Suing the Department of Transportation for Not Paying Medical Bills Related to a Work Injury
In Twyman v. Workers' Compensation Appeal Board (Pennsylvania Department of Transportation), 720 A.2d 780 (Pa. Cmwlth. 1998), the Court relied on identical language to support the imposition of penalties against the employer, the Pennsylvania Department of Transportation (DOT).
In Twyman, the claimant filed a penalty petition, alleging that DOT failed to reimburse him for the cost of an orthopedic bed and to pay other medical bills related to his work injury.
The WCJ concluded that DOT violated the Act, and, consequently, the WCJ granted Claimant's penalty petition and assessed penalties against DOT.
On appeal, the Workers' Compensation Appeal Board (WCAB) reversed based upon its conclusion that some of the bills were paid and that there was confusion between DOT's insurer, the State Workmen's Insurance Fund (SWIF), and the third party administrator, Pennsylvania Insurance Management Company (PIMCO), as to who should have paid the bills.
On appeal from the WCAB's order, this court reversed, relying on section 306(f) of the Act, which provided that "the employer shall provide payment ... as and when needed...." Twyman, 720 A.2d at 786.
The court also noted its prior holding that "'an employer has an 'absolute duty' to pay a claimant's medical bills until a [WCJ] determines that liability no longer exists.'" Id. (quoting Listino v. Workmen's Compensation Appeal Board (INA Life Insurance Co.), 659 A.2d 45, 47 (Pa. Cmwlth. 1995).
Additionally, in Twyman, the court reasoned that where a claimant or provider has complied with the Act and an employer's failure to make timely payment is caused by the insurance carrier, it would be unfair to penalize Claimant's credit rating and future treatment with his medical providers by excusing the employer's illegal delays. See Twyman.
Finally, the court stated that under the Act, the employer, per se, is primarily liable for the payment of a claimant's medical expenses, and an employer should not be able to use an insurer's actions to shield the employer from its responsibility.
Accordingly, this court held that it was erroneous for the WCAB to conclude that DOT did not violate the Act, and this court reinstated the WCJ's assessment of penalties against the employer, DOT. Twyman.