Case Review: Pennsylvania Workers’ Compensation Subrogation, Medical Expenses, and Reimbursement

In a Commonwealth Court Decision dated June 30, 2014, the Court affirmed the Order of the Workers’ Compensation Appeal Board which affirmed the Workers’ Compensation Judge’s decision that $29,995.59 of work-related medical expenses were not directly payable to Claimant. See Evans v. WCAB (Highway Equipment And Supply Company) No. 2252 C.D. 2013.

Claimant had filed and won a Claim Petition- the Work Comp Judge awarded ongoing work comp benefits for total disability and medical expenses. Claimant’s counsel submitted a letter to Employer informing it of the amount due and also submitted a subrogation lien of Highmark Blue Shield for payment of medical expenses in the amount of $29,995.59.

Claimant contended that pursuant to Frymiare v. Workers’ Compensation Appeal Board (D. Pileggi & Sons), 524 A.2d 1016 (Pa. Cmwlth. 1987), the WCAB erred by not directing payment directly to Claimant. However, the Commonwealth Court distinguished this instant case from Frymiare because there an employer must still pay for medical expenses to a claimant even if a third-party, such as Highmark (private insurer), has already defrayed the cost but has not asserted its subrogation lien. Here, Claimant had already submitted into evidence a letter from Healthcare Recoveries stating that Highmark had a subrogation lien for the awarded medical expenses. As such, they had preserved their lien and the WCJ did not err in finding that the medical expenses should not be paid directly to Claimant.

This case isn’t terribly interesting to most injured workers. But it underscores the notion that the assertion of a lien can affect where payments go for medical expenses. Timing is everything in this regard.

For more information about Pennsylvania Work Comp Law, call or email Attorney Michael W. Cardamone 7 days a week at (215) 206-9068 or myphillyworkerscomp@gmail.com

 

The Cardamone Law Firm, LLC

100% Work Comp; 100% For Injured Workers

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