PHILADELPHIA – The Commonwealth Court has affirmed a Workers' Compensation Appeal Board ruling related to the validity of insurer Independence Blue Cross’ subrogation lien against medical benefits provided by the city of Philadelphia to a city firefighter, according to a July 3 order.
On March 31, 2016, the board upheld a majority of a decision rendered by a Workers’ Compensation judge that approved a claim filed by a Philadelphia firefighter who was treated for kidney cancer. The city subsequently appealed the board’s decision to the Commonwealth Court.
Specifically, the board upheld the judge’s finding that the insurer provided enough evidence to back up its lien, which the Commonwealth Court’s opinion defined as “the amount IBC paid to cover claimant’s medical expenses prior to the WCJ’s benefit determination.”
The board also overturned the judge’s ruling that only some of the firefighter’s medical expenses related to the cancer diagnosis were subject to reimbursement because they came before a law was passed on July 7, 2011, “which designated cancer in firefighters as an occupational disease.”
The board and the Commonwealth Court agreed that all of the expenses in question were reimbursable.
“On appeal, the city argues that, as a matter of law, IBC’s lien can only attach to medical expenses incurred after the effective date of Act 46,” the Commonwealth Court ruling said.
“Accordingly, IBC, as claimant’s health insurer, cannot claim a lien for medical expenses paid on account of services rendered prior to July 7, 2011, even though the services related to claimant’s work-related cancer.”
The Commonwealth court said Act 46 applies to anyone who files a claim after the effective date of the law, which the firefighter did.
The city also said the Statement of Benefits produced as evidence by the insurer was not enough to “support the existence and amount of IBC’s subrogation lien,” according to the court ruling.
However, aside from limited redactions that were agreed to by both sides, the court said the city did not object to the statement as hearsay at the hearing before the Workers’ Compensation judge, nor did it “raise any of the issues with respect to exhibit I-1 that it attempted to raise before the board and now before this court.”