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

23 A.3d 511, 611 Pa. 10, 2011 Pa. LEXIS 1609
CourtSupreme Court of Pennsylvania
DecidedJuly 19, 2011
StatusPublished
Cited by10 cases

This text of 23 A.3d 511 (Department of Labor & Industry, Bureau of Workers' Compensation v. Workers' Compensation Appeal Board) is published on Counsel Stack Legal Research, covering Supreme Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Department of Labor & Industry, Bureau of Workers' Compensation v. Workers' Compensation Appeal Board, 23 A.3d 511, 611 Pa. 10, 2011 Pa. LEXIS 1609 (Pa. 2011).

Opinions

OPINION

Justice EAKIN.

Claimant Kevin Ressler suffered a recognized work injury July 21, 1995, in the nature of tendonitis of the right shoulder. A notice of compensation payable was issued, and Mr. Ressler began receiving Workers’ Compensation benefits and coverage for his medical bills. On March 16, 2004, Mr. Ressler submitted to an independent medical evaluation (IME); the sequence of events thereafter is the crux of this case.

On June 1, 2004, Mr. Ressler had surgery, purportedly associated with the work-related injury. On July 19, 2004, employer filed a petition to terminate benefits as of March 16, the date of the IME. The employer concurrently requested su-persedeas pursuant to § 413 of the Workers’ Compensation Act, 77 P.S. §§ 1-1041.4. A Workers’ Compensation Judge (WCJ) denied the supersedeas request August 30, 2004. On October 11, 2004, a $35,405.45 bill for the June 1 surgery was submitted to the insurer, which paid the bill January 25, 2005. On June 28, 2005, a WCJ granted the employer’s July 19 petition to terminate benefits. The Workers’ Compensation Appeal Board (WCAB) affirmed the decision.

[513]*513The insurer then requested reimbursement of $35,405.45 from the Supersedeas Fund.1 However, the Bureau of Workers’ Compensation, in its capacity as conservator of the Fund, challenged the request because Mr. Ressler’s surgery predated the supersedeas request.2 The WCJ found that while a service date generates the potential for a claim, no obligation to pay arose until a bill was submitted to the insurer in October; as the obligation to pay arose after the denial of supersedeas, reimbursement was appropriate. The WCAB affirmed.

On appeal, the en banc Commonwealth Court determined:

the language of Section 443 of the Act “is clear in its focus on payments made rather than on periods of disability” and “contains no plain language prohibiting reimbursement of retroactive benefits.” Thus, “the right to reimbursement relates to payments made after denial of a supersedeas request. ” Here, it does not matter that the date of service of the medical expenses in question preceded the request for supersedeas — what matters is that the treatment in question was later determined to be ineligible for payment, and the bill for that treatment was submitted to and paid for by Insurer after supersedeas was requested and denied. Thus, we agree with the Board that Insurer is eligible for reimbursement from the Supersedeas Fund. This outcome is clearly in line with the language of the statute and recent case law.

Dep’t of Labor Indus. Bureau of Workers’ Comp. v. Workers’ Comp. Appeal Bd. (Crawford & Co.), 965 A.2d 332, 338-39 (Pa.Cmwlth.2009) (en banc) (emphasis in original) (citations omitted).

Judge Pellegrini, joined by Judge Friedman, dissented, opining that whether a payment is made “as a result” of superse-deas denial is determined by whether the insurer would have been required to pay the bill if the supersedeas had been granted. Id., at 340 (Pellegrini, J., dissenting). He stated supersedeas only relieves the insurer of making payments from the day of its granting and does not sanction re-coupment of any payments made prior to that date. Id., at 341. Under Judge Pel-legrini’s analysis, even if supersedeas had been granted, the insurer was still obligated to pay expenses incurred before it filed the supersedeas request, such that the payments made could not have been made as the result of supersedeas denial, as is required by § 443(a). Id.

We granted appeal to consider “[wjhether the Supersedeas Fund may deny reimbursement of medical treatment rendered before an insurer requested supersedeas, where the Workers’ Compensation Act [514]*514only permits reimbursement of amounts paid as a result of a denial of supersede-as?” Dep’t of Labor Indus. Bureau of Workers’ Comp. v. Workers’ Comp. Appeal Bd. (Crawford & Co.), 604 Pa. 685, 987 A.2d 637 (2009) (per curiam).

The Bureau argues § 443(a)’s language pertaining to payments made “as a result” of a denial of supersedeas does not allow the insurer to recover reimbursement for treatment costs incurred prior to the su-persedeas filing. As the insurer did not request supersedeas until six weeks after the surgery, the insurer could not have made the payment as a result of denial of supersedeas as required by § 443(a). Payment, the Bureau argues, was an obligation cemented by the failure to seek supersedeas before the service was provided. To find as did the Commonwealth Court, it contends, may encourage insurers to withhold payment of medical bills until after supersedeas requests are resolved, improperly shifting medical costs to the Supersedeas Fund and its contributing employers.

The insurer points to the plain language of § 443(a), which does not mention medical services when referring to supersedeas timing; the statute points to “payment of compensation” as the triggering event when evaluating an insurer’s right to reimbursement. It contends it is sufficient under § 443(a) that Mr. Ressler’s treatment occurred after he had fully recovered, and the relevant medical bill was submitted to and paid by the insurer after the date supersedeas was requested and denied. Section 413 echoes this conclusion: “A su-persedeas shall serve to suspend the payment of compensation in whole or to such extent as the facts alleged in the petition would, if proved, require.” 77 P.S. § 774(2) (emphasis added).

The insurer discounts the Bureau’s policy arguments, pointing out the Act requires insurers to make all payments within 30 days of receipt unless the bill itself is disputed; thus, there is no incentive for insurers to delay payments because they will be penalized for doing so. It further notes the Supersedeas Fund is maintained for the very purpose embodied in this case — it is simply seeking reimbursement from the Fund to which it contributed of the amount it paid for a bill that was ultimately determined to be unrelated to Mr. Ressler’s work injury.

In reviewing an agency decision, our standard of review is restricted to determining whether there has been a constitutional violation, an error of law, or a violation of agency procedure, and whether necessary findings of fact are supported by substantial evidence. 2 Pa.C.S. § 704; Pieper v. Ametek-Thermox Instruments Div., 526 Pa. 25, 584 A.2d 301, 303 (1990). Statutory interpretation poses a question of law; thus, our standard of review is de novo, and our scope of review is plenary. Borough of Heidelberg v. Workers’ Comp. Appeal Bd. (Selva), 593 Pa. 174, 928 A.2d 1006, 1009 (2007).

The elements in the relatively straightforward language of § 443(a) can be examined in order, as the facts are not in dispute. First, is this a case “in which a supersedeas has been requested and denied”? It is — supersedeas was requested in July, 2004, and denied August 20, 2004.

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Bluebook (online)
23 A.3d 511, 611 Pa. 10, 2011 Pa. LEXIS 1609, Counsel Stack Legal Research, https://law.counselstack.com/opinion/department-of-labor-industry-bureau-of-workers-compensation-v-workers-pa-2011.