The Supreme Court holds that an insurer is entitled to Supersedeas Fund reimbursement for payment of a medical bill made after a request for supersedeas was denied, even though the bill was for treatment received before the supersedeas request was made.

In this case, the claimant, who was receiving benefits for a July 1995 work injury, was seen for an independent medical evaluation (IME) on March 16, 2004. On June 1st of that year, surgery was performed on the claimant, which the claimant maintained was related to his work injury. On July 19, 2004, the employer filed a petition to terminate the claimant's benefits, based on the results of the March 2004 IME. The employer also requested supersedeas in connection with the termination petition. The request for supersedeas was denied. In October 2004, the bill for the June 2004 surgery was submitted to the insurer, who made payment in January 2005. In June 2005, the employer's termination petition was granted by the workers' compensation judge. The Workers’ Compensation Appeal Board (WCAB) affirmed. The insurer then requested reimbursement from the Supersedeas Fund for the surgery bill, which was over $35,000. However, the Bureau challenged the request. The Bureau took the position that because the claimant's surgery occurred before the supersedeas request was made, the insurer was not entitled to a Supersedeas Fund reimbursement. The workers' compensation judge, however, awarded reimbursement, and the WCAB affirmed, as did the Commonwealth Court. The Supreme Court affirmed the decisions below, holding that the insurer was entitled to reimbursement from the Supersedeas Fund for the bill for surgery performed prior to the supersedeas request being made, but submitted after the request was denied. According to the court, the insurer had the obligation to cover the bill pending the final determination and that obligation was the direct and singular result of the denial of supersedeas. In the court's view, to make reimbursement dependent on the date of the event giving rise to the bill would serve to insert an additional element into the Act. The court also noted that the insurer was not asking for payments made before the supersedeas filing date, much less the date of granting supersedeas. The insurer was seeking reimbursement for payment made after a supersedeas denial, "[a]n obligation incurred when the insurer was denied permission to suspend compensation payments."

Case Law Alert - 4th Qtr 2011