 |
 |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|
|
|
|
Uniforce Services and State Workmen's Insurance Fund v. Workers' Compensation Appeal Board11/18/2003
elated to the compensable injury and, thus, his employment, and it will be the burden of the employer to prove that the new symptoms complained of are unrelated to the compensable injury. If, however, the connection is not obvious, then the burden will be on the claimant to establish the connection through unequivocal medical testimony.
Id. at 447-448 (footnotes omitted; internal citations omitted; emphasis in original). We also note that, in accordance with the Act of July 2, 1993, P.L. 90, commonly referred to as "Act 44", a medical provider must submit all medical bills on the proper forms. Specifically, Section 306(f.1)(5) provides that:
(5) The employer or insurer shall make payment and providers shall submit bills and records in accordance with the provisions of this section. All payments to providers for treatment provided pursuant to this act shall be made within thirty (30) days of receipt of such bills and records unless the employer or insurer disputes the reasonableness or necessity of the treatment provided pursuant to paragraph (6). The nonpayment to providers within thirty (30) days for treatment for which a bill and records have been submitted shall only apply to that particular treatment or portion thereof in dispute; payment must be made timely for any treatment or portion thereof not in dispute. A provider who has submitted the reports and bills required by this section and who disputes the amount or timeliness of the payment from the employer or insurer shall file an application for fee review with the department no more than thirty (30) days following notification of a disputed treatment or ninety (90) days following the original billing date of treatment. If the insurer disputes the reasonableness and necessity of the treatment pursuant to paragraph (6), the period for filing an application for fee review shall be tolled as long as the insurer has the right to suspend payment to the provider pursuant to the provisions of this paragraph. Within thirty (30) days of the filing of such an application, the department shall render an administrative decision.
77 P.S. § 531(5). In addition, the regulations promulgated by the Bureau of Workers' Compensation provide that: "Until a provider submits bills on one of the forms specified in § 127.201 (relating to medical bills--standard forms) insurers are not required to pay for the treatment billed." 34 Pa. Code § 127.202(a). The regulations also provide that: "Providers who treat injured employees are required to submit periodic medical reports to the employer ..." 34 Pa. Code § 127.203(a).
"If a provider does not submit the required medical reports on the prescribed form, the insurer is not obligated to pay for the treatment covered by the report until the required report is received by the insurer." 34 Pa. Code § 127.203(d).
In this case, Employer stopped paying Claimant's medical bills because it disputed whether they were causally related to the work-related injury . In response, Claimant filed a Penalty Petition. Section 435(d)(i) of the Act provides that:
(d) The department, the board, or any court which may hear any proceedings brought under this act shall have the power to impose penalties as provided herein for violations of the provisions of this act or such rules and regulations or rules of procedure:
(i) Employers and insurers may be penalized a sum not exceeding ten per centum of the amount awarded and interest accrued and payable: Provided, however, That such penalty may be increased to fifty per centum in cases of unreasonable or excessive delays. Such penalty shall be payable to the same persons to whom the compensation is payable.
77 P.S
Page 1 2 3 4 Pennsylvania Personal Injury Attorneys
Personal Injury Lawyers
|
| |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|