Another Appellate Victory – Workers’ Compensation Fee Review Officers May Not Order Reimbursement of Overpayments
In our office’s 8th consecutive precedential victory before the Commonwealth Court, the Court ruled today (January 27, 2023) that the Commonwealth of Pennsylvania Workers’ Compensation Fee Review Section and Fee Review Hearing Officers may determine the fact and amount of an overpayment to a provider. In the absence of legislative authority permitting the Bureau to direct a provider to reimburse an insurer for an overpayment of fees for medical services, neither the Hearing Office nor a Court may create such authority in contravention of the Act.
Attorney Daniel J. Siegel of the Law Offices of Daniel J. Siegel, LLC was lead counsel and argued the case before the Commonwealth Court. Dan regularly represents injured workers, medical providers and others in workers’ compensation and appellate matters.
Why is this important? The Workers’ Compensation Act is flawed in so many ways. For example, there are virtually no mechanisms in the law to enforce decisions that order insurance companies to pay benefits, to pay medical expenses, and to pay for other items under the Pennsylvania law. In addition, when providers that have not been paid seek payment from insurers, they receive orders from the Fee Review Section and Fee Review Hearing Officers specifying how much they are owed. But those orders, inexplicably, do not have enforcement power and there is no way to force or compel an insurer or employer to pay the money they owe. This is wrong, but the Pennsylvania Supreme Court has said, “Sorry, unless the legislature creates the remedy/mechanism, you are out of luck.” While this is a paraphrase, it is the truth.
In this case, a Hearing Officer ordered a provider to refund the money he determined was overpaid. Our client challenged this ruling because the law does not create remedies for insurers just as it does not create remedies for providers. Unfair? Perhaps, but insurers have withheld millions and millions of dollars with impunity. Elected officials in Harrisburg presumably know this, and have done nothing.