Bureau of Workers’ Compensation v. Workers’ Compensation Appeal Board (Crawford & Company), No. 102 MAP 2009 (Pa. July 19, 2011)
In 1995, Ressler began receiving Workers’ Compensation benefits and medical bill coverage. Nine years later, he underwent an independent medical evaluation and surgery. The employer filed a petition to terminate benefits as of the date of the evaluation. It also requested supersedeas, which a Workers’ Compensation Judge denied.
The surgery bill was then submitted to and paid by the insurer. Later, a Workers’ Compensation Judge granted the employer’s petition to terminate benefits. The Workers’ Compensation Appeal Board affirmed the decision.
The insurer then requested and received reimbursement from the Supersedeas Fund. The Workers’ Compensation Appeal Board affirmed and so did the Commonwealth Court. The Bureau of Workers’ Compensation then appealed to the Pennsylvania Supreme Court.
Section 443 (a) of the Workers’ Compensation Act sets out the required elements for reimbursement:
If, in any case in which a supersedeas has been requested and denied under the provisions of section 413 or section 430, payments of compensation are made as a result thereof and upon the final outcome of the proceedings, it is determined that such compensation was not, in fact, payable, the insurer who has made such payments shall be reimbursed therefor.
Because statutory interpretation is a question of law, the Pennsylvania Supreme Court exercised a de novo standard of review.
The Court found that all of the elements were met, including the one in dispute, “payments of compensation are made as a result thereof.” The Court noted that the surgery bill arrived after supersedeas was denied. The denial mandated that the insurer pay the bill, while the insurer’s obligation before the denial was uncertain. Since the surgery did not mandate the payment, the date of the surgery was irrelevant.
To make reimbursement dependent on the date of the event giving rise to the bill is to insert an additional element into the statute.
In affirming the Commonwealth Court, the Court concluded that the insurer may be reimbursed for payment even though the medical treatment was rendered before the supersedeas request and denial.
