the Act requires an employer to continue payment of medical bills during the pendency of any petition for review; an employer’s unjustified, unilateral withholding of benefits triggers the penalty provisions of Section 435 of the Act
How later courts described this case
- the Act requires an employer to continue payment of medical bills during the pendency of any petition for review; an employer’s unjustified, unilateral withholding of benefits triggers the penalty provisions of Section 435 of the Act
- unilateral failure to pay bill for post-NCP hospitalization incurred before employer obtained termination of 8 benefits on the ground that employee was no longer disabled
- an employer’s filing of a petition to review the necessity of medical expenses does not act as a supersedeas and a referee may not retroactively terminate a claimant’s medical benefits
- employer’s petition to terminate claimant’s compensation benefits
Written by the judges who cited it.
Distinguished
Distinguished by Burkey v. Workmen's Compensation Appeal Board, 168 Pa. Commw. 320 (1994)
Employer contends that Loose is inapplicable because, unlike the claimant in Loose, Claimant here was not receiving benefits pursuant to a notice of compensation payable and Employer did not file a petition for review.
The opinion
PELLEGRINI, Judge,
concurring and dissenting.
I concur with the majority that the employer, under the present state of the law, cannot unilaterally cease payment of medical expenses, nor may a referee retroactively authorize an employer not to pay for medical expenses for treatment already given. However, I dissent as to the majority’s imposition of a 20 percent penalty upon the employer where the referee found that the medical costs were not work-related.
Section 435(d) of the Workmen’s Compensation Act, 77 P.S. § 991(d), provides in relevant part:
The department, the board or any court which may hear any proceedings brought under this act, shall have the power to impose penalties as provided herein for violations of the provisions of this act or such rules and regulations or rules of procedure:
(ii) Employers and insurers may be penalized a sum of 10% of the amount awarded in interest accrued payable: Provided, however, that such a penalty may be increased to 20% of the amount awarded in interest accrued payable: provided, however, that such penalty may be increased to 20% in cases unreasonable or excessive delays. Such penalties shall be payable to *342 same persons to whom the compensation is payable. (Emphasis added.)
Here, the referee, exercising the discretion conferred in Section 435, found that a penalty of 20 percent should not be assessed. In Findings of Fact Nos. 6 and 7, finding the medical expenses both non work-related and unreasonable, the referee explained why the imposition of a penalty was not appropriate as follows:
No. 6. This Referee has thoroughly reviewed the evidence in this manner in which there basically is a dispute in the medical testimony presented. After reviewing the testimony of both physicians, this Referee is more impressed and finds more persuasive Dr. Steinman’s testimony in this case. Dr. Steinman saw and examined the Claimant six (6) times over a twenty-one (21) month span from November 1986 through August 1988____ While the doctor felt that the Claimant had returned to his preinjury status, he did suggest that the Claimant not return to mechanical type work, but that these restrictions were because of the Claimant’s long standing congenital condition of osteogenesis imperfecta in the size of his body which restrictions were unrelated to the compensation injury. This Referee also finds Dr. Steinman’s testimony more credible and believable and persuasive than that of Dr. Kent and accepts Dr. Steinman’s testimony for purposes of this adjudication.
No. 7. With respect to the Claimant’s position for penalties, and the issue of a ten (10) week hospitalization at Community General Hospital from April 1988 through June 1988, this Referee is quite shocked at such a long hospitalization being authorized by any physician and it appears that both the hospital and the physician were lax in allowing such a long hospitalization to take place. In fact, the hospitalization would have continued except that the Claimant checked himself out of the hospital voluntarily due to a domestic problem. This Referee accepts the opinions of Dr. Steinman that the hospitalization was not necessary or reasonable for the treatment of the Claim *343 ant’s work-related injury except for the first week’s stay in the hospital. Since the Defendant was relying on Dr. Steinman’s testimony for nonpayment of that bill, and this Referee accepts the testimony of Dr. Steinman in that regard, no penalties are due and payable. Defendant had adequate reason to contest payment of the bill and this Referee, in his discretion, will not impose penalty in any event for failure to pay that bill. (Emphasis added.)
While the majority agrees that the referee has a right to exercise discretion as to whether to award a penalty, the majority nonetheless reversed the referee. Apparently, the majority believed because the employer had no right to unilaterally stop payment for unjustified medical bills, then, per se, the employer was liable for the penalty, and consequently, the referee abused his discretion. In view of the developing nature of the law relating to medical bills and the complete unrelatedness and unreasonableness of the medical bills in question, the referee properly exercised his discretion not to award a penalty. Accordingly, I would affirm the referee’s and the Board’s denial of the imposition of a penalty.