Fees
In Parrish v. Yeager Supply (WCAB), 2026 Pa. Commw. LEXIS 25 (2026), the court found that WCJs do not have authority to assess attorney’s fees against the Security Fund. The Security Fund is a statutorily-created entity that pays WC benefits. It is not included in the definition of Insurer under the act and 77 P.S. §701 mandates the award of attorney’s fees against an employer or insurer. The fact that EC’s contest was reasonable did not distinguish this case from Lebanon Valley Brethren Home v. Flammer (WCAB), where the court found the Security Fund could not be assessed attorney’s fees for an unreasonable contest.
Reporting Injury
In Erie Ins. Prop. & Cas. Co. v. David Heater (WCAB), 2026 Pa. LEXIS 554 (2026), the Pa Supreme Court found a sole owner/employee of a business is not required to notify his insurer of a work-related injury within 120 days to be eligible for compensation. While the court acknowledged that this puts a sole proprietor in charge of their own investigation, the plain language of 77 P.S. §631, which requires notice to an employer and 1 WCA §103 which defines employer and does not include insurer. There was no ambiguity in the language of the act, and it was not within the court’s discretion to use legislative intent to construct the meaning of the statute to include insurers.
Medical Reimbursement
In Am. Select Ins. Co. v. York Hosp. C/O Wellspan Health Bureau of Workers’ Comp. Fee Review Hearing Off., 2026 Pa. Commw. Unpub. LEXIS 146, the court affirmed a decision directing insurer to pay the remainder of provider’s bill. Provider billed $142,460.54 and insurer paid $43,492.43, through WellRithms, a third-party payment provider. Normally, fees for medical services are capped at 113% of the Medicare reimbursement rate. There is an exception for level I or II trauma centers that provide treatment for an immediately life threatening or urgent injury. The payment in these instances is the usual and customary charges. Insurer did not have standing to challenge the constitutionality of the legislature’s delegation of rule making authority to the American College of Surgeons (which defines “life-threatening”) where they agreed the treatment was properly classified as trauma. Insurer was not unfairly prejudiced by the disqualification of their expert’s opinions where the expert was allowed to testify based on professional experience in medical billing. Nor were they prejudiced by accepting provider’s testimony because Insurer bore the burden of proving its payment was proper
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