Does an employer’s payment of medical bills constitute an admission of liability?

by Steven Tregea

Question: Does an employer’s payment of medical bills constitute an admission of liability?

Recently the Commonwealth Court handed down a ruling in Securitas Security Systems USA v. WCAB (Schuh).  The ruling dealt with whether an employer’s payment of medical expenses constituted an admission of liability such that the employer was estopped from denying  liability of an injury.

The claimant, Schuh, injured her low back in a work-related accident. She was paid benefits for the November 30, 2004 injury.  The Notice of Compensation Payable described the injury as a “lower back strain”.

Approximately one year later, claimant began treating with a psychiatrist for depression.  After a number of months, employer filed for utilization review.  The UR peer determined that all care was reasonable and necessary.  The employer did not file an appeal to this decision.

One year later, in July of 2007, claimant filed a review petition seeking to amend the NCP to include the diagnosis of depression and anxiety. Employer denied the allegations.  Claimant did not testify or present any evidence…instead, claimant simply averred that the employer “was estopped from denying liability for the phychological injuries by virtue of the unappealed UR determination.  The Judge and Board agreed with this argument, the Commonwealth Court reversed.

The Court rejected the idea that collateral estoppel applied.  The court insisted that the issue before it was different than that which was determined by the UR peer.  The Court went on to note that an employer’s voluntary payment of employee’s medical expenses is NOT an admission of liability.  The court also noted that neither precedent nor regulations provide “that the mere filing of a UR request imposes liability on an employer for a specific injury”.

It is important that if you are receiving workers’ compensation benefits for an injury but you later develop other injuries such as depression, that you make sure that the later developed injury becomes part of the NCP so that the employer becomes liable to pay for those medical bills.

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