IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Indemnity Insurance Company of : North America and Sedgwick Claims : Management Services, Inc., :

Petitioner s :

: No. 1 767 C .D. 201 9
v. : : Submitted : September 15 , 20 20 Bureau of Workers’ Compensation , : Fee Review Hearing Office : (Lehigh Valley Hospital), :

Respondent :

BEFORE: HONORABLE MARY HANNAH LEAVITT, President Judge

HONORABLE PATRICIA A. McCULLOUGH, Judge HONORABLE ELLEN CEISLER, Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY JUDGE McCULLOUGH FILED: October 16, 2020

Indemnity Insurance Company of North America and Sedgwick Claims Management Services, Inc. (collectively, Insurer) petition for review from the
December 1 1 , 2019 fina l determination of a hearing o fficer (Hearing Officer) of the
Bureau of Workers’ Compensation Fee Review Hearing Office (Bureau), which
vacated an administrative decision by the Bureau and concluded that Lehigh Valley Hospital (Provider) was entitled to $50, 239.57, less the $5,135.97 Insurer previously paid, plus statutory interest, under the trauma center exemption for medical services provided to Thomas Woolever (Claimant). In vacating the Bureau’ s fee review determination, the Hearing Officer found that C laimant su ffered an immediately life

-2

threatening or urgent injury and, therefore, Insurer was obligated to reimburse Provider the full amount of its usual and customary charges as opposed to a lesser

a mount as delineated in the statutory provisions that ca p reimbursement rates and payments for medical services

.

Facts and Procedural History The relevant facts and procedural history, as found by the Hearing
Officer and based predominately on Claimant’s medical records , are as follows. On February 5, 2019, Claimant, who was 58 years old at the time, was injured while working for Nestle USA, Inc. (Employer) when his right ar m became stuck in a conveyor belt

. Emergency Medical Services (EMS) transported Claimant by
ambulance to Provider’ s emergency depa rtment (ER) as a trauma alert due to the crush injury and he arrived at 12:41 p.m. EMS reported that Claimant had lost approximately 50

- 100 milliliters of blood at the scene and that Claimant had a “dusky
hand

. ” EMS therefore put Claimant in a splint and administered 100 mcg of Fentanyl
in route to Provider. Upon arrival at the ER, Claimant reported that he immediately
felt pain in his right arm after it became stuck in the conveyor belt and numbness and mild pain in his r ight fourth finger

. T he attending physician, Dr. Rovinder Sandhu, M.D. (Dr. Sandhu), noted that Claimant’ s forearm was deformed and that he had
lacerations to both his forearm and hand. Claimant wa s admitted to the trauma center at 1:24 p.m. (Finding of Facts (F.F.) Nos. 1

- 4 .)

After Claimant’s admission , Dr. Haley Phillips, D.O. (Dr. Phillips) performed a physical examination of Claimant at 1:24 p.m. Claimant’ s temperature was 97.8 degrees Fahrenheit; his blood pressure was 161/80; his heart rate was 65; his respiratory rat e was 16; and h is Glasgow Coma Scale score was 15. Dr. Phillips3

noted that Claimant’ s right forearm was crushed inwards into his wrist and his right
hand was swollen between his first and second digits

. Claimant experienced, among other things, decreased sensation over his fourth distal finger, and he had multiple skin tears on his anterior and posterior forearm and anterior hand. An x

- ray revealed
that there was abnormal subcutaneous air along his right wrist, but no fracture
dislocation. Dr. Phillips ordered hourly neurovascular checks with vitals, due to Claimant being at a high risk of developing compartment syndrome ( i.e. , pressure build

- up), and later diagnosed Claimant with a “ crush injury ” to the right arm. (F.F.
Nos. 5

- 6.) Dr. Sandhu later signed an attestation agreeing with Dr. Phillip s’ medical findings and treatment plan. (F.F. No. 6 n.2.)

Claimant was then admitted to the trauma/neuro intensive care unit at
3:19 p.m. Shortly thereafter , Samantha Rabenold, R.N. (Nurse Rabenold), noted that
Claimant had diminished strength in his right upper extremity, minimal numbness at the tip of the right ring finger, and all of his pulses were palpable. She applied dressing to Claimant’ s abrasions and skin tears on his fore arm

. (F.F. Nos. 7

- 8.) Next, Claimant underwent a plastic, reconstructive, and hand surgery consultation
with Dr. Nathan Miller, M.D. (Dr. Miller), of the plastic surgery department at 4:32
p.m. Dr. Miller made a number of observations, (F.F. Nos. 9

. a.

- c.), and diagnosed
C laimant with a right forearm crush injury with superficial skin abrasions. (F.F. No. 9.d.) According to the medical charts, a t 4:56 p.m., Nurse Rabenold indicated that frequent neurovascular checks would continue as part of Claimant’ s treatment plan. (F .F. No. 10.)

The following morning, o n February 6, 2019, at 6:09 a.m., Dr. Phillips
reexamined Claimant and observed the following: Claimant had undergone hourly
neurovascular checks ove rnight; it was unlikely that he would develop compartment4

syndrome; the numbness on the tip of Claimant’ s fou rth digit was minimal; Claimant’ s lower right arm was dressed with gauze; and the dorsal and volar compartments of the forearm were soft and ther e were skin tears and abrasions. In addition, Dr. Phillips documented that Claimant’ s radial pulses were 2+; his right hand had normal sensation and 4/5 grip strength; and his pain was controlled with Fentanyl and Morphine and he was to start on oral pain medications. Dr. Phillips also
noted that Dr. Miller had recommended local wound care, sterile dressing, and a
follow

- up at the plastic surgery department

. Dr. Phillips opined that Claimant could
be discharge d to home

. (F.F. No. 11.a.

- e.)

Claimant was reexamined by Dr. Miller at 6:23 a.m. Claiman t reported his pain was not any worse and there was no increasing numbness or tingling in his
forearm or hand. Dr. Miller found that Claimant’ s condition was unchanged since the day before and , although there was persi stent swelling, Claimant displayed a full range of motion of his fingers and wrist. Dr. Miller noted that surgical intervention was not necessary and recommended that Claimant follow

- up with Claimant’s doctor after his discharge. (F.F. No. 12.a.

- c.)

At 8:00 a.m., Claimant was examined agai n , this time by Susan McCauley, R.N. (Nurse McCauley), who observed that Claimant could self

reposition, was able to wiggle his fingers, was somewhat edematous (swollen), and
denied sensations of pain and tingling. (F.F. No. 13.) Ultimately, Claimant was discharged at 2:42 p.m., on February 6, 2019, in good condition and was prescribed Tramadol for pain and triple antibiotic ointment for lacerations , and was further
advised to follow

- up with plastic surgery in two weeks. In the paperwork
docu menting Claimant’s discharge diagnosis , it was noted that Claimant was
admitted to the trauma center the day before in stable condition; his creatine5

ph osphokinase (CPK) was within normal limits; Claimant remained intact on a
neurovascular level; and his p ain was controlled during his admission. (F.F. No.
14

. a.

- c.) On February 19, 2019, Provider billed Insurer $50,239.57 for the treatment and services provided to Claimant on February 5 and 6. The bill indicated that acute care had been provided to Claima nt for an urgent or life

- threatening injury
and that Provider is an accredited trauma center. (F.F. No. 15.) On April 8, 2019, Provider filed a timely a pplication for f ee r eview with the Bureau, pursuant to s ection 306(f.1) of the Workers’ Compensation A ct (WC Act), 1 77 P.S. § 531, for the dates of service of February 5 and 6, 2019, contesting the amount of payment and the timeliness of payment. (F.F. No. 16.a.

- b.)

On May 8, 2019, the Bureau circulated an administrative determination,
in which it concluded that $5,135.97 was due to Provider for the treatment and services rendered to Claimant on the above dates, plus interest at the rate of 10% per annum, to be calculated from the date on which payment was due. The Bureau also
determined that the s ervi ces rendered to Claimant did not meet the criteria of the trauma guidelines as defined in s ection 127.128 of the Workers’ Compensation
Medical Cost Containment Regulations, 34 Pa. Code § 127.128

. 2 Consequently, the

1 Act of June 2, 1915, P .L. 736, as amended , 77 P.S. §§ 1

- 1041.1, 2501

- 2710.

2 Section 127.128(a), (c)

- (d) of the Workers’ Compensation Medical Cost Containment Regulations provides, in pertinent part, that:

(a) Acute care provided in a trauma center or a burn facility is exempt from the medical fee caps, and shall be paid based on 100% of usual and customary charges if the following apply:
(1) The patient has an immediately life

- threatening injury or urgent injury. (Footnote continued on next page...)6

Bureau ordered that payment shall b e made in accordance with the Workers’ Compensation Fee Schedule. (F.F. No s . 16.a. n.4, 17.a.

- c .)

Thereafter, on May 30, 2019, Provider filed a r equ est to c ontest the Bureau’s fee review d etermination and , pursuant to 34 Pa. Code §127.259 (relatin g to fe e review hearings), the r equest was assigned to the Hearing Officer

. Subsequently,

(continued...)

(2) Services are provided in an acute care facility that is one of the following:
(i ) A level I or level II trauma center, accredited by the Pennsylvania Trauma Systems Foundation under the Emergency Medical Services Act[, Act of July 3, 1985, P.L. 164, as amended , 35 P.S. §§ 6921

- 6938].

* * *
(c) If the patient is initially transported to the trauma center or burn facility in accordance with t he American College of Surgeons’ (ACS) triag e guidelines, payment for transportation to the trauma center or burn facility, and payments for the full course of acute care services by all trauma center or burn facility personnel, and all individuals authorized to provide patient care in the trauma ce nter or burn facility, shall be at the provider's usual and customary charge for the treatment and services rendered. (d) The det ermination of whether a patient’ s initial and presenting condition meets the definition of a life

- threatening or urgent injury shall be based upon the information available at the time of the initial assessment of the patient

. A decision by ambulance p ersonnel that an injury is life

- threatening or urgent shall be presumptive of the reasonableness and necessity of the transport to a trauma center or burn facility, unless there is clear evidence of violation of the ACS triage guidelines.
34 Pa. Code §127.128(a), (c)

- (d)

.7

the Hearing Officer held hearings , Provider introduced documentary evidence , and both parties submitted written argument. (F.F. Nos. 18

- 19.)

At the hearing, Provider presented evidence, including the 2011 ACS
Guidelines that are used for deciding whether a patient should be transported to a

trauma center and definition s of a “ crush inj ury” in medical d ictionaries

. (F.F. Nos.
20.a.

- e., 21.) In surer filed its written argument on November 5, 2019, averring, inter
alia , that Claimant’ s injury was neither urgent nor life

- threatening, and citing Crozer
Chester Medi cal Center v. Bureau of Workers’ Compensation Fee Review Hearing Office (Pa. Cmw l th., No. 648 C.D. 2018, filed April 3, 2019) (unreported), as support fo r its position. (F.F. No. 22.a.

- c.) Provider filed its written argumen t on November 26, 2019, asserting , in pertinent part, that Claimant’ s injuries met the trauma criteria and qualified for an exemption from the medical fee caps in the Workers’ Compensation Fee Schedule. (F.F. No. 23.a.

- e.)

In her decision , the Hearing Officer stated that the central issue in Provider’ s appeal was whether the treatment provided to Claimant was for an immediately life

- threatening or urgent injury, such that Provider is entitled to reimbursement at 100% of the usual and customary charges and not limited by the medical fee caps. See F.F. No. 2; see also s ection 306(f.1)(10) of the WC Act, 77 P.S. §531(10 ) (prescribing that a provider is entitled to its usual and customary charge for acute care in an acute care facility, accredited as a Level I or Level II trauma center, of a pati ent with an immediately life

- threatening or urgent injury). Based upon the e vidence presented, the Hearing Officer found that Claimant
sustained a “ crush injury ” at work on February 5, 2019, and his crush injury met the
criteria in the ACS Guidelines for transport to a trauma center. More s pecifically, the Hearing Officer found t hat Claimant met steps two and four of the ACS G uidelines,8

in that the G uidelines do not require that an additional injury be present to warrant transport to a trauma facility when a crush injury occurs, and the guidelines
recommend ed transport to a trauma center when the patient is over 55 years old. Relying on the plain language of the ACS G uidelines, the Hearing Officer found that Provider’ s proffered medical definition s of a crush injury were irrelevant and further
found that Insurer’ s reliance on Crozer Chest e r was misplaced and distinguishable , because, unlike the situation in Crozer Chester , there was no dispute in this case as to the mechanism of injury and neither Provider nor Insurer submitted expert medical testimony. Ultimatel y, t he Hearing Officer determined that Claiman t sustained an immediately life

- threatening or urgent injury on February 5, 2019, for purposes of the trauma center exemption under the WC Act. (F.F. No . 24.a.

- g.)

The Hearing Officer then noted that, because Pro vider’s a pplication was filed timely, Insurer bore the burden of proving by a preponderance of the evidence that it properly paid Provider $5,135.97 for the dates of healthcare services rendered

on February 5 and 6, 2019, rather than the Provider’s cha rge of $50,239.57. The Hearing Officer noted that acute care provided in a trauma center is exempt from the medical fee caps and that an insurer shall pay a provider at 100% of the provider’s
usual and customary charges if the patient has an immediately l ife

- threatening or urgent injury under the regulations. B ecause th e evidence established that Claimant’ s inj ury satisfied this standard under the ACS G uidelines, the Hearing Officer concluded that Insurer did not sustain its burden of proving that it properly reimbursed Provider the $5,135.97 for the treatment and serv ices rendered to Claimant on February 5 and 6, 2019. (Conclusions of Law (COL) Nos. 1

- 5.)

Accordingly, by or der dated December 11, 2019, the Hearing Officer
vacated the May 8, 2019 administrative determination of the Bureau and ordered9

reimbursement at 100% of Provider’ s billed amount of $50,239.57, less $5,135.97
Insurer previously paid, plus statutory interest on the unpaid portion of the bill, for
the treatment and services rendered to Claimant on February 5 and 6, 2019.

Insurer subsequently petitioned this Court for review. 3

Discussion Before this Court, Insurer basically argues that, as matter of medic al and scientific fact, Claimant did n ot sustain a “crush injury ” for purposes of the ACS
Guidelines. For support, Insurer quotes a medical definition submitted by Provider at the hearing , which defines a “crush injury” as “[t]rauma to body tissues result ing from an applied force that compresses or squeezes tissues, causing damage such as compartment syndrome, dislocation, fracture, laceration, or nerve damage.” (Insurer’s B r

. at 11.) Insurer then reasons as follows: “ Claimant did not have muscle
tissue damage, the lacerations were ‘superficial,’ the x

- rays showed no fracture or dislocation, there was no compartment syndrome, Claimant’ s pulse was 2+, his range
of motion was normal, and his strength was 5/5. ” (Insurer’s brief at 4.) Following this course of argument, Insurer continues: “A s indicated in the Claimant’ s discharge summary, Claimant’ s CPK was within normal limits. When muscle tissue is damaged
CPK leaks into the bloodstream. A normal CPK level indicates no muscle tissu e damage. Additionally, the medical records are clear that Claimant did not sustain compartment syndrome, dislocation, [or] fracture

. ” (Insurer’s Br. at 8.)

3 Our standard of review is limited to determining whe ther the Hearing Officer’ s f indings are supported by substantial evidence and whether the Hearing Of ficer erred as a matter of law or violated a party’ s constitutional rights. Roman Catholic Diocese of Allentown v. Bureau of Workers’ Compensation , Fee Review Hearing Office (Lehigh V alley Health Network) , 33 A.3d 691 , 696 n.5 (Pa. Cmwlth. 2011).10

Insurer also relies heavily on this Court’s unpublished decision in Crozer
Chest er , citing it for persuasive value and proffering the following analogy:

In the Crozer Chester case, the [c] laimant sustained a crush injury and a pelvic frac ture when a tractor pushed the [c] laimant to the ground and ran over the [c]laimant’ s right foot. In determining that the [c]laimant’ s injury was not a crush injury [,] the Court in Crozer Chester noted that the [c]laimant’ s foot “ was not pulseless, crushed, degloved or mangled.” In the Crozer Chester case, the [c]laimant’s right

- foot injury showed no evidence of compartment syndrome or neurovascular structural damage. Further, the [c] laimant in Crozer Chester had a Glasgow Coma scale of 15, meaning that he was alert and responsive. The Court noted that a Glasgow Coma Scale of less than 14 requires tr ansport to a trauma center under [s]tep [o] ne of the [ACS Guidelines]. Comparing the [c]laimant’ s injury in the Crozer Chester case to the case at hand, [] Claimant’ s injury in this case was a much less significant injury. For instance, the [c] laimant in Crozer Chester sustained a pelvic fracture and his right hand was fractured/dislocated requiring an open reduction and internal fixation, whereas [] Claimant in this case had no fractures or dislocations and did not require any surgery. Just as the [c] la imant in Crozer Chester , the Claimant in this case had 2+ pulse in his right upper extremity and his right upper extremity was not degloved or mangled. Rather, Claimant had 5/5 strength in the right upper extremity and full range of motion of his right el bow, wrist and digits. Importantly, the medical records show that Claimant’ s CPK level was within normal limits, an indicator that Claimant did not suffer damage to muscle tissue. Additionally, Claimant’ s Glasgow Coma Scale was 15, which is the same as t he [c] laimant in Crozer Chester

. (Insurer’s Br. at 11

- 12.)

Furthermore, for juxtaposition, Insurer cites Roman Catholic Diocese of Allentown v. Bureau of Workers’ Compensation, Fee Review Hearing Office (Lehigh Valley Health Network) , 33 A.3d 691 (Pa. Cmwlth. 2011), in which this Court found11

that the claimant met the requirements of the trauma center exception to the medical fee caps, where x

- rays found that the claimant sustained two unstable spinal fractures and was placed in an intensive care u nit.

Initially, we note that w hile payments for medical treatment are usually capped under the WC Act and made in accordance with the scales and rates enumerated in the applicable regulations and the Workers’ Compensation Fee
Schedule , section 306(f.1) (10) of the WC Act contains what is known as the “trauma center exception.” In pertinent part, section 306(f.1)(10) states that “ [i] f acute care is provided in an acute care facility to a patient with an immediately life threatening or urgent injury by a Level I or Level II trauma center

. . . the amount of payment shall be the usual and customary charge. ” 77 P.S. §531(10)

. Relatedly, the regulation at 34 Pa. Code §127.128(c) provides that “ [i]f the patient is initially transported to the
trauma center i n ac cordance with the [ACS] [G] uidelines, payment for transpo rtation
to the trauma center . . . and payments for the full course of acute care s ervices by all

trauma center . . . personnel, and all individuals authorized to provide patient care in
the trau ma center . . . shall be at the provider’ s usual and customary charge for the

t reatment and services rendered.” 34 Pa. Code § 127.128(c)

.

In workers’ compensation cases, matters of credibility and evidentiary weight are within the sole province of the fact

- finder. Pittsburgh Mercy H ealth Sys tems v. Bureau of Workers’ Compensation, Fee Review Hearing Office (U.S. Steel Corp.) , 980 A.2d 181 , 184

- 85 (Pa. Cmwlth. 2009). We will not reweigh the evidence or substitute our credibility determinations for those of the hearing officer. Id. at 185. Further, it is irrelevant whether the record contains evidence to support findings other
than those made by the fact

- finder; the critical inquiry is whether there is evidence to support the findings actually made. See A & J Builders, Inc. v. Workers’12

Compensation Appeal Board (Verdi) , 78 A.3d 1233 , 1238 (Pa. Cmwlth. 2013). In making such a determination ,

[w] e examine the entire record to see if it contains evidence a reasonable person might find sufficient to support the [] findings. If the record contains such evidence, the findings must be upheld, even though the record may contain
co nflicting evide nce. Additionally, we must view the evidence in the light most favorable to the prevailing party and give it the benefit of all inferences reasonably deduced from the evidence. Id. at 1238

- 39.

In a fee review proceeding, an employer or its insurer has th e burden of proving by a preponderance of the evidence that it properly reimbursed a provider of
medical services. 34 Pa. Code §127.259(f); Roman Catholic Diocese of Allentown , 33 A.3d at 695

. Pursuant to 34 Pa. Code §127.128(d), a decision by EMS person nel that an injury is immediately life

- threatening or urgent shall be presumptive of the reasonableness and necessity of th e transport to a trauma center unless there is clear
evidence of violat ion of the ACS Guidelines

. Id. ; see Roman Catholic Dio cese of
Allentown , 33 A.3d at 699 . Significantly, this same regulation states that “ [t]he
det ermination of whether a patient’ s initial and presenting condition meets the definition of an immediately life

- threatening or urgent injury shall be based on the informa tion available at the time of the ini tial assessment of the patient .” 34 Pa.
Co de §127.128(d) (emphasis added). As pertinent to this case, step two of the ACS Guidelines states that an individual should be transported to a trauma center when that individual has a “ crushed , degloved, mangled, or pulseless extremity .” ( Reproduced Record (R.R.) at 25a ) (emphasis added). Also, step four of the ACS
Guid elines appear to recommend that, regardless of the nature of the injury sustained,13

an individual over the age of 55 should be transported to a trauma center due to an increase in the risk of injury and/or death. See i d.

Here, the Hearing Officer found th at Claimant sustained a crush injury to an extremity, i.e. , the right arm, and this finding is supported by substantial evide nce. When EMS personnel originally assessed Claimant, they observed that Claimant’s right hand was “dusky,” that is, exhibiting bl uish or purplish discoloration , noted that
Claimant had a “trauma alert/crush injury,” and documented that Claimant sustained
a “ crush injury of [the] right arm in a conveyer belt at work. ” (R.R. at 35a.) Under 34 Pa. Code §127.128(d) , the decision of th e EMS personnel is entitled to a presumption o f reasonableness unless Insurer can show a clear violation of the ACS
Guidelines. Insurer, however, did not submit any evidence to demonstrate that there was a violation of the ACS Guidelines. To the contrary , the evidence found credible by the Hearing Officer establishes that when Claimant was initially assessed by physicians of the trauma center upon his arrival at the hospital, the physicians identified the injury as a “crush/compression injury,” noting, among other things, that Claimant’s “[r] ight forearm [was] crushed inwards from posterior to anterior ” and
that there was “[a] bnormal subcutaneous air along the posterior aspect of the right
wrist. ” (R.R. at 36a.) Claimant was then admitted to th e trauma/neuro intensive care
unit with a diagnosis of “crush injury, arm, right.” (R.R. at 57a.) Subsequ ent evaluations by other physicians and medical personnel, including a plastic surgeon, confirmed that Claimant sustained a crush injury. (R.R. at 8 6a, 93a, 98a, 104a, 109a.) Indeed, in the discharge summary contained in Claimant’s medical records, it was indicated that his “admission diagnosis” was a “[c]rushing injury of right forearm ”
and “crush injury arm” and that his “discharge diagnosis” was “ crush injury arm, right.” (R.R. at 173a.)14

In light of this record, Insurer’s reliance on Crozer Chester is misplaced. In that case, the hearing officer found the report and testimony of the insurer’ s medical expert to be credible and persuasive in e stablishing , inter alia , that the claimant did not sustain a “crush injury” as referenced in step two of the ACS
Guidelines

. Specifically, the hearing examiner credited the testimony of the insurer’s medical expert that the claimant did not sustain a crus h injury because “ the external exams [of the claimant] did not note any bruising, laceration, or any real evidence that [the claimant’s] right

- foot injury was the result of a crush,” and rejected the provider’s evidence to the contrary. Crozer Chester , sl ip op. at 6

- 10. On appeal, this Court concluded that the hearing officer did not err in determining that the claimant’s injury was not immediately life

- threatening or urgent for purposes of the trauma center exemption. In doing so, we determined that the hearing officer’ s decision to reject the testimony of the provider’s physician that the claimant sustained a crush injury was supported by substantial competent evidence, i.e. , the credible testimony
of the insurer’s physician that the claimant’s foot inj ury was not a “crush injury” because it “was not pulseles s, crushed, degloved, or mangled” and did not show any evidence of compartment syndrome or neurovascular structural damage. Id. , slip op.
at 18.
In essen ce, Insurer maintains that Provider’s submitted medical
definition and Crozer Chester necessitate that , in order for there to be a primary diagnosis of “crush injury,” there must be a secondary diagnosi s that includes a broken, or at least fractured bone in an extremity

.

However, in the course of this argument, Insurer fails to recognize th e distinguishing feature of Crozer Chester i n its comparison to the facts of this case. In Crozer Chester , the parties offered competing expert medical testimony on the issue15

of whether the cla imant’s injury constituted a life

- threatening or urgent injury for purposes of the trauma center exem ption, and the hearing officer’s decision was based upon his credibility assessment pertaining to the medical experts’ opinions. Here, on the other hand, neither Insurer nor Provider offered expert medical testimony, and the Hearing Officer recognized as much in her decision. See F.F. No.
24.f.II. As there was no expert medical testimony presented in this case, the Hearing
Officer found as a fact, based o n the evidence that was presented to her, namely Claimant’s medical records, that there was no dispute that Claimant sustained a crush injury at work on February 5, 2019, when his arm got stuck in a conveyor belt. (F.F. No. 24.a.) In so determining, t he Hearing Officer noted the language of step two of
the ACS Guidelines , which recommends transport to a tr auma facility where there is
a “ crushed . . . extremity,” and found, based upon that language, t hat an additional injury, such as a fracture or compartment syndrome, is not required in order to warrant transport to a trauma facility when a crush injury occurs. (F.F. No. 24.b.) In addition, t he Hearing Officer found Insurer’ s reliance on Crozer Ches ter to be misplaced on the basis that there was no factual dispute that Claimant ’s medical
records demonstrated that he sustained a crush injury when his arm got stuck in the conveyor belt and Insurer did not submit any rebutting expert medical testimony

e xplaining why the injury could not be considered a “crush injury.” (F.F. No. 24.f.I.

- IV.) As such , the Hearing Officer found that Cla imant met step two of the ACS
G uidelines, in that he sustained a crush injury despite not sustaining any other injury,

an d further found that Provider’ s medical definitions were irrelevant on that basis. (F.F. No. 24.b., d.)

Upon review, we discern no error in the Hearing Officer’s interpretation and application of the ACS Guidelines or her assessment of our decision in Crozer16

Chester

. Although there may be debate within the medical communit y as to whether Claimant’ s injury was a crush injury, in the absence of a broken or fractured bone , it is not the role of this Court to determine the scientific validity of a medical diagnosis or to support one school of medical opinion and thought over another

. If Insurer desired to contest the notations and diagnoses in Claimant’s medical records stating that Claimant sustained a crush injury , Insurer could have provided expert testimony to contradict those notations and diagnoses or deposed the treating physicians to challenge the foundation and methodology of their medical opinions. Insurer,
ho wever, did not do so, and we reject its suggestion that Crozer Chester definitively decided the medical criteria needed to support a sound and medically acceptable diagnosis of a “crush injury.” Instead, it is up to a hearing officer, as trier of fact , to determine the credibility and weight of the medic al evidence and circumstances of the particular case to determine whether a claimant sustained a crush injury, and where, as here, the hearing officer’s finding in that regard is supported by substantial

ev idence, this Court must accept it irrespective of any evidence to the contrary. Notably, Claimant’s medical records demonstrated that he was consistently assessed and diagnosed with a crush injury from the moment the EMS arrived at the scene of the injury and committed an initial evaluation, to Claimant’s examinations at both the trauma center and the trauma/neuro intensive care unit, and, finally, in the medical documentation pertaining to his discharge from the hospital. Consequently, we find
no merit i n the arguments of Insurer insofar as they try to impugn Claimant’s diagnosis of a crush injury by highlighting any aspect of Claimant’s physical
conditions or overall well

- being at the time of his discharge. Therefore, a pplying our
well

- settled standard of review, this Court concludes that the Hearing Officer did not err in finding that Claimant sustained a crush injury and ordering Insurer to pay17

Provider its usual and customary charge for the treatment and services rendered to
Claimant. Accordingly, we affirm.

________________________________ PATRICIA A. McCULLOUGH, JudgeIN THE COMMONWEALTH COURT OF PENNSYLVANIA

Indemnity Insurance Company of : North America and Sedgwick Claims : Management Services, Inc., :

Petitioners :

: No. 1767 C.D. 2019
v. : : Bureau of Workers’ Compensation, : Fee Review Hearing Office : (Lehigh Valley Hospital), :

Respondent :

ORDER

AND NOW, this 16 th day of October , 20 20 , the December 1 1 , 2019 final determination of a hearing o fficer of the Bureau of Workers’ Compensation
Medical Fee Review Section is hereby affirmed.

________________________________ PATRICIA A. McCULLOUGH, Judge