Commonwealth Court Upholds Penalties Against Employer for Failure to Pay Fee Review Determinations

The Commonwealth Court affirmed a workers’ compensation judge’s award of penalties and counsel fees against an employer that failed to comply with multiple Fee Review Determinations. The case stemmed from a claimant’s long-standing injury, where her medical provider successfully challenged underpayments for prescription medications. Despite the Fee Review Section ordering the employer to pay more than $1,400 plus interest, the employer neither contested the Determinations nor issued payment. The court held that the employer’s inaction constituted a violation of the Workers’ Compensation Act, confirming the workers’ compensation judge’s authority under Section 435 to impose penalties and rejecting the employer’s claim that the claimant lacked standing to pursue the petition.

In this case, the claimant sustained a work-related back injury in 1998 that was later settled by a Compromise & Release Agreement. The claimant received monthly prescription medications from a provider for her injury. Between July 2022 and January 2023, the provider submitted five Applications for Fee Review to the Bureau of Workers’ Compensation Medical Fee Review Section (Fee Review Section) challenging the amounts paid by the employer. 

The Fee Review Section determined the provider billed the employer $426.00, that the proper repriced amount was $312.64, and the amount paid by the employer was $14.59 for each date of service. The Fee Review Section issued a Determination indicating the employer owed the provider $298.05, plus interest, on each Application, for a total of $1,490.25. The employer did not contest the Determinations, nor did they issue payment as ordered.

The claimant subsequently filed a petition requesting penalties on the basis that the employer failed to pay the amount owed on the Determinations. The employer moved to dismiss the petition on the basis that the workers’ compensation judge lacked jurisdiction. The motion was denied, and the employer did not present any evidence in opposition to the review petition. The judge granted the penalty petition, ordered a 50% penalty and awarded counsel fees to the claimant. The employer appealed to the Appeal Board, which affirmed.

The employer then appealed to the Commonwealth Court, arguing the workers’ compensation judge lacked jurisdiction because the dispute involved a Fee Review between a provider and an employer. The Commonwealth Court affirmed the decisions below and dismissed the employer’s appeal. In doing so, the court found that the employer failed to pay the amounts owed to the provider and, therefore, violated the Act. The court noted Section 435 of the Act authorizes the judge to impose penalties for violations. Further, the court rejected an argument raised by the employer that the claimant was not aggrieved by the lack of payment to the provider.  

_{What’s Hot in Workers’ Comp, Vol. 29, No. 9, September 2025, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2025 Marshall Dennehey, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.}