Penalty Award for Not Paying Medical Bills In Pennsylvania
In Westinghouse Electric Co. v. Workers' Compensation Appeal Board (Weaver), 823 A.2d 209 (Pa. Cmwlth. 2003), the Court determined that a penalty awarded for non-payment of medical bills was not legally defective because the bills were not on the appropriate forms.
In other words, the failure to use the appropriate forms was a factual matter addressed to the Workers' Compensation Judge's (WCJ) discretion.
"Once it is determined that an employer is liable for an injury under the Act, the employer is required to pay a claimant's medical bills within thirty days of receipt." Westinghouse, 823 A.2d at 218.
Also in Westinghouse the Court discussed the WCJ's jurisdiction.
The Court held that disputes concerning utilization issues, reasonableness or necessity of treatment, must be resolved through the utilization review process in Section 306(f.1)(6) of the Act.
Thus, the Court noted the WCJ generally lacks original subject matter jurisdiction over the utilization issues of reasonableness or necessity of treatment. Id.
However, the employer in Westinghouse failed to challenge the reasonableness or necessity of Claimant's treatment.
As a result, we held "claimant is entitled to an award of penalties . . . for employer's failure to timely pay and reimburse . . . providers for claimant's work-related medical expenses as ordered by the WCJ." 823 A.2d at 219.