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Supersedeas Fund Awards $1.7M Reimbursement

We secured a favorable decision from the Supersedeas Fund awarding $1,771,961.74 for medical payments. ‚ÄčThe case involved a 2005 injury with a self-insured employer who had excess coverage provided by a carrier, which was a reimbursement policy. In 2000, the employer lost its self-insurance status and replaced it with a WC self-insurance replacement policy. The claim then pierced to self-insured retention, and the replacement policy carrier became insolvent (liquidated in 2001). Upon liquidation, the claim came under the ongoing payment policy of the Pa WC Security Fund. The fund administered payment of the ongoing claim benefits and submitted reimbursement requests to the excess carrier under the excess policy originally issued to the employer. A URO request was filed challenging the medical treatment as of 4/5/2010, and a decision was issued finding the treatment reasonable and necessary, which was appealed and remanded back to the Judge. The Judge ultimately found the treatment was not reasonable and necessary by decision in August 2014. No further appeals were filed. In January 2014 the indemnity aspect of the claim resolved by Compromise and Release. The issue in the case was the right/standing of the excess carrier to secure reimbursement for the medical payments found unreasonable and unnecessary. The Supersedeas Fund found that the excess carrier was ultimately the liable entity and awarded the reimbursement.

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