Under the Pennsylvania Workers’ Compensation Act, the insurance carrier has 30 days to either pay a medical bill for treatment related to a work injury, or file for Utilization Review (to challenge whether such treatment is reasonable and necessary). The question, at times, is whether the treatment is “related” to the work injury or not. Some workers’ comp insurance carriers simply deny payment, alleging the bills are for treatment unrelated to the work injury. A recent decision by the Commonwealth Court of Pennsylvania casts doubt on this type of response.
First, it is important to note that this decision is “unreported,” and is only persuasive (not binding). In Pennsylvania Liquor Control Board v. 3B Pain Management (Bureau of Workers’ Compensation Fee Review Hearing Office), the injured worker fell in the parking lot outside the store. A Claim Petition was filed and litigated. Ultimately, the Workers’ Compensation Judge granted the Claim Petition, finding the work injury to be a “meniscal tear of the right knee and chondromalacia of the femoral and tibial condyle of the right knee.”
The injured worker had chiropractic treatment, which the Court described as, “ . . . spinal manipulation relating to low back pain, manipulation of Claimant’s knees and his right hip for pain, low level laser treatment on his right knee, and therapeutic massage for unidentified muscle spasms.”