Department of Labor & Industry, Bureau of Workers' Compensation v. Workers' Compensation Appeal Board
23 A.3d 511
| Pa. | 2011Background
- Employer issued notice of compensation for Ressler's July 21, 1995 right shoulder tendonitis; benefits and medicals paid.
- IME conducted March 16, 2004; June 1, 2004 surgery related to work injury.
- July 19, 2004 employer filed to terminate benefits as of IME date and sought supersedeas under §413.
- Supersedeas denied August 20, 2004; October 11, 2004 surgery bill submitted; insurer paid January 25, 2005.
- June 28, 2005 WCJ granted termination of benefits; WCAB affirmed.
- Insurer sought reimbursement from Supersedeas Fund; Bureau challenged due to pre-supersedeas surgery; Commonwealth Court held reimbursement appropriate; dissents noted.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether §443(a) allows reimbursement for medical treatment paid after denial of supersedeas but incurred before denial. | Insurer argues payments after denial qualify for reimbursement. | Bureau contends reimbursement only for payments made as a result of denial occurring after billing; pre-denial services not reimbursable. | Reimbursement permitted for post-denial payments linked to denial. |
| Whether §413(a.2) supersedeas relief is limited to post-supersedeas obligations or includes pre-denial payments. | Insurer asserts authority to suspend payments for pre-denial charges if warranted by petition and denial. | Bureau contends relief only affects payments accruing after supersedeas request; pre-denial payments remain unaffected. | Supersedeas relief can suspend post-denial payments; pre-denial payments are not retroactively recouped. |
| Does the WCJ have authority to suspend insurer payments for treatment rendered before the supersedeas request in this case? | Insurer relies on statutory suspension authority to delay or suspend payment for pre-request treatments when appropriate. | Bureau argues no suspension for pre-request treatments and that reimbursement rules govern only post-denial payments. | WCJ has authority to suspend and insurers may be reimbursed for post-denial payments; pre-denial treatment payments are governed by §443(a) as interpreted. |
Key Cases Cited
- Gardner v. Workers’ Compensation Appeal Board (Genesis Health Ventures), 585 Pa. 366 (Pa. 2005) (burden to continue payment during litigation absent supersedeas; longstanding principle)
- McLaughlin v. Workers’ Compensation Appeal Board (St. Francis Country House), 808 A.2d 285 (Pa. Cmwlth. 2002) (employer must continue payments absent authorization to suspend)
- Kuemmerle v. Workers’ Compensation Appeal Board (Acme Markets, Inc.), 742 A.2d 229 (Pa. Cmwlth. 1999) (automatic supersedeas; absence requires continued payment)
- Jones v. Workers’ Compensation Appeal Board (Pennsylvania Power & Light), 735 A.2d 185 (Pa. Cmwlth. 1999) (continued payment required without final receipt or supersedeas)
- Department of Labor & Industry, Bureau of Workers’ Compensation v. Workers’ Compensation Appeal Board (Crawford & Co.), 965 A.2d 332 (Pa.Cmwlth.2009) (en banc; reimbursement depends on payments made after denial and final nonpayability)
- Department of Labor & Industry v. Workers’ Compensation Appeal Bd. (Crawford & Co.), 987 A.2d 637 (Pa. 2009) (per curiam discussion on supersedeas and reimbursement)
- Crucible, Inc. v. Workers’ Compensation Appeal Board, 713 A.2d 749 (Pa.Cmwlth. 1998) (related costs and employer obligations under CBA principles)
- Loose v. Workers’ Compensation Appeal Board, 601 A.2d 491 (Pa.Cmwlth. 1991) (early authority on ongoing employer payments during litigation)