In the Commonwealth of Pennsylvania, the regulations relating to Workers’ Compensation Acts 44 and 57 give medical providers and employer/insurers the opportunity to appeal adverse administrative determinations of applications for fee review by the Health Care Services Division of the Bureau of Workers’ Compensation to a fee review hearing officer. Seven workers’ compensation judges (WCJs), located in Philadelphia, Pittsburgh and Lancaster, were recently appointed in the summer of 2011, through the Bureau of Workers’ Compensation, to act as hearing officers. In June 2011, the bureau also issued a new form, entitled “Request for Hearing to Contest Fee Review Determination (LIBC-606),” in order to provide a process to appeal decisions of the bureau’s health care services division to these newly minted hearing officers. This change in procedure is very significant for practitioners. Whereas nonjudicial fee review officers and, at times, some WCJs previously adjudicated fee review disputes, now the advent of utilizing WCJs only to adjudicate these disputes significantly changes the game.
The appointed WCJs are attorneys and are also quite experienced in litigation of workers’ compensation claims. They bring a series of perceptions regarding various physicians, hospitals and treatment providers from their previous experience as judges and practitioners. Further, they will now be forced to make determinations regarding the nature, coding and description of the care provided, as well as rule on whether care is emergent. All of the previous decisions by the centralized hearing officer, as a practical matter, are less controlling on a WCJ determination. Practitioners handling such disputes are now in a completely new and unknown forum and are, to some extent, rudderless in determining how to litigate these cases.
