Pennsylvania Statutory Law

Another Victory for Pa. Workers’ Compensation Medical Providers

The Commonwealth Court has, in another case in which Attorneys Dan Siegel and Christa High were appeals court counsel, eliminated yet another method used by insurers and employers to prevent medical providers who treat injured workers in Pennsylvania from being paid. In the case, Workers’ First Pharmacy v. Bureau of Workers’ Compensation Fee Review Hearing Office, the Court ruled that when a provider seeks payment for treatment or services under the Pennsylvania Workers’ Compensation Act, the insurer or employer may not claim that the care was not “causally related” to the injury. If it intends to dispute whether the treatment was related to the work injury, it must file a utilization review.

This is the latest in a series of appeals court victories for the Law Offices of Daniel J. Siegel, LLC that has yet again helped assure that doctors and other medical providers will be paid for the care they provide to injured workers. This also helps assure that doctors and other medical providers will be willing to provide the care these injured workers need.

Attorneys Dan Siegel and Christa High not only represent medical providers, but also represent injured workers, assuring that they receive every type of compensation they are entitled to. Dan Siegel wrote The Pennsylvania Workers’ Compensation Law Book  and The Injured Worker’s Guide to Pennsylvania Workers’ Compensation Law, a FREE book for injured workers

When you need a lawyer who not only knows the Pennsylvania Workers’ Compensation Law system, contact the Law Offices of Daniel J. Siegel, LLC the Law Firm Whose Cases Make the Law.

We don’t have billboards and TV ads, WE HAVE RESULTS!

Read More

Another Supreme Court Victory for Injured Workers (In Which Philadelphia Area Attorney Dan Siegel Was Counsel)!

If you get hurt walking to your job from the parking lot, you are often eligible for workers’ compensation benefits in Pennsylvania. On November 20, 2019, the Pennsylvania Supreme Court unanimously agreed that injured workers should be compensated if they are injured in a parking area—even if that parking area is optional. Attorney Daniel J. Siegel of the Law Offices of Daniel J. Siegel, LLC submitted the friend of the court brief on behalf of the Pennsylvania Association for Justice.

In US Airways, Inc. and Sedgwick Claims Management Services, Inc. v. Workers’ Compensation Appeal Board (Bockelman), the Court agreed that a US Airways employee, who was injured on a shuttle bus taking her to an employee parking lot that was not owned by the employer, was entitled to wage losses and payment of her medical bills. Justice David Wecht authored the Opinion, writing that “the phrase ‘the employer’s premises’ in [the Pennsylvania Workers’ Compensation] Act should be construed liberally to include any area that is integral to the employer’s business operations, including any reasonable means of ingress to or egress from the workplace.” Because “the lot in which Bockelman parked her vehicle was integral to US Airways’ business operations,” she was entitled to benefits.

This is one of many Pennsylvania Supreme Court cases in which our office successfully represented the interests of injured workers and other accident victims, including many cases referred to our office by other lawyers. Just give us a call at (610) 446-3457 to learn how we can help you.

Read More

Why Voting Matters – the General Assembly and Protz

We all hear that voting matters. Recent events highlight why voting matters for every worker in Pennsylvania and why, if the legislature reflected the values of injured workers, this blog post might be different. Tomorrow, Pennsylvanians vote for judges, and it’s important to vote for candidates who reflect your values; your vote matters.

Here are the details. In 1997, the legislature amended the Workers’ Compensation Act to allow insurance companies to reduce injured workers’ benefits through a process known as an impairment rating exam (IRE). It took 20 years, but through the efforts of our office and others, the Pennsylvania Supreme Court declared the IRE process unconstitutional in an opinion known as Protz II.

So what did the legislature do? In 2018, it enacted a new IRE process, fixing the problems that made the entire process unconstitutional. As a result, the IRE is back and insurance companies are using it one again to reduce the benefits available to Pennsylvania’s injured workers. And one appeals court has now ruled that the amendments were legally enacted.

If we had elected more legislators sympathetic to the plight of injured workers, there would not have been a new IRE process, and workers would have more rights than they do now.

Just like that, we are back to a process that can be used to reduce benefits for the majority of injured workers. So when you go to vote, for judges, for legislators, or for anyone else, make sure you find out where they stand on issues that matter to you.

Our office regularly represents injured workers and fights hard to get them the benefits they deserve – even if the system is not always fair. Just give us a call at (610) 446-3457.

Read More

Commonwealth Court Enhances Medical Providers’ Rights Against Workers Compensation Carriers

Attorney Dan Siegel Was Lead Counsel in Decision Affirming That Medical Providers Have a Right to Payment Under the Pennsylvania Workers’ Compensation Act

The Commonwealth Court today affirmed that insurance companies and their attorneys may not take actions that prevent medical providers from being paid for care for injured workers. The decision, in Workers First Pharmacy Services, LLC v. Bureau of Workers’ Compensation Fee Review Hearing Office (Cincinnati Insurance Co.), disallowed a procedure used by an insurer and its counsel intended to prevent a pharmacy not only from being paid, but also from having a hearing about its right to payment.

Havertown workers’ compensation and appellate Attorney Daniel J. Siegel, whose cases have dramatically expanded the protections available to medical providers caring for Pennsylvania’s injured workers, was counsel and argued the case before the Court.  Before this and other decisions in which Siegel was counsel, Pennsylvania courts had never ruled that doctors, physical therapists, orthopedic surgeons and other medical caregivers cannot be cutout from payment without a hearing.

“I am proud that this case, and others my office has handled, have expanded the rights of every medical professional in Pennsylvania. My firm’s recent cases have extended the rights of more injured persons and their medical providers than any other firm’s,” said Siegel, founder of the Law Offices of Daniel J. Siegel, LLC. He also credited attorneys Christa Frank High and Nicole A. Kratzer, who also handled the case.

In this case, a workers’ comp claim settled, and the insurance company’s lawyer included a provision in the settlement saying that (1) the injured worker was not obligated to pay for medicine he received, and (2) the insurer agreed to be bound by the separate fee review process used by medical providers to assert and protect their right to payment.  As soon as the settlement was approved, the carrier’s lawyer argued in the fee review that the pharmacy was not entitled to any payment because the insurer had never “admitted” that the worker was injured. The Fee Review Officer agreed and dismissed the matter, barring the pharmacy from any compensation. The Commonwealth appeals Court disagreed, stating: “Employer accepted full liability for the debt to Pharmacy. Employer’s counsel told Claimant that even if Employer was found not liable, Pharmacy could not hold Claimant responsible for the debt. Stated otherwise, Employer accepted “responsibility” for the debt to Pharmacy when it released Claimant from any obligation to pay Pharmacy in the C&R Agreement. Accordingly, the Hearing Office has jurisdiction to decide the three fee review contests.”

Click here to read the decision authored by President Judge Leavitt.

 

Read More

Attention Doctors, Pharmacies & Medical Providers Treating Pa. Workers’ Compensation Patients

Pennsylvania Appeals Court Eliminates Defense That Prevented Countless Workers’ Compensation Providers From Getting Paid

Doctors and every other entity providing medical care or services to injured workers under the Pennsylvania Workers’ Compensation Act will benefit from the Commonwealth Court Opinion today in Armour Pharmacy v. Bureau of Workers’ Compensation Fee Review Hearing Office. The unanimous court eliminated the ability of insurers and employers to simply allege a few “magic words” to halt the process used to determine how much they should be paid for caring for injured workers. Attorney Dan Siegel of the Law Offices of Daniel J. Siegel, LLC represented the medical provider in the case.

In the case, the Court ruled that that “where the employer challenges a fee determination of the Medical Fee Review Section for the stated reason that the medical service was not rendered by a ‘provider’ within the meaning of the Act, the threshold question must be decided by the Hearing Officer.” This means that insurers and employers must now provide evidence why they are disputing a medical bill, eliminating the often-bogus defenses that have prevented a Hearing Officer from deciding how much they are owed.

This case applies to every doctor, hospital, chiropractor, medical equipment company, pharmacy and any other entity providing medical care or services to workers injured and receiving benefits under the Pennsylvania Workers’ Compensation Act. This case also affirms that these medical providers have a due process right to compensation, as established in Armour Pharmacy I, another case handled by Attorney Dan Siegel.

Our office regularly represents medical providers and other entities seeking to be paid for treatment to injured workers. In the past week, Attorney Dan Siegel has received numerous honors for his work: (1) Philadelphia Inquirer Influencer of Law (Personal Injury) award, (2) voted Delaware County’s #1 personal injury attorney by Delaware County Daily Times readers, and (3) honored as a Pennsylvania Best Lawyer in workers’ compensation law, based upon voting by other attorneys.

When you need an attorney, contact our office. Over half of our clients are attorneys; that’s why we’re known as the Lawyers Other Lawyers Call for Advice.

Read More

A Message to Insurance Companies, Self-Insureds and Others: Some of Your Lawyers Aren’t Always On Your Side

Imagine that one of the law firms that you hire to defend you and your insureds wants you to pay more, a lot more. It’s true.

One law firm proudly states that it defends employers, self-insureds, and [insurance] carriers in matters involving workers’ compensation, auto claims, slips and falls, and many other types of personal injury lawsuits.

But whose side are they really on? After all, this law firm wants to void and eliminate all medical fees schedules based on Medicare and other non-Pennsylvania guidelines, thus increasing the amount that its clients would have to pay for medical care, and even for future medical care in some cases.

You don’t have to imagine it. It’s true.

This Pennsylvania-based insurance defense firm is arguing in a case in the Commonwealth appeals Court that every fee schedule based on an outside formula is unconstitutional. This means that according to a law firm that exclusively represents insurance companies, employers and self-insureds, the fee schedules that they use to determine how much to:

  • Pay for medical bills
  • Pay for hospital bills
  • Pay for medical tests
  • Pay for diagnostic tests
  • Pay for medical equipment
  • Pay for pharmaceuticals, and
  • Pay for every other type of medical care

would be void (in other words – all of these fee schedules would be eliminated) if they were based on a Medicare fee schedule, the Red Book for medications/pharmaceuticals, and any other guidelines that the Pennsylvania legislature did not create.

That’s right, every doctor, every hospital, and every type of medical provider could charge and would be entitled to be paid whatever amount it asked for based on this logic. I am certain that insurance companies would be thrilled to know that their lawyers are taking a position that would cost them millions, all because they don’t like how a small group of pharmacies is compensated under the Pennsylvania Workers’ Compensation Act for dispensing medication to help injured workers deal with pain without exposing them to cheap, addictive opioids.

Here is what the firm wrote in their Commonwealth Court brief:

It was unconstitutional for the legislature to delegate the law on pricing of pharmaceuticals to a private company without providing that company with any policy direction, limits, or guidance, and with the ability of that private company to change the rules at rates at its whim, in secrecy, and without legislative review.

Analogously, this also means that it is unconstitutional for the legislature to delegate the law on pricing of medications and other care to Medicare without providing any policy direction, limits, or guidance, and with the ability of Medicare to change rates at its whim, in secrecy, and without legislative review.

Our office does not and never will represent insurance companies, we represent injured workers, victims of auto accidents, slips and falls and other negligence. We also recognize that fee schedules are necessary, and that they are best when derived from reputable sources like Medicare and the Red Book. Otherwise, the cost of medical care would have no boundaries.

Imagine that.

Read More

Pa. Supreme Court, Citing Dan Siegel’s Brief, Issues Landmark Car Accident Ruling

The Pennsylvania Supreme Court ruled today that, in car accidents claims against Pennsylvania governments and governmental agencies, “operation of a vehicle” is the continuum of activity from when a vehicle begins its journey until it reaches its final destination.  This case will impact every auto accident claim against the Commonwealth of Pennsylvania, every municipality, and every governmental agency, such as SEPTA.

In the case, known as Balentine, the Supreme Court specifically cited and adopted the standard suggested by Attorney Daniel J. Siegel of the Law Offices of Daniel J. Siegel, LLC, who authored the Amicus/Friend of the Court Brief for the Pennsylvania Association for Justice. The Opinion reverses 30 years of inconsistent and illogical decisions, and creates a uniform and logical standard for evaluating the responsibility of a governmental entity in motor vehicle accident cases. Our law firm is proud that over the past 13 years since we opened, our cases have protected and expanded the rights of more injured workers and car accident victims than those of any other law firm in Pennsylvania! Last year, our Pennsylvania Supreme Court case expanded the statute of limitations in all uninsured and underinsured motorist cases.

The Opinion in Balentine specifically cited Attorney Dan Siegel’s Brief, “The approach set forth in the Warrick dissent, as advocated for by Amicus Curiae Pennsylvania Association for Justice, does not contradict the ‘intent of the Tort Claims Act to insulate local government agencies from liability.'”

Click here to read the Opinion in Balentine v. Chester Water Authority.

Click here to read Dan Siegel’s Brief.

Read More

Pennsylvania Workers’ Compensation Settlements Cannot Bar Medical Provider From Being Paid Without Notice

In a precedential decision that will impact every Compromise & Release (Settlement) Agreement under the Pennsylvania Workers’ Compensation Act, the Commonwealth Court ruled today that “The parties to a C&R agreement can bind each other, but they cannot release themselves from liability to a person who is not a party to the C&R agreement and who has been given neither notice nor opportunity to be heard on the C&R Agreement.” Attorney Dan Siegel of the Law Offices of Daniel J. Siegel, LLC was lead appellate counsel, and argued the case for the medical provider; he was assisted by Attorney Nicole Kratzer.

The Court also ruled that “A C&R Agreement cannot be employed to avoid the procedures in the Act for challenging a provider’s invoice or a fee review determination that the invoice must be paid. To hold otherwise would eviscerate Section 30l(f.1)(5) and (6) of the Act and violate the due process of law guaranteed to providers.”

Click here to read our latest appellate victory, which yet again impacts virtually every injured worker in Pennsylvania.

Read More

Pedestrians, Bicyclists, and Drivers: Sharing the Roadway

A 34-year-old bicyclist was struck and killed by an SUV at around 7:40 p.m. on Saturday, May 12th near 10th and Spring Garden streets in Philadelphia. This is only one instance of a sadly all too common occurrence in both Philadelphia and the surrounding suburbs. Drivers must always be aware of growing numbers of pedestrians, runners, and bicyclists who share the roadways and crosswalks. There are several things you should know if you are one of the many drivers, walkers, or bicyclists in Pennsylvania.

Pennsylvania’s Motor Vehicle Code considers bicycles as vehicles for purposes of traffic laws, and every person riding a bike on a roadway has the same rights and responsibilities as a driver of a vehicle, with a few exceptions. Thus, while you have every right to ride your bicycle on the street, if you violate traffic laws, you not only increase your risk of an accident, but can be found at fault in the event of an accident. The following are a few examples of safety precautions drivers must take when encountering bicyclists on the roadway:

  • Vehicles must allow 4 feet of distance when overtaking/passing a bike, and travel at a careful and prudent speed. It is the motorist’s responsibility to provide this distance, not the biker.
  • Vehicles may overtake/pass a bike in a no-passing zone to avoid excessive delays, but must be with due care and still providing the required 4 feet of clearance.
  • No person shall open any car door while parked alongside a roadway unless it is reasonably safe to do so, and must not interrupt a biker’s path or disrupt traffic flow.

A pedestrian is subject to traffic signals just like a vehicle, and a pedestrian has the right of way at a crosswalk where no traffic control signal is in place. If the pedestrian is not in a crosswalk, the vehicle has the right of way. However, even if you are not in a crosswalk, or a jury finds you partly to blame for the accident (e.g., you were texting or otherwise distracted when you walked into traffic), you may still be able to recover damages if you were 50 percent or less at fault. There is one important difference for those struck by vehicles while walking: limited tort does not apply to pedestrians. Thus, even if you or your household chose limited tort car insurance, you are considered full tort if you were injured as a pedestrian and not a driver or occupant of a vehicle.

We regularly represent injured persons in auto accident claims in Philadelphia, Delaware County, and the surrounding area, including pedestrians, runners, and bicyclists struck by vehicles. While nothing can completely erase the physical and emotional impacts of a car accident, our experienced attorneys can help when insurance companies refuse to fully compensate you for your suffering. If you have been injured by a vehicle while walking, jogging, or riding your bicycle, call our office at 610-446-3457 to set up a consultation with our attorneys. We will explain the process, guide you, and fight to get you compensation for your injuries.

Read More

Commonwealth Court Rules that Pre-Protz IREs are Invalid When a Petition to Reinstate is Filed Within Three Years of the Most Recent Payment

The Commonwealth Court ruled today that injured workers in Pennsylvania whose benefits were limited because of an impairment rating examination (IRE) may seek additional benefits if they file a petition within three years of the date of the most recent payment of compensation (wage losses). Applying the Pennsylvania Supreme Court’s landmark 2017 decision in Protz v. WCAB (Derry Area School Dist.), the Commonwealth Court – in Whitfield v. WCAB (Tenet Health System Hahnemann LLC)  – invalidated an IRE that modified the Claimant’s benefits in 2008, holding:

Because Claimant filed her Petition within three years from the date of her last payment of compensation as permitted by Section 413(a) of the WC Act, she was entitled, as a matter of law, to seek modification of her disability status based upon the Protz decisions, which found the IRE provision unconstitutional. Allowing Claimant to seek modification under these circumstances does not prejudice employers or insurers by upsetting their expectation of finality because such determinations are not yet truly “final” until three years have passed since the date of last payment.

The en banc Opinion by Judge Renée Cohn Jubelirer contains a thorough history of the decisions in Protz v. WCAB (Derry Area School District), in which the Pennsylvania Supreme Court declared as unconstitutional the impairment rating evaluation (IRE) provision in Section 306(a.2) of the Workers’ Compensation Act, as well as other cases that have addressed IRE issues.

In the underlying litigation in Whitfield, the WCJ found that Claimant was not entitled to reinstatement of her benefits. The Commonwealth Court disagreed, concluding that Claimant had a statutory right to seek reinstatement because she filed her Petition within three years of her most recent compensation payment, and had not waived her constitutional challenge:

The impediment that rendered her partially disabled under the WC Act, i.e., the impairment rating, is no longer a valid means of changing a claimant’s status. There was no longer a legal basis for Claimant’s disability status to remain partial because the IRE upon which the change in status was predicated was found, as a matter of law, unconstitutional and invalid. This change in the law was a basis upon which Claimant could seek reinstatement.

The Court remanded the case for a determination whether Claimant continues to be totally disabled irrespective of her IRE status. The Opinion did not address whether Protz applied to cases in which the last payment was made outside the three-year period under Section 413(a) of the Act. Judge Covey was the lone dissent.

Click here to read the Whitfield opinion.

Read More

Sign Up for Our Newsletters

I would like to receive...