Leventakos v. Workers' Compensation Appeal Board
82 A.3d 481
Pa. Commw. Ct.2013Background
- Claimant (Leventakos) injured on the job in 1983 and later moved to Greece; weekly benefits were suspended in 2008 effective 1992 for voluntary workforce removal.
- In December 2010 Employer requested utilization review (UR) of treatment provided in Greece by Dr. Athanasopoulos Ioannis beginning November 5, 2010.
- The URO requested medical records; Dr. Ioannis provided a written “Medical Expert Opinion” summary and later spoke by phone to the reviewer but produced no contemporaneous medical records.
- The reviewer (Dr. Ritz) issued a UR determination that treatment from November 5, 2010 onward was not reasonable or necessary due to lack of documentation.
- Claimant appealed; WCJ dismissed the UR petition for lack of jurisdiction because no medical records were submitted; the Board affirmed, holding that oral recollection and a post-hoc summary prepared for UR do not constitute a “record” appropriate for review.
- The Commonwealth Court affirmed, holding that written summaries prepared for UR and oral recollections after the fact are not medical records and the WCJ lacked jurisdiction where required records were not provided.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a provider’s post-hoc written summary prepared for UR qualifies as a “record” for review | Leventakos: the Act/regulations/dictionary do not require records be written; the summary should qualify | Employer/Bureau: UR instructions prohibit reliance on summaries prepared solely for UR; such summaries are not contemporaneous records | Summary prepared solely for UR is not an appropriate record; cannot be considered |
| Whether an oral account by an out-of-country provider constitutes a “record” | Leventakos: oral account should qualify, especially given foreign practice where records may not be kept | Employer/Bureau: a record must document treatment; oral recollection is not documentation | Oral recollection after the fact is not a record; cannot substitute for documented medical records |
| Whether WCJ has jurisdiction to review UR determination absent provider records | Leventakos: WCJ should still have jurisdiction to consider the UR appeal | Employer/Bureau: WCJ lacks jurisdiction where required records were not provided to URO under regulations | WCJ lacked jurisdiction because required records were not provided to the URO |
| Whether exception should be made for foreign medical-record practices | Leventakos: physicians in Greece may not maintain records; equity requires exception | Employer/Bureau: provider/claimant seeking payment must comply with PA medical conventions and recordkeeping | No exception; foreign practice does not excuse failure to provide records |
Key Cases Cited
- County of Allegheny (John J. Kane Center–Ross) v. Workers’ Compensation Appeal Board (Geisler), 875 A.2d 1222 (Pa. Cmwlth. 2005) (WCJ lacked jurisdiction where provider did not submit any medical records)
- Stafford v. Workers’ Compensation Appeal Board (Advanced Placement Services), 933 A.2d 139 (Pa. Cmwlth. 2007) (WCJ lacked jurisdiction where reviewer’s summary concluded treatment not reasonable because no medical records were provided)
- Stanish v. Workers’ Compensation Appeal Board (James J. Anderson Construction Co.), 11 A.3d 569 (Pa. Cmwlth. 2010) (deference owed to Board’s interpretation of its regulation)