IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Indemnity Insurance Company of :

North America and Sedgwick Claims :

Management Services, Inc., :

Petitioners :

: No. 1767 C.D. 2019

v. :

: Submitted: September 15, 2020

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 11, 2019 final determination of a hearing officer (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 Claimant suffered 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 

amount as delineated in the statutory provisions that cap 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 arm became stuck in a 

conveyor belt. Emergency Medical Services (EMS) transported Claimant by 

ambulance to Provider’s emergency department (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 right fourth finger. The 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 was 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 rate was 16; and his Glasgow Coma Scale score was 15. Dr. Phillips
3

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. Phillips’ 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 forearm. (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 

Claimant with a right forearm crush injury with superficial skin abrasions. (F.F. No. 

9.d.) According to the medical charts, at 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, on February 6, 2019, at 6:09 a.m., Dr. Phillips 

reexamined Claimant and observed the following: Claimant had undergone hourly 

neurovascular checks overnight; it was unlikely that he would develop compartment 
4

syndrome; the numbness on the tip of Claimant’s fourth digit was minimal; 

Claimant’s lower right arm was dressed with gauze; and the dorsal and volar 

compartments of the forearm were soft and there 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 discharged to home. (F.F. No. 11.a.-e.)

Claimant was reexamined by Dr. Miller at 6:23 a.m. Claimant 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 persistent 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 again, this time by Susan 

McCauley, R.N. (Nurse McCauley), who observed that Claimant could selfreposition, 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 

documenting Claimant’s discharge diagnosis, it was noted that Claimant was 

admitted to the trauma center the day before in stable condition; his creatine 
5

phosphokinase (CPK) was within normal limits; Claimant remained intact on a 

neurovascular level; and his pain 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 Claimant 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 application for fee review with the Bureau, pursuant to section 

306(f.1) of the Workers’ Compensation Act (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 services rendered to Claimant did not meet the criteria of the 

trauma guidelines as defined in section 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 be made in accordance with the Workers’

Compensation Fee Schedule. (F.F. Nos. 16.a. n.4, 17.a.-c.)

Thereafter, on May 30, 2019, Provider filed a request to contest the 

Bureau’s fee review determination and, pursuant to 34 Pa. Code §127.259 (relating to 

fee review hearings), the request 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 the American College of Surgeons’ (ACS) 

triage 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 center or burn facility, 

shall be at the provider's usual and customary charge for the treatment 

and services rendered.

(d) The determination 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 personnel 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 definitions of a “crush injury” in medical dictionaries. (F.F. Nos. 

20.a.-e., 21.) Insurer 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 Medical Center v. Bureau of Workers’ Compensation Fee Review Hearing 

Office (Pa. Cmwlth., No. 648 C.D. 2018, filed April 3, 2019) (unreported), as support 

for its position. (F.F. No. 22.a.-c.) Provider filed its written argument 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 section 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 patient with an immediately life-threatening or urgent injury). 

Based upon the evidence 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 specifically, the 

Hearing Officer found that Claimant met steps two and four of the ACS Guidelines, 
8

in that the Guidelines do not require that an additional injury be present to warrant 

transport to a trauma facility when a crush injury occurs, and the guidelines 

recommended transport to a trauma center when the patient is over 55 years old. 

Relying on the plain language of the ACS Guidelines, the Hearing Officer found that

Provider’s proffered medical definitions of a crush injury were irrelevant and further 

found that Insurer’s reliance on Crozer Chester 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. Ultimately, the Hearing Officer determined that Claimant 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 Provider’s application 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 charge 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 life-threatening or 

urgent injury under the regulations. Because the evidence established that Claimant’s 

injury satisfied this standard under the ACS Guidelines, 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 services rendered to

Claimant on February 5 and 6, 2019. (Conclusions of Law (COL) Nos. 1-5.)

Accordingly, by order dated December 11, 2019, the Hearing Officer 

vacated the May 8, 2019 administrative determination of the Bureau and ordered 
9

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 medical and 

scientific fact, Claimant did not 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 resulting 

from an applied force that compresses or squeezes tissues, causing damage such as 

compartment syndrome, dislocation, fracture, laceration, or nerve damage.” 

(Insurer’s Br. 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: “As 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 tissue 

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 whether the Hearing Officer’s findings 

are supported by substantial evidence and whether the Hearing Officer 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 Valley 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 

Chester, 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 fracture 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 

transport 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]laimant 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 elbow, 

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 the [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 found 
11

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 unit. 

Initially, we note that while 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 in accordance with the [ACS] [G]uidelines, payment for transportation 

to the trauma center . . . and payments for the full course of acute care services by all 

trauma center . . . personnel, and all individuals authorized to provide patient care in 

the trauma center . . . shall be at the provider’s usual and customary charge for the 

treatment 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 Health 

Systems 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 

conflicting evidence. 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 the 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 personnel 

that an injury is immediately life-threatening or urgent shall be presumptive of the 

reasonableness and necessity of the transport to a trauma center unless there is clear 

evidence of violation of the ACS Guidelines. Id.; see Roman Catholic Diocese of

Allentown, 33 A.3d at 699. Significantly, this same regulation states that “[t]he 

determination 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 

information available at the time of the initial assessment of the patient.” 34 Pa. 

Code §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 

Guidelines 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 id.

Here, the Hearing Officer found that Claimant sustained a crush injury to 

an extremity, i.e., the right arm, and this finding is supported by substantial evidence. 

When EMS personnel originally assessed Claimant, they observed that Claimant’s 

right hand was “dusky,” that is, exhibiting bluish 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 the EMS personnel is entitled to a 

presumption of 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 the trauma/neuro intensive care 

unit with a diagnosis of “crush injury, arm, right.” (R.R. at 57a.) Subsequent 

evaluations by other physicians and medical personnel, including a plastic surgeon,

confirmed that Claimant sustained a crush injury. (R.R. at 86a, 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 establishing, 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 crush 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, slip 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 injury was not a “crush injury” 

because it “was not pulseless, crushed, degloved, or mangled” and did not show any 

evidence of compartment syndrome or neurovascular structural damage. Id., slip op. 

at 18.

In essence, 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 diagnosis that includes a 

broken, or at least fractured bone in an extremity. 

However, in the course of this argument, Insurer fails to recognize the 

distinguishing feature of Crozer Chester in its comparison to the facts of this case. In

Crozer Chester, the parties offered competing expert medical testimony on the issue
15

of whether the claimant’s injury constituted a life-threatening or urgent injury for 

purposes of the trauma center exemption, 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 on 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, the Hearing Officer noted the language of step two of 

the ACS Guidelines, which recommends transport to a trauma facility where there is 

a “crushed . . . extremity,” and found, based upon that language, that 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, the Hearing Officer found Insurer’s reliance on Crozer Chester 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

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

IV.) As such, the Hearing Officer found that Claimant met step two of the ACS 

Guidelines, in that he sustained a crush injury despite not sustaining any other injury, 

and 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 Crozer 
16

Chester. Although there may be debate within the medical community 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, 

however, 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 medical 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 

evidence, 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 in 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, applying 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 pay 
17

Provider its usual and customary charge for the treatment and services rendered to 

Claimant. 

Accordingly, we affirm. 

________________________________

PATRICIA A. McCULLOUGH, Judge
IN 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 16th day of October, 2020, the December 11, 2019 

final determination of a hearing officer of the Bureau of Workers’ Compensation 

Medical Fee Review Section is hereby affirmed. 

________________________________

PATRICIA A. McCULLOUGH, Judge