Until 2004, one of the more ambiguous areas of Pennsylvania workers’ compensation law had been cases where there was a claim for medical bills only, with no wage loss or disability. The respective rights, remedies and obligations of the parties was largely subject to debate.
This situation began to change in 1999 with the Commonwealth Court’s decision in Lemansky v. Workers’ Compensation Appeal Board (Hagan Ice Cream), 738 A.2d 498 (Pa. Commw. 1999), which essentially required insurance companies to issue a “formal document” accepting liability for a claim, even if the injured worker missed no time from work. Although the Lemansky court imposed unreasonable contest attorney fees and penalties for the failure to file the appropriate document with the Bureau of Workers’ Compensation in a “medical only” case, the court never identified what that appropriate document should be. This is because no such document existed. Up until that point, the claims-adjusting practice had been to issue formal documents acknowledging responsibility for a work injury only where the work injury resulted in an inability to work. Oftentimes, adjusters issued no document at all, or a notice of compensation denial with “box four” checked off, indicating an injury had taken place, with no corresponding disability. Unfortunately, neither of these practices conferred any rights on the injured worker, even if the intent was to pay medical expenses.
