. Here, no additional injuries had been found by any WCJ, and Dr. Pande had no reason to evaluate anything beyond the conditions he was given. Claimant’s reliance on Duffey was therefore misplaced. The court also rejected Claimant’s argument that the Board had focused its review on the wrong question (credibility versus legal error), reasoning that the supposed legal error was entirely predicated on the incorrect interpretation of “inter alia.”
Key Takeaways
- The scope of an IRE is bounded by the injury description established in prior WCJ decisions. A physician is not required to evaluate diagnoses that no WCJ has found to be part of the compensable injury.
- “Inter alia” in a WCJ’s credibility ruling refers to the breadth of the expert’s opinions—not to an open-ended list of the claimant’s ailments. Claimants cannot invoke the phrase to expand the injury description after the fact.
- Duffey’s requirement that an IRE cover “additional injuries known at the time” applies only where those injuries have actually been established as part of the compensable claim. The rule does not create an obligation to speculate about unnamed conditions.
- An IRE expert who departs from the AMA Guides’ methodology—here, awarding extra impairment points for subjective pain beyond the Guides’ ceiling—provides testimony that a WCJ may reasonably reject as unsupported.
Why It Matters
Pennsylvania workers’ compensation practice turns heavily on the precise language WCJs use when describing compensable injuries. Smith confirms that phrase choices in credibility rulings do not silently expand the injury description. Claimants’ counsel should ensure that the injury description in the formal findings is as complete as possible at each stage of the proceeding, because attempting to enlarge it through later textual argument is unlikely to succeed.
For defense counsel, the decision reinforces the utility of a well-documented IRE: an examiner who works from the established injury description, applies the AMA Guides methodology faithfully, and explains the basis for the impairment rating will generate findings that are difficult to overcome on appeal. The contrast with Dr. Bonner’s rejected methodology—awarding extra impairment points unsupported by the Guides—illustrates the risks of straying from the statutory framework.