Constructo Temps, Inc. v. Workers' Compensation Appeal Board

907 A.2d 52, 2006 Pa. Commw. LEXIS 493
Commonwealth Court of Pennsylvania·Decided September 8, 2006·Published·Cited by 6 cases

Opinions

OPINION BY

Judge COHN JUBELIRER.

Construct» Temps, Inc. (Employer) and the Workers’ Compensation Security Fund1 (Security Fund) (together, Petitioners) petition for review of the July 18, 2005 order of the Workers’ Compensation Appeal Board (Board), which affirmed, as modified, the decision of a workers’ compensation judge (WCJ) to assess a twenty percent penalty against Petitioners under the Workers’ Compensation Act (Act),2 for failure to pay for some of Gregory Ten-nant’s (Claimant) medical treatments.

Claimant sustained a work-related injury to his right knee on March 6, 2000, and started to receive payments from Employer pursuant to a notice of compensation payable. Employer’s workers’ compensation insurance coverage was provided by Reliance Insurance Company (Reliance); however, this Court placed Reliance into liquidation by order dated October 3, 2001. As successor in interest to Reliance, the Security Fund became responsible for administering and paying all of Pennsylvania’s eligible workers’ compensation claims related to periods of coverage provided by Reliance prior to its date of liquidation.3

The WCJ Decision in this case involved a consolidation of three petitions. First, on March 17, 2003, Petitioners filed a termination petition alleging that Claimant was fully recovered from his work-related injury as of December 9, 2002;4 Claimant filed a timely answer denying the allegations. (WCJ Findings of Fact dated 11/29/04 (FOF), ¶ 1, 2.) Second, on March 26, 2004, Claimant filed a penalty petition against Petitioners, alleging that they had not paid for various work-related medical expenses; Petitioners filed a timely answer denying the allegations. (FOF ¶ 3, 4.) Third, on June 15, 2004, Claimant filed a review petition alleging that Petitioners had refused to pay for reasonable and necessary work-related medical treatment; Petitioners filed a timely answer denying the allegations. (FOF ¶ 5, 6.) Both the Claimant and Petitioners presented evidence before the WCJ in support of these consolidated petitions.

After considering all of the evidence, the WCJ denied Petitioners’ termination petition and granted Claimant’s penalty and review petitions in part. Relevant to the [54] issues now before this Court are those portions of the WCJ’s order assessing a penalty against “Employer/Insurance Carrier” in an amount equal to twenty percent of the re-priced value of the outstanding medical bills relating to treatment rendered to Claimant by Craig Bennett, M.D., at the University of Pittsburgh Medical Center (UPMC) and by Richard M. Va-glienti, M.D., at HealthSouth.5 (WCJ Order dated 11/29/04; see FOF ¶ 18; WCJ’s Conclusions of Law dated 11/29/04 ¶¶ 4, 7.) The WCJ found that there was no acceptable reason for Petitioners’ failure to pay the bills related to this treatment. (FOF ¶ 18.)6 Accordingly, the WCJ ordered “[t]he Employer/Insurance Carrier is assessed a twenty (20%) percent penalty for its failure to pay in a timely fashion the medical expenses incurred by Claimant. ...”

Petitioners appealed to the Board, arguing that neither Employer nor the Security Fund can be liable for penalties here. The Board disagreed, and affirmed the penalty award. The Board reasoned that:

We believe that Defendant’s arguments would lead to an absurd result. At some point, a decision was made to deny the payments to Dr. Bennett and Dr. Vaglienti. To allow Defendant to disclaim its responsibility for the decisions it made would frustrate the “humanitarian purposes” of the Workers’ Compensation Act. ANR Freight System v. Workers' Compensation Appeal Board (Bursick), 728 A.2d 1015 (Pa.Cmwlth.1999). We note that employers and insurance companies are deemed to be a “single complex entity”. Manolovich v. Workers’ Compensation Appeal Board (Kay Jewelers, Inc.), 694 A.2d 405 (Pa.Cmwlth.1997). Both parties agree that the Workers’ Compensation Security Fund was established to provide benefits to injured workers when the insurance company on the risk became insolvent. We believe that, since the original carrier became insolvent, its successor in interest would become the Workers’ Compensation Security Fund and that Inservco Insurance Services, as its Third Party Administrator, would become liable for any penalties incurred by failure to make timely payment of the medical treatments rendered to Claimant. ... No error of law was committed.

(Bd. Op. dated 7/18/05 at 6.)7

Petitioners have now appealed to this Court arguing that when the Act’s defini[55] tions for insurer and employer are applied in the Act’s penalty provision in Section 435(d)(i), 77 P.S. § 991(d)(i), neither the Security Fund, nor the Employer, are entities subject to the penalties. We address these arguments in turn.8

As Petitioners raise purely legal issues, our standard of review is limited to determining whether the Board committed an error of law. Luvine v. Workers’ Compensation Appeal Board (Erisco Indus.), 881 A.2d 72 (Pa.Cmwlth.2005); see Section 704 of the Administrative Agency Law, 2 Pa.C.S. § 704. Additionally, the assessment of penalties is discretionary, and this Court may overturn a penalty only when the WCJ has abused his or her discretion. Fearon v. Workers’ Compensation Appeal Board (Borough of Ashland), 827 A.2d 539, 542 (Pa.Cmwlth.2003). “An abuse of discretion is not merely an error of judgment but occurs, inter alia when the law is misapplied in reaching a conclusion.” Id.

As background, we first discuss the Pennsylvania Workers’ Compensation Security Fund Act (Security Fund Act), then the Act’s penalty provision at issue, after which we address Petitioners’ arguments.

Security Fund Act

The Security Fund Act establishes the Security Fund:

for the purpose of assuring to persons entitled thereto the compensation provided by the Workmen’s Compensation Law for employments insured in insolvent stock companies; insolvent mutual carriers; insolvent reciprocal exchanges; or the State Workmen’s Insurance Fund.

77 P.S. § 1053. The Security Fund Act provides that the Security Fund:

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Constructo Temps, Inc. v. Workers' Compensation Appeal Board, 907 A.2d 52, 2006 Pa. Commw. LEXIS 493 (Pa. Ct. App. 2006).

907 A.2d 52 (Constructo Temps, Inc. v. Workers' Compensation Appeal Board) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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