Opinion

Commonwealth, Department of Labor & Industry v. Workers' Compensation Appeal Board

  • 827 A.2d 529
  • 2003 Pa. Commw. LEXIS 388
Court
Commonwealth Court of Pennsylvania
Filed
Jun 6, 2003
Status
Published
Author
Cohn
On the bench
Pellegrini, Cohn, Jiuliante
Cited by
7 cases
Authority
More cited than 8.5%

The opinion

JUDGE COHN

DISSENTING.

With all due respect to the majority, I dissent.

I do not disagree with the majority’s recitation of the facts, the applicable statutory law or the statutory language. I believe, however, that the majority does not discuss or apply existing precedent that addresses the issue of whether an employer can receive reimbursement from the supersedeas fund under Section 306(f) of the Act. In Department of Labor and Industry v. Workmen’s Compensation Appeal Board (Commercial Union Insurance Co.), 137 Pa.Cmwlth.387, 586 A.2d 496 (1991), affirmed per curiam, 533 Pa. 112 , 619 A.2d 1356 (1993), (Commercial Union) and Insurance Company of North America v. Workmen’s Compensation Appeal Board (Kline and Packard Press), 137 Pa.Cmwlth.393, 586 A.2d 500 (1991), affirmed per curiam, 533 Pa. 112 , 619 A.2d 1356 (1993), (INA), the issue was whether the word “compensation” in Section 443 of the Act included medical expenses. 1 The reason for the inquiry was to determine whether reimbursement from the superse-deas fund for medical fees sought under Section 306(f) was permissible. 2

At that time, Section 306(f) of the Act, 77 P.S. § 531, read:

(ii) The employer shall have the right to petition the department for review of the necessity or frequency of treatment *534 or reasonableness of fees for services provided by a physician or other duly licensed practitioner of the healing arts. Such a petition shall in no event act as a supersedeas, and during the pendency of any such petition the employer shall pay all medical bills if the physician or other practitioner of the healing arts files a report or reports as required by subpar-agraph (I) of paragraph (2) of this subsection.

Relying on the “common sense approach” that must be taken when deciding questions of first impression, we stated:

We can perceive no valid reason for holding that an insurer can recover work loss benefits but cannot recover medical expenses when it is ultimately decided that neither should have been paid. This conclusion is buttressed by the fact that the Supersedeas Fund consists solely of payments made by insurers and self-insurers within the Commonwealth. Furthermore, the assessments by which the insurers and self insurers provide money for the Supersedeas Fund, the Subsequent Injury Fund and the Administration Fund are based, in part, upon medical expenses.

INA, 586 A.2d at 502 (relying on Haley to Use of Martin v. Matthews, 104 Pa.Super. 313 , 158 A. 645 (1932)). This specific reasoning was also adopted by Judge Craig in Commercial Union.

While the holdings of these two cases are not exactly on point with the matter presently before us, in both instances it was acknowledged that there was no precise authorization for payment from the supersedeas fund where the claim was one brought by the employer under Section 306(f) for medical expenses. Nonetheless, the Court read the statute liberally to reach a just result and found that such reimbursement was permissible under Section 306. In my view, we should follow these cases to their logical extension and hold that reimbursement under Section 306 is also permissible in matters involving the forfeiture provision of that Section. Since it was the action of Claimant, here, that caused the forfeiture, the “common sense approach” dictates that we do not penalize Employer by compelling it to wait for future crediting opportunities that may or may not arise. ■

In Sears Roebuck & Co. v. Workers’ Compensation Appeal Board (Lear), 707 A.2d 618 (Pa.Cmwlth.1998), we decided a case which, in my view, is procedurally similar to the matter sub judice. Interestingly, there, the employer filed a petition to suspend benefits arguing that, because Claimant refused reasonable medical treatment, his benefits should be forfeited under the prior version of the forfeiture petition, which, for our purposes here, was the same as it is now. Employer sought and was granted a supersedeas. While the efficacy of the supersedeas was not raised on appeal there, the case is one indication that supersedeas petitions in cases such as this one have been granted by WCJs and the Board for more than a decade and we have not yet been asked to review this question. This leads me to conclude that, as a practical matter, the “system” is working.

Based on these reasons, I would affirm the Board.

. A related case was filed concomitantly. See ADIA Personnel Agency v. Workmen's Compensation Appeal Board (Coleman), 137 Pa.Cmwlth.405, 586 A.2d 507 (1991), petition for allowance of appeal denied, 528 Pa. 624 , 597 A.2d 1154 (1991).

. As phrased by Judge Craig in Commercial Union:

On appeal we have a question of first impression on an issue which has far-reaching consequences. We must decide the question of whether medical expenses, that have been paid out and that are ultimately determined to have been paid in error because they were unreasonable or unnecessary, are “compensation” which can be reimbursed from the supersedeas fund.

Id. at 497-98.

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.

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