United States Steel Corp. v. Workers' Compensation Appeal Board

887 A.2d 817, 2005 Pa. Commw. LEXIS 708
CourtCommonwealth Court of Pennsylvania
DecidedDecember 2, 2005
StatusPublished
Cited by20 cases

This text of 887 A.2d 817 (United States Steel Corp. v. Workers' Compensation Appeal Board) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States Steel Corp. v. Workers' Compensation Appeal Board, 887 A.2d 817, 2005 Pa. Commw. LEXIS 708 (Pa. Ct. App. 2005).

Opinions

OPINION BY

Judge McGINLEY.

United States Steel Corporation (Employer) petitions for review from an order [819]*819of the Workers’ Compensation Appeal Board (Board) that affirmed a Workers’ Compensation Judge’s (WCJ) decision to deny Employer’s Petition for Review of Utilization Review Determination (UR Review Petition) and concomitantly assessed attorney’s fees against Employer for unreasonable contest.

Peter Luczki (Claimant) was injured while in the course and scope of his employment on March 2, 2000, when he fell after breaking through a step to a remote crane that Claimant operated. An Agreement for Compensation executed by the parties, dated March 14, 2002, described Claimant’s injury as a low back strain.

Beginning on June 2, 2000, Claimant began receiving chiropractic treatment from Robert Homonai, D.C. (Dr. Homo-nai), including intersegmental traction and myofascial release. From August 2, 2000, and ongoing, Claimant received treatment from Dr. Homonai two times per month, with more treatment periodically occasioned by temporary flare ups of Claimant’s symptoms.

On August 29, 2000, Employer filed a Utilization Review (UR) Request pursuant to Section 306(f.l)(6) of the Workers’ Compensation Act (Act),1 77 P.S. § 531(6), seeking review of the reasonableness and/or necessity of Claimant’s chiropractic treatments from August 2, 2000, ongoing. The UR Request was assigned to Louis Camilli, D.C., who issued a UR Determination dated October 4, 2000, and concluded that Dr. Homonai’s treatments of Claimant, from August 2, 2000, ongoing and at a rate of two treatments per month, were reasonable and necessary. Pursuant to Section 306(f.1)(6)(iv) of the Act, Employer timely filed its UR Review Petition on November 17, 2000.2

[820]*820Before the WCJ, both parties, represented by counsel, presented medical evidence regarding the reasonableness and necessity of Claimant’s treatments. The WCJ found Claimant’s medical experts more credible than those of Employer, and ultimately concluded that Employer failed to show that the treatments at issue were neither reasonable nor necessary, and concomitantly denied Employer’s UR Review Petition. The WCJ then addressed whether Employer’s contest of the UR Determination had a reasonable basis under the Act. The WCJ noted that the only medical evidence offered by Employer on the issue of the treatment was obtained by Employer on February 15, 2001, some three months after Employer filed its UR Review Petition. The WCJ found that Employer’s contest of the UR Review Petition was not reasonable at the time of the contest. The WCJ, by order and decision dated June 10, 2002, awarded attorney’s fees for the UR Review Petition contest in favor of Claimant and against Employer.

Employer timely appealed the WCJ’s order to the Board, which heard argument on the matter without receiving any additional evidence. By order dated January 5, 2004, the Board affirmed.3 Employer now petitions this Court for review of the Board’s order.4

Employer presents the following issue for review: whether the Board erred as a matter of law when it affirmed the WCJ’s award of attorney’s fees for an unreasonable contest. Employer’s argument is based on the fact that, while Employer did not have a medical opinion on which to base its contest at the time it filed its UR Review Petition, the Act mandates that the Petition be filed within thirty days of Employer’s receipt of the UR Determination, and the Act does not expressly state that the challenge be based upon medical evidence at the time of filing.

Section 306(f.l)(6) of the Act, 77 P.S. § 531(6) controls disputes over the reasonableness or necessity of treatments received by a claimant in a Workers’ Compensation claim. Employer recognizes that precedent has long established that Workers’ Compensation contests will be held unreasonable where an employer does not possess a medical opinion when the contest is filed. Additionally, Employer accurately notes that this precedent, addressing foundational medical evidence, has never been applied to UR Review Petitions under Section 306(f.l)(6) of the Act. Employer emphasizes that Section 306(f.l)(6) does not expressly require a medical opinion as a prerequisite to filing a UR Review Petition. Employer further argues that Section 306(f.l)(6) mandates that a UR Review Petition be filed within thirty days after the receipt of the UR Determination — a time period that does not facilitate the timely acquisition of a medical opinion.

Section 440(a) of the Act, 77 P.S. § 996(a), provides that where a claimant succeeds in a litigated case reasonable counsel fees are awarded against the employer, as a cost, unless the employer meets its burden of establishing facts sufficient to prove a reasonable basis for the contest. Weiss v. Workmen’s Compensation Appeal Board (Birch), 106 Pa.Cmwlth.361, 526 A.2d 839, petition for al[821]*821lowance of appeal denied, 517 Pa. 612, 536 A.2d 1335 (1987). This section is intended to deter unreasonable contests of workers’ compensation claims and to ensure that successful claimants receive compensation, undiminished by the costs of litigation. Poli v. Workmen’s Compensation Appeal Board (Arlyn Printing & Advertising Co.), 34 Pa.Cmwlth.630, 384 A.2d 596 (1978).

A reasonable contest is established when medical evidence is conflicting or susceptible to contrary inferences, and there is an absence of evidence that an employer’s contest is frivolous or filed to harass a claimant. Wertz v. Workmen’s Compensation Appeal Board (Department of Corrections), 683 A.2d 1287 (Pa.Cmwlth.1996), petition for allowance of appeal denied, 547 Pa. 747, 690 A.2d 1165 (1997). Our Courts have long held that an employer’s contest of a claim under the Act is not reasonable, and that a claimant is entitled to an award of counsel fees under Section 440(a) of the Act, where the employer bases its contest on medical evidence obtained after the employer filed its contest. Jones & Laughlin Steel Corp. v. Workmen’s Compensation Appeal Board (White), 92 Pa.Cmwlth.318, 500 A.2d 494 (1985). Whether the evidence of record establishes a reasonable contest under the Act is a question of law fully subject to review by this Court. Yeagle v. Workmen’s Compensation Appeal Board (Stone Container Corp.), 157 Pa.Cmwlth.597, 630 A.2d 558 (1993).

Employer correctly notes that the General Assembly has provided a narrow thirty day window of Section 306(f.l)(6) of the Act, during which a UR Review Petition must be filed, and that this mandatory provision was not at issue in any prior holding, that if an employer does not have medical evidence in hand the challenge is unreasonable. The General Assembly, Employer argues, did not intend to impose penalties or fees upon a challenge to a UR Determination, or it would have provided so in Section 306(f.l)(6). This Court must disagree.

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United States Steel Corp. v. Workers' Compensation Appeal Board
887 A.2d 817 (Commonwealth Court of Pennsylvania, 2005)

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Bluebook (online)
887 A.2d 817, 2005 Pa. Commw. LEXIS 708, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-steel-corp-v-workers-compensation-appeal-board-pacommwct-2005.