Crozer Chester Medical Center v. Department of Labor & Industry, Bureau of Workers' Compensation, Health Care Services Review Division
610 Pa. 459
| Pa. | 2011Background
- Crozer filed a mandamus petition to compel the Department of Labor and Industry to decide the merits of a fee review petition filed under 77 P.S. § 531(5).
- The Department dismissed Crozer’s fee review as premature under 34 Pa. Code § 127.255(1) due to an outstanding liability/compensability issue and denied a de novo hearing.
- Crozer alleged Zurich North American Insurance Company had an open, medical-only NCP admitting liability for the December 2005 injury and Crozer’s February 2006 treatment.
- Crozer’s fee review was to dispute the amount or timeliness of payment, not liability, and the Department argued liability questions are outside the fee-review scope.
- The Commonwealth Court sustained the Department’s objections and dismissed the petition; Crozer appealed directly to the Pennsylvania Supreme Court.
- The Supreme Court affirmed, holding that Crozer did not show a clear right to a merits decision on the fee review petition under the Act and regulations.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the Department properly denied the fee review as premature | Crozer asserts an open NCP constitutes an unequivocal liability admission requiring merits review | Department contends fee review cannot resolve liability and is premised on avoiding premature determinations | Prematurity affirmed; Department proper to dismiss |
| Whether an open, unmodified NCP binds the insurer to liability for a specific treatment in fee review | Open NCP is binding admission of liability for the treatment | Open NCP does not automatically bind for fee review; liability is for WCJ to decide | Open NCP not dispositive; liability disputes belong before WCJ; no mandate to merit-review decision |
| Whether fee review is limited to timeliness/amount and not liability | Fee review should resolve Crozer’s payment dispute | Fee review is narrow and cannot adjudicate liability disputes | Fee review is limited to amount/timeliness; liability issues go to workers’ compensation process |
Key Cases Cited
- Beissel v. WCAB (John Wanamaker, Inc.), 502 Pa.178 (Pa. 1983) (NCP admission of liability; Beissel rule on finality of NCPs)
- Barna v. WCAB (Jones & Laughlin Steel Corp.), 513 Pa.518 (Pa. 1987) (Barna modification/ Barna rule relative to NCPs and liability)
- Mahon v. WCAB (Expert Window Cleaning), 835 A.2d 420 (Pa.Cmwlth.2003) (NTCPs and Beissel/Mahon lineage; en banc opinion on NTCPs)
- Catholic Health Initiatives v. Heath Family Chiropractic, 720 A.2d 509 (Pa.Cmwlth.1998) (Fee review context; liability not decided in fee review)
- Delaware River Port Auth. v. Thornburgh, 493 A.2d 1351 (Pa.1985) (Mandamus scope; ministerial duties; testing legal sufficiency)