Commonwealth Court Enhances Medical Providers’ Rights Against Workers Compensation Carriers

Attorney Dan Siegel Was Lead Counsel in Decision Affirming That Medical Providers Have a Right to Payment Under the Pennsylvania Workers’ Compensation Act

The Commonwealth Court today affirmed that insurance companies and their attorneys may not take actions that prevent medical providers from being paid for care for injured workers. The decision, in Workers First Pharmacy Services, LLC v. Bureau of Workers’ Compensation Fee Review Hearing Office (Cincinnati Insurance Co.), disallowed a procedure used by an insurer and its counsel intended to prevent a pharmacy not only from being paid, but also from having a hearing about its right to payment.

Havertown workers’ compensation and appellate Attorney Daniel J. Siegel, whose cases have dramatically expanded the protections available to medical providers caring for Pennsylvania’s injured workers, was counsel and argued the case before the Court.  Before this and other decisions in which Siegel was counsel, Pennsylvania courts had never ruled that doctors, physical therapists, orthopedic surgeons and other medical caregivers cannot be cutout from payment without a hearing.

“I am proud that this case, and others my office has handled, have expanded the rights of every medical professional in Pennsylvania. My firm’s recent cases have extended the rights of more injured persons and their medical providers than any other firm’s,” said Siegel, founder of the Law Offices of Daniel J. Siegel, LLC. He also credited attorneys Christa Frank High and Nicole A. Kratzer, who also handled the case.

In this case, a workers’ comp claim settled, and the insurance company’s lawyer included a provision in the settlement saying that (1) the injured worker was not obligated to pay for medicine he received, and (2) the insurer agreed to be bound by the separate fee review process used by medical providers to assert and protect their right to payment.  As soon as the settlement was approved, the carrier’s lawyer argued in the fee review that the pharmacy was not entitled to any payment because the insurer had never “admitted” that the worker was injured. The Fee Review Officer agreed and dismissed the matter, barring the pharmacy from any compensation. The Commonwealth appeals Court disagreed, stating: “Employer accepted full liability for the debt to Pharmacy. Employer’s counsel told Claimant that even if Employer was found not liable, Pharmacy could not hold Claimant responsible for the debt. Stated otherwise, Employer accepted “responsibility” for the debt to Pharmacy when it released Claimant from any obligation to pay Pharmacy in the C&R Agreement. Accordingly, the Hearing Office has jurisdiction to decide the three fee review contests.”

Click here to read the decision authored by President Judge Leavitt.

 

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