Harburg Medical Sales Company v. Bureau of Workers' Compensation (PMA Insurance Company)

In Harburg Medical Sales Company v. Bureau of Workers' Compensation (PMA Insurance Company), 784 A.2d 866 (Pa. Cmwlth. 2001), the provider submitted a bill to insurer, which insurer denied because the provider failed to comply with the statutory reporting requirements of the Act. The provider's subsequent application for fee review was denied for lack of standing. Thereafter, the provider resubmitted a bill to the insurer that complied with the Act, which the insurer again denied. When the provider applied for fee review based on the denial of the resubmitted bill, the application was dismissed as untimely. On appeal to this court, the provider argued that the insurer's obligation to pay the claim arose only after it submitted a bill that complied with the Act's reporting requirements, 77 P.S. 531(2), 34 Pa. Code 127.203, and, therefore, the statutory time period for filing its fee review was linked to the resubmitted, rather than the original, bill. The court agreed, stating that to hold otherwise would "leave the provider without any recourse to seek payment for a disputed treatment if the provider is barred from resubmitting a bill that has gone through the fee review process and denied on the basis of failure to comply with the reporting requirements...." Harburg, 784 A.2d at 870.