Court Opinion

ID: 9396665
Source: CourtListenerOpinion
Date Created: 2023-05-23 15:07:56.884258+00
Date Added: 2024-06-11T17:19:18.722114
License: Public Domain

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Harburg Medical Sales Company,           :
                 Petitioner              :
                                         :
             v.                          :
                                         :
State Workers’ Insurance Fund            :
(Bureau of Workers’ Compensation         :
Fee Review Hearing Office),              :   No. 579 C.D. 2022
                  Respondent             :   Submitted: February 10, 2023

BEFORE:      HONORABLE PATRICIA A. McCULLOUGH, Judge
             HONORABLE ANNE E. COVEY, Judge
             HONORABLE STACY WALLACE, Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY
JUDGE COVEY                                          FILED: May 23, 2023

             Harburg Medical Sales Company (Harburg) petitions this Court for
review of the Bureau of Workers’ Compensation, Fee Review Hearing Office’s
(Bureau) June 1, 2022 order granting the State Workers’ Insurance Fund’s (SWIF)
Motion to Dismiss (Motion to Dismiss) Harburg’s applications for fee review
(Applications), and dismissing claim numbers 614953, 617268, 617766, and
620132. Harburg presents one issue for this Court’s review: whether the Bureau
erred by granting SWIF’s Motion to Dismiss. After review, this Court affirms.
             On December 13, 2004, Derrick Curtis (Curtis) was injured in the
course and scope of his employment with Recycle Metals Corporation. Harburg
filed the Applications to determine the appropriateness of payments SWIF made for
durable medical equipment supplies it provided to Curtis, specifically, for its bills
generated for the following service dates: April 20, April 28, June 6, July 31, and
August 3, 2021. Medical Fee Hearing Officer Derrick Coker (Hearing Officer
Coker) held hearings on October 14, 2021, and April 11 and May 12, 2022. On
October 14, 2021, SWIF orally made the Motion to Dismiss, relying on Harburg
Medical Sales Co. v. PMA Management Corp. (Pa. Cmwlth. No. 635 C.D. 2020,
filed Aug. 30, 2021), wherein this Court held that Harburg was not a health care
provider within the meaning of Section 109 of the Workers’ Compensation Act
(Act),1 and, therefore, lacked standing to invoke the Bureau’s fee review process.
                On May 12, 2022, the parties jointly offered, and Hearing Officer Coker
admitted, into evidence: Medical Fee Hearing Officer David Torrey’s (Hearing
Officer Torrey) June 15, 2020 decision (ruling that Harburg “failed to meet the
burden of proof required to demonstrate that it is a health care provider under the
Act”), Reproduced Record (R.R.) at 16a; this Court’s Unreported Memorandum
Opinion, Harburg Medical Sales Co.; and the Pennsylvania Supreme Court’s March
31, 2022 Order (denying Harburg’s appeal in Harburg Medical Sales Co.). R.R. at
29a. On June 21, 2022, the Bureau granted SWIF’s Motion to Dismiss and dismissed
claim numbers 614953, 617268, 617766, and 620132. Harburg appealed to this
Court.2

       1
         Act of June 2, 1915, P.L. 736, as amended, added by Section 3 of the Act of July 2, 1993,
P.L. 190, 77 P.S. § 29. Section 109 of the Act, defines a “health care provider” as:
                [A]ny person, corporation, facility or institution licensed or
                otherwise authorized by the Commonwealth to provide health care
                services, including, but not limited to, any physicians, coordinated
                care organization, hospital, health care facility, dentist, nurse,
                optometrist, podiatrist, physical therapist, psychologist,
                chiropractor or pharmacist and an officer, employee or agent of
                such person acting in the course and scope of employment or
                agency related to health care services.
77 P.S. § 29.
       2
                This Court’s scope of review of a decision by the [Bureau]
                determines whether the necessary findings of fact are supported by
                substantial evidence, whether constitutional rights were violated,
                                                  2
              Harburg argues that Hearing Officer Coker erred by granting the
Motion to Dismiss because SWIF did not offer any evidence that Harburg was not a
provider under the Act or the Board’s Regulations. Harburg contends that Harburg
Medical Sales Co. dealt with service dates and circumstances which existed prior to
2019, and SWIF offered no evidence that Harburg was not a provider as defined in
the Act or the Board’s Regulations on the dates when the services in question were
provided.3 SWIF rejoins that the Applications were properly dismissed pursuant to
Hearing Officer Torrey’s June 15, 2020 decision determining that Harburg was not
a health care provider under the Act, which this Court affirmed. See Harburg Med.
Sales Co.
              Because the issue of whether Harburg is a health care provider under
the Act has been previously litigated and decided by this Court, see Harburg Medical
Sales Co., this Court must determine whether res judicata or collateral estoppel
applies herein in order to determine whether the Bureau erred in granting SWIF’s
Motion to Dismiss.

              Res judicata - literally, a thing adjudicated - is a judicially[
              ]created doctrine. See Est[.] of Bell, . . . 343 A.2d 679, 681
              ([Pa.] 1975). It bars actions on a claim, or any part of a
              claim, which was the subject of a prior action, or could
              have been raised in that action. See R/S Fin[.] Corp. v.
              Kovalchick, . . . 716 A.2d 1228, 1230 ([Pa.] 1998); Balent

              and whether the hearing officer committed an error of law. 2 Pa.C.S.
              § 704; Walsh v. Bureau of Workers’ Comp[.] Fee Rev[.] Off[.]
              (Traveler’s Ins[.] Co.), 67 A.3d 117, 120 n.5 (Pa. Cmwlth. 2013).
              Regarding questions of law, our scope of review is plenary and our
              standard of review is de novo.
Armour Pharmacy v. Bureau of Workers’ Comp. Fee Rev. Hearing Off. (Wegman’s Food Mkts.,
Inc.), 206 A.3d 660, 664 n.2 (Pa. Cmwlth. 2019).
        3
          Harburg does not proffer any reason or evidence that the service dates at issue would
change the analysis of whether Harburg is a health care provider. Its only claim is that, because
the dates of service are different, SWIF should be required to prove that it is not a health care
provider under the Act.
                                               3
            v. City of Wilkes-Barre, . . . 669 A.2d 309, 313 ([Pa.]
            1995). Th[e Pennsylvania Supreme] Court has explained
            that
                [r]es judicata, or claim preclusion, prohibits
                parties involved in prior, concluded litigation from
                subsequently asserting claims in a later action that
                were raised, or could have been raised, in the
                previous adjudication.       The doctrine of res
                judicata developed to shield parties from the
                burden of re-litigating a claim with the same
                parties, or a party in privity with an original
                litigant, and to protect the judiciary from the
                corresponding inefficiency and confusion that re-
                litigation of a claim would breed.
            Wilkes ex rel. Mason v. Phoenix Home Life Mut. Ins. Co.,
            . . . 902 A.2d 366, 376 ([Pa.] 2006) (citation omitted); see
            also R/S Fin[.], . . . 716 A.2d at 1230 (“The purposes of
            the rule are the protection of the litigant from the dual
            burden of relitigating an issue with the same party or his
            privy and the promotion of judicial economy through
            prevention of needless litigation.” (Quoting Foster v. Mut.
            Fire, Marine & Inland Ins. Co., . . . 676 A.2d 652, 661
            ([Pa.] 1996))).
            Four elements common to both actions, sometimes termed
            the “four identities,” see, e.g., Est[.] of Tower, . . . 343
            A.2d 671, 674 ([Pa.] 1975), must be present for res
            judicata to apply: “an identity of issues, an identity of
            causes of action, identity of persons and parties to the
            action, and identity of the quality or capacity of the parties
            suing or being sued.” In re Iulo, . . . 766 A.2d 335, 337
            ([Pa.] 2001) (citing Safeguard Mut. Ins. Co. v.
            Williams, . . . 345 A.2d 664, 668 ([Pa.] 1975)).
In re Coatesville Area Sch. Dist., 244 A.3d 373, 378-79 (Pa. 2021).
            Collateral estoppel is similar in that it bars re-litigation of
            an issue that was decided in a prior action, although it does
            not require that the claim as such be the same. For
            example, if, in a breach of contract action, the defendant
            asserts that the contract is invalid because of fraud, but the
            contract is ruled valid and the defendant is found liable, in
            a future lawsuit against the same party alleging a separate
            breach of the same contract the defendant is precluded
                                          4
              from asserting the invalidity of the contract based on
              fraud. See RESTATEMENT (SECOND) OF JUDGMENTS §
              27, cmt. a, illus. 2 ([Am. Law Inst.] 1982).
              Collateral estoppel will only apply where: the issue is the
              same as in the prior litigation; the prior action resulted in
              a final judgment on the merits; the party against whom the
              doctrine is asserted was a party or in privity with a party
              to the prior action; and the party against whom the doctrine
              is asserted had a full and fair opportunity to litigate the
              issue in the prior action. See Rue v. K-Mart Corp., . . . 713
              A.2d 82, 84 ([Pa.] 1998). In some renditions, courts add a
              fifth element, namely, that resolution of the issue in the
              prior proceeding was essential to the judgment. See, e.g.,
              Off[.] of Disciplinary Couns[.] v. Kiesewetter, . . . 889
              A.2d 47, 50-51 ([Pa.] 2005).
              Collateral estoppel is premised on practical considerations
              that overlap substantially with those of res judicata. These
              include avoiding the “cost and vexation” of repetitive
              litigation, conserving judicial resources, “and, by
              preventing inconsistent decisions, encourag[ing] reliance
              on adjudication.” Id. . . . at 51.

Coatesville, 244 A.3d at 379 (italics added).
              Here, res judicata cannot apply because SWIF was not a party to the
prior action. However, all five collateral estoppel elements are met: (1) the issue in
both actions was whether Harburg is a health care provider under the Act; (2) the
prior action resulted in a final judgment on the merits; (3) Harburg was a party to the
prior action; (4) Harburg had a full and fair opportunity to litigate the issue; and (5)
the resolution of the issue was essential to the judgment in the prior action. Because
collateral estoppel applies, re-litigation of whether Harburg is a health care provider
under the Act is barred. Accordingly, the Bureau properly granted SWIF’s Motion
to Dismiss.

                                           5
For all of the above reasons, the Bureau’s order is affirmed.

                          _________________________________
                          ANNE E. COVEY, Judge

                            6
            IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Harburg Medical Sales Company,         :
                 Petitioner            :
                                       :
            v.                         :
                                       :
State Workers’ Insurance Fund          :
(Bureau of Workers’ Compensation       :
Fee Review Hearing Office),            :   No. 579 C.D. 2022
                  Respondent           :

                                   ORDER

            AND NOW, this 23rd day of May, 2023, the Bureau of Workers’
Compensation, Fee Review Hearing Office’s June 1, 2022 order is affirmed.

                                    _________________________________
                                    ANNE E. COVEY, Judge