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Employer subject to penalty for continuing nonpayment of medical expenses while litigating petition to review URO that found medical treatment reasonable and necessary.

July 1, 2010
Scranton School District v. WCAB (Carden); 1567 C.D. 2009; filed March 12, 2010; by Judge Butler

The employer challenged the imposition of a penalty for violating the Act for failing to pay medical bills which were determined by a utilization review to be reasonable and necessary during the time that the employer's UR Review Petition was in litigation. The employer argued that Section 306(f.1)(5) of the Act specifically provides for suspension of payment to medical providers if the employer disputes the reasonableness and necessity of the treatment. The Board and the court rejected this position, holding that Sections 127.208(e) and 127.208(g) of the regulations specifically provide that the insurer shall pay the disputed treatment if the URO determines that the medical treatment is reasonable and necessary, and additionally holds that the filing of a petition for review does not further suspend the obligation to pay for the treatment. The court noted that the interpretive regulations are given controlling authority unless clearly erroneous, which is not the case since they were viewed by the court to be consistent with the statute.

Case Law Alert, 3rd Qtr 2010

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Francis X. Wickersham
(610) 354-8263
G. Jay Habas
Managing Attorney, Erie, PA Office
(814) 480-7802

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