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Anchor Glass Container Corp. v. Workers' Compensation Appeal Board6/21/2002
Anchor Glass Container Corp. (Employer) appeals from an order of the Workers' Compensation Appeal Board (Board) affirming the decision of the Workers' Compensation Judge (WCJ) finding that the medical treatment Mark Calvey (Claimant) had received was both reasonable and necessary for the purpose of treating his work-related injury.
On March 3, 1996, Claimant sustained an injury to his back as a result of a fall that took place on Employer's premises. Claimant subsequently sought treatment for his injury from William J. Mitchell, M.D. (Dr. Mitchell), a board certified orthopedic surgeon, and underwent physical therapy treatments through
West Penn Rehabilitation Services (West Penn). On March, 30, 1996, Employer issued a notice of workers' compensation denial declining to pay Claimant benefits for his fall contending that although the injury was work-related, Claimant was not disabled as a result of the incident. Claimant continued to seek medical treatment for his injuries from Dr. Mitchell and West Penn, which Employer continued to pay.
Seeking determinations as to the reasonableness and necessity of the physical therapy provided to Claimant from West Penn between May 14, 1996 and March 24, 1997, and the medical treatment provided by Dr. Mitchell from November 4, 1997 onward, Employer filed requests for utilization reviews. Agreeing with Employer, the Utilization Review Organization (URO) found both the medical treatment provided by Dr. Mitchell and the physical therapy provided by West Penn was neither reasonable nor necessary. Both Claimant and West Penn appealed the URO decision and the matter was assigned to a WCJ.
Before the WCJ, Claimant testified that he had continued to see Dr. Mitchell on a once per-month basis since May 1996, he was referred to physical therapy by Dr. Mitchell for his neck and back, and the physical therapy helped to relieve some of his pain. Claimant also presented the testimony of Dr. Mitchell who discussed his course of treatment for Claimant stating that the treatment and his referral of Claimant to physical therapy was both reasonable and necessary to treat Claimant's work-related injury.
In addition to the submission of utilization review reports of Stanley R. Askin, M.D. discussing the treatment rendered to Claimant by Dr. Mitchell, and Jeffrey Swerdlow, M.S., P.T. discussing Claimant's physical therapy treatments with West Penn, both finding that the treatments were unnecessary, Employer argued that Claimant's failure to file a claim petition within three years of his injury as required by Section 315 of the Workers' Compensation Act (Act), 77 P.S. ยง602, precluded him from seeking payment for medical expenditures.
Concluding that Claimant's continued medical treatment with Dr. Mitchell and his physical therapy were both reasonable and necessary, the WCJ granted the petitions for review. As to whether the claim was timely, the WCJ determined that because Employer had initiated the utilization review procedure and acknowledged on its compensation denial form that Claimant had sustained a work-related injury, the medical payments it made to Claimant were in lieu of compensation which tolled the running of the statute. Employer then appealed to the Board which, without addressing Employer's contention that Claimant's action was time barred, affirmed the WCJ's decision. This appeal followed.
On appeal, Employer contends that pursuant to Section 315 of the Act, it is exempt from liability for Claimant's medical expenditures because Claimant failed to establish that he received any work-related benefits from Employer. It asserts that although it did pay for some of Claimant's medical e
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