The Pennsylvania Supreme Court has recently upheld a decision issued by The Commonwealth Court which found that an insurer was entitled to reimbursement from Supersedeas Fund for medical expenses paid on behalf of claimant. In Dept. Of Labor & Industryv. WCAB (Crawford & Co.), the Court ruled that the insurance carrier for the injured worker was entitled to reimbursement from the Supersedeas Fund relative to medical expenses that were paid on the injured workers workers compensation claim. In this case, the claimant injured his low back at work on July 21, 1995. The employer had the claimant examined by a physician on March 16, 2004. The claimant had surgery involving the implantation of a spinal cord stimulator on June 1, 2004. The cost of this surgery was in excess of $35,000.00. The employer, subsequent to the date of the surgery, received the March, 2004 exam report which found a full and complete recovery from the work injury. The employer filed a Termination Petition and Request for Supersedeas on July 19, 2004 based upon the March, 2004 exam report. A Request for Supersedeas asks immediate relief from payment of all workers compensation benefits- wage loss paymenst and medical expenses- while the Termination Petition is being litigated. The Request for Supersedeas was denied on August 30, 2004. The medical bill for the June, 2004 surgery was forwarded to the carrier in October, 2004 and paid by the carrier in January, 2005. The employer ultimately prevailed and the Termination Petition was granted in late 2005. The employer then sought reimbursement from the Supersedeas Fund regarding the payment of the $35,000.00 surgery bill which it paid after Supersedeas was requested and denied in August of 2004.
The Pennsylvania Supreme Court allowed the reimbursement request stating that, while the date of the medical service preceded insurer’s application for supersedeas reimbursement, the bill for claimant’s surgery did not arrive until six weeks after the denial of supersedeas. Since the denial meant the insurer was not relieved of obligation to pay the bill, the payment of the bill was the result of the denial. Insofar as there was final determination that compensation was not in fact payable, the insurer was not asking for payments made before supersedeas filing date, much less the date of granting supersedeas. Rather, the insurer was asking about a payment made after denial, an obligation that incurred when the insurer’s Supersedeas request was denied.
Disclaimer: The above article is for instructive purposes only and each case is fact sensitive. Consultation with an attorney should be obtained instead of reliance upon the legal issues discussed in this column.