Commonwealth Court Prevents Workers' Compensation Insurance Carriers From Limiting Injured Worker Recourse
The Commonwealth Court in Ruth Hough v. WCAB (AC&T Companies) handed down an important ruling that prevented workers' compensation insurance carriers from limiting an injured worker's recourse when medical bills are not paid in a timely manner. In Hough, the injured worker filed a Penalty Petition alleging that the insurance carrier had failed to pay for the claimant's prescription medications in the time period prescribed by the Pennsylvania Workers' Compensation Act and its medical cost containment regulations. The workers' compensation judge granted the Penalty Petition and assessed penalties against the carrier. The carrier appealed, arguing that rather than filing a Penalty Petition, the claimant was obligated to first seek to rectify the issue by filing a fee review request under Section 306(f.1)(5) of the Act. This Section calls for an "administrative decision" by the Department of Labor and Industry where the medical provider is alleging that the carrier is not making payment in the proper amount or in a timely manner. The Workers' Compensation Appeal Board (WCAB) agreed with the carrier and reversed the judge's award. The Claimant then appealed to the Commonwealth Court.
The Commonwealth Court held that the fee review provision of the Pennsylvania Workers' Compensation Act does not restrict the injured worker's right to file a Penalty Peition. Rather, the fee review provision only applies to disputes solely between the insurer and the medical providers. The injured worker is not prohibited from filing a Penalty Petition where his/her medical bills are not being paid in violation of the Act. The Commonwealth Court reversed the WCAB's order and reinstated the judge's order granting the Penalty Petition.
