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United States Steel Corp. v. Workers' Compensation Appeal Board12/2/2005
United States Steel Corporation (Employer) petitions for review from an order of the Workers' Compensation Appeal Board (Board) that affirmed a Workers' Compensation Judge's (WCJ) decision to deny Employer's Petition for Review of Utilization Review Determination (UR Review Petition) and concomitantly assessed attorney's fees against Employer for unreasonable contest.
Peter Luczki (Claimant) was injured while in the course and scope of his employment on March 2, 2000, when he fell after breaking through a step to a remote crane that Claimant operated. An Agreement for Compensation executed by the parties, dated March 14, 2002, described Claimant's injury as a low back strain.
Beginning on June 2, 2000, Claimant began receiving chiropractic treatment from Robert Homonai, D.C. (Dr. Homonai), including intersegmental traction and myofascial release. From August 2, 2000, and ongoing, Claimant received treatment from Dr. Homonai two times per month, with more treatment periodically occasioned by temporary flare ups of Claimant's symptoms.
On August 29, 2000, Employer filed a Utilization Review (UR) Request pursuant to Section 306(f.1)(6) of the Workers' Compensation Act (Act), 77 P.S. § 531(6), seeking review of the reasonableness and/or necessity of Claimant's chiropractic treatments from August 2, 2000, ongoing. The UR Request was assigned to Louis Camilli, D.C., who issued a UR Determination dated October 4, 2000, and concluded that Dr. Homonai's treatments of Claimant, from August 2, 2000, ongoing and at a rate of two treatments per month, were reasonable and necessary. Pursuant to Section 306(f.1)(6)(iv) of the Act, Employer timely filed its UR Review Petition on November 17, 2000.
Before the WCJ, both parties, represented by counsel, presented medical evidence regarding the reasonableness and necessity of Claimant's treatments. The WCJ found Claimant's medical experts more credible than those of Employer, and ultimately concluded that Employer failed to show that the treatments at issue were neither reasonable nor necessary, and concomitantly denied Employer's UR Review Petition. The WCJ then addressed whether Employer's contest of the UR Determination had a reasonable basis under the Act. The WCJ noted that the only medical evidence offered by Employer on the issue of the treatment was obtained by Employer on February 15, 2001, some three months after Employer filed its UR Review Petition. The WCJ found that Employer's contest of the UR Review Petition was not reasonable at the time of the contest. The WCJ, by order and decision dated June 10, 2002, awarded attorney's fees for the UR Review Petition contest in favor of Claimant and against Employer.
Employer timely appealed the WCJ's order to the Board, which heard argument on the matter without receiving any additional evidence. By order dated January 5, 2004, the Board affirmed. Employer now petitions this Court for review of the Board's order.
Employer presents the following issue for review: whether the Board erred as a matter of law when it affirmed the WCJ's award of attorney's fees for an unreasonable contest. Employer's argument is based on the fact that, while Employer did not have a medical opinion on which to base its contest at the time it filed its UR Review Petition, the Act mandates that the Petition be filed within thirty days of Employer's receipt of the UR Determination, and the Act does not expressly state that the challenge be based upon medical evidence at the time of filing.
Section 306(f.1)(6) of the Act, 77 P.S. § 531(6) controls disputes over the reasonableness or necessity of treatments received by a claimant in a Workers' Compensation cl
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