Medical bills not paid for treatment/therapy given in India proper as practitioners not licensed in PA, services not provided under supervision of licensed health care practitioner, and medical certificates did not comply with requirements of the Act.

The claimant was receiving indemnity benefits for a February 2000 work injury. In an unreported opinion, the Commonwealth Court affirmed the disallowance of Ayurvedic medical treatment (one of the world’s oldest whole-body healing systems developed thousands of years ago in India) because the services were performed by non-licensed medical providers who were not under the supervision of, or upon referral of, a licensed practitioner.

The claimant had another work injury with the employer in 2008. Again, the compensability of Ayurvedic medical care the claimant received was at issue. The judge denied the claim petition, finding that the practitioners—located in India—were not licensed providers in Pennsylvania; their services were not under the supervision of a licensed Pennsylvania health care practitioner; and the medical certificate submitted by the claimant did not describe the treatment or to what body parts the treatment was applied, nor did it include any medical reports required by the Act. The Board affirmed.

On appeal to the Commonwealth Court, the claimant argued that the treatment she received from providers in India, although unlicensed in the Commonwealth, was compensable based on the claimant’s testimony that it was prescribed by a treating physician and that the claimant, as a licensed registered nurse, could be considered the supervising health care practitioner over her own care. However, the court concluded that there was no evidence of record that a doctor actually prescribed the treatment. Nor was there evidence that the claimant exercised supervisory control over the practitioners in India or in any way guided them during administration of the treatment. The court further rejected the claimant’s argument that §109 of the Act—limiting payment of medical bills to services by Pennsylvania licensed healthcare providers—was unconstitutional under the Equal Protection Clauses of the Pennsylvania and United States Constitutions.

Case Law Alerts, 1st Quarter, January 2015