Court Opinion

ID: 9765224
Source: CourtListenerOpinion
Date Created: 2023-08-29 03:56:47.629611+00
Date Added: 2024-06-11T12:54:04.007424
License: Public Domain

CONCURRING AND DISSENTING OPINION BY
Judge FRIEDMAN.
I agree with the majority that penalties may not be assessed against the Workers’ Compensation Security Fund (Security Fund),1 and, therefore, I concur in part with the majority opinion. However, I also dissent in part because I disagree with the majority that penalties may not be assessed against Constructo Temps, Inc. (Employer) because it obtained insurance.
Despite stating that “penalties are not workers’ compensation benefits!,]” (majority op. at 57), the majority, nevertheless, begins its analysis “by examining the compensation provisions of the [Workers’ Compensation] Act [ (Act)2], found in Article III, which is titled ‘Liability and Compensation[,]’” (majority op. at 60). The majority relies on these provisions to conclude that once an employer has insured its liability with an insurance company, the insurance company has assumed all of the employer’s liability under the Act, including liability for penalties.3 (Majority op. at 60-62.) Implicit in that conclusion is that “liability” always includes both compensation and penalties. However, the issue before us is whether the Workers’ Compensation Appeal Board (WCAB) properly affirmed the workers’ compensation judge’s (WCJ) grant of Gregory Tennant’s (Claimant) penalty petition against Employer; therefore, article IV, entitled Procedure, rather than article III, of the Act controls.4
In article IV, section 435(d)(i) of the Act provides, “Employers and insurers may be penalized ....”5 Article IV, section 401 of the Act states,
The term “employer,” when used in this article, shall mean the employer as defined in article one of this [A]ct, or his duly authorized agent, or Ms insurer if such insurer has assumed the employer’s liability or the [State Workmen’s Insurance] [F]und if the employer be insured therein.
77 P.S. § 701 (emphases added). Under this definition, “employer” only can refer *65to Employer itself or to Employer’s “insurer if such insurer has assumed the employer’s liability.” 77 P.S. § 701 (emphases added). The majority and I agree that the Security Fund is not Employer’s insurer for the purpose of paying penalties under article TV of the Act. Additionally, because Reliance Insurance Company (Reliance) is insolvent and is no longer able to assume Employer’s liability, it no longer should be considered Employer’s insurer under this definition. This leaves only Employer, and, pursuant to the plain language of section 435(d)(i) of the Act, “[e]m-ployers ... may be penalized.” 77 P.S. § 991(d)(1). Where the Act permits penalties to be imposed on an employer or an insurer, and the insurer is no longer able to satisfy the liability it has assumed, the “ ‘claimant[ ] [should be] in the same position that [he or she] would have been in if the liability insurer had not become insolvent.’ ” American States Insurance Company v. State Auto Insurance Company, 721 A.2d 56, 62 (Pa.Super.1998) (quoting Luko v. Lloyd’s London, 393 Pa.Super. 165, 573 A.2d 1139, 1143, appeal denied, 526 Pa. 636, 584 A.2d 319 (1990)). Consequently, I believe Employer may be penalized for any violation of the Act.6
Even assuming that the majority properly considered Article III of the Act, my reading of section 306(f.1) and this court’s decision in Twyman v. Workers’ Compensation Appeal Board (Pennsylvania Department of Transportation), 720 A.2d 780 (Pa.Cmwlth.1998), suggests that a penalty may be imposed on an employer for a failure to pay for medical treatment. Section 306(f.1) of the Act provides that “[t]he employer shall provide payment in accordance with this section for reasonable surgical and medical services, services rendered by physicians or other health care providers, ... as and when needed.” 77 P.S. § 531(l)(i) (emphasis added). In Twyman, this court relied on identical language to support the imposition of penalties against the employer, the Pennsylvania Department of Transportation (DOT).7
In Twyman, the claimant filed a penalty petition, alleging that DOT faded to reimburse him for the cost of an orthopedic bed and to pay other medical bills related to his work injury. The WCJ concluded that DOT violated the Act, and, consequently, the WCJ granted Claimant’s penalty petition and assessed penalties against DOT. On appeal, the WCAB reversed based upon its conclusion that some of the bills were paid and that there was confusion between DOT’S insurer, the State Workmen’s Insurance Fund (SWIF), and the third party administrator, Pennsylvania Insurance Management Company (PIM-CO), as to who should have paid the bills.8
*66On appeal from the WCAB’s order, this court reversed, relying on section 306(f) of the Act, which provided that “the employer shall provide payment ... as and when needed.... ” Twyman, 720 A.2d at 786 (emphasis in original). The court also noted its prior holding that “ ‘an employer has an ‘absolute duty’ to pay a claimant’s medical bills until a [WCJ] determines that liability no longer exists.’ ” Id. (quoting Listino v. Workmen’s Compensation Appeal Board (INA Life Insurance Co.), 659 A.2d 45, 47 (Pa.Cmwlth.1995)).9 Additionally, in Twyman, the court reasoned that where a claimant or provider has complied with the Act and an employer’s failure to make timely payment is caused by the insurance carrier, it would be unfair to penalize Claimant’s credit rating and future treatment with his medical providers by excusing the employer’s illegal delays. See Twyman. Finally, the court stated that under the Act, the employer, per se, is primarily liable for the payment of a claimant’s medical expenses, and an employer should not be able to use an insurer’s actions to shield the employer from its responsibility.10 Accordingly, this court held that it was erroneous for the WCAB to conclude that DOT did not violate the Act, and this court reinstated the WCJ’s assessment of penalties against the employer, DOT. Twyman.
Similarly, here, the parties do not dispute that there was a violation of the Act based on a failure to timely pay for medical treatment related to Claimant’s work injury. Because Employer has an absolute duty to pay for Claimant’s causally related medical treatment11 and because it is “[E]mployer, per se, [who] is primarily liable” for Claimant’s medical treatment,12 I believe the WCAB properly affirmed the WCJ’s imposition of penalties against Employer. Thus, I would affirm the WCAB’s order with respect to Employer.
Judge SMITH-RIBNER joins in this concurrence and dissent.

. In addition to relying on the holding in Luvine v. Workers' Compensation Appeal Board (Erisco Industries), 881 A.2d 72 (Pa.Cmwlth.2005), I also would conclude that the Security Fund lacks the authority to pay penalties. The Security Fund was created and is authorized by its statutory language to pay only "valid claims for compensation.” Sections 3 and 11(1) of the Workers’ Compensation Security Fund Act (Security Fund Act), Act of July 1, 1937, P.L. 2532, as amended, 77 P.S. §§ 1053, 1061(1) (emphasis added).

. Act of June 2, 1915, P.L. 736, as amended, 77 P.S. §§ 1-1041.4, 2501-2626.

. As additional support for its position, the majority states that subsections 2 and 4 of section 11 of the Security Fund Act, 77 P.S. § 1061(2), (4), preclude the Insurance Commissioner from seeking payment from an employer. (Majority op. at 57.) However, the majority's reliance on those sections is misplaced. Those sections of the Security Fund Act address the Security Fund’s subrogation rights where the Security Fund has paid an award of compensation. See 77 P.S. § 1061(2) and (4); (Majority op. at 57, 61). This case deals with an award of penalties. Because, under this court’s holding here and in Luvine, the Security Fund cannot pay an award for penalties, any sections of the Security Fund Act which address the Security Fund’s subrogation rights are inapposite in this context.

. Penalties are procedural measures for enforcing provisions of the Act, as well as rules, regulations and rules of procedure. See section 435(d) of the Act, 77 P.S. § 991(d).

. Section 435(d)(i) of the Act, added by section 3 of the Act of February 8, 1972, P.L. 25, as amended, 77 P.S. § 991(d)(1) (emphasis added).

. As between a claimant who otherwise would be awarded penalties were the insurer solvent and an employer, the employer, rather than the claimant, should bear the burden of the insurer’s, or its successor's, violation of the Act.

. I note that, in Twyman, the WCJ found that DOT violated section 306(f) of the Act, 77 P.S. § 531, which has since been replaced by section 306(f.1), containing identical language.

. DOT was insured for workers’ compensation purposes through SWIF, and SWIF used PIMCO on all of its state cases as its third party administrator (TPA). Twyman, 720 A.2d at 782 n. 3. We note that one of the WCJ’s findings in Twyman stated that DOT was self-insured; however, that same finding went on to state that the defendants in the matter, DOT and SWIF, were directed to pay compensation and that the claimant's medical providers billed the proper insurer, whose TPA was PIMCO. Id. at 785 n. 11. Thus, to the degree that the finding stated that DOT was self-insured, it is clear from the remainder of the opinion that this was error because DOT was insured through SWIF. I further note that SWIF is expressly included within both the definition of "insurer” and "employer” in section 401 of the Act, 77 P.S. § 701.

.I recognize that Listino discussed the concept of an "absolute duty” by relying on Stonebraker v. Workmen’s Compensation Appeal Board (Seven Springs Farm, Inc.), 163 Pa.Cmwlth. 468, 641 A.2d 655 (1994), and that Stonebraker was abrogated by statute and correspondingly limited by Listino. Although an employer's duty to pay for medical treatment has now been limited in certain circumstances, both the Act and the court in Listino make it clear that where, as here, an employer unilaterally stops paying a claimant’s medical bills based on its belief that the treatment was not causally related to the work injury, and a WCJ later determines that the employer was liable for that treatment, the employer's duty to pay the bills is absolute, and, in such a situation, the WCJ may assess penalties. See 77 P.S. § 531(1)(i); Listino.

. Twyman; see American States Insurance Company.

. Twyman; see Listino.

. Twyman, 720 A.2d at 786; see section 306(f.1) of the Act, 77 P.S. § 531(1)(i) (stating that "employer shall provide payment ... for medical services ... as and when needed").