Section 127.203. Medical bills—submission of medical reports

(a) Providers who treat injured employees are required to submit periodic medical reports to the employer, commencing 10 days after treatment begins and at least once a month thereafter as long as treatment continues. If the employer is covered by an insurer, the provider shall submit the report to the insurer.

(b) Medical reports are not required to be submitted in months during which treatment has not been rendered.

(c) The medical reports required by subsection (a) shall be submitted on a form prescribed by the Bureau for that purpose. The form shall require the provider to supply, when pertinent, information on the claimant’s history, the diagnosis, a description of the treatment and services rendered, the physical findings and the prognosis, including whether or not there has been recovery enabling the claimant to return to pre-injury work without limitations. Providers shall supply only the information applicable to the treatment or services rendered.

(d) If a provider does not submit the required medical reports on the prescribed form, the insurer is not obligated to pay for the treatment covered by the report until the required report is received by the insurer.

Notation

Notes of Decisions

Medical Reports

An employeer is only responsible to pay reasonable and necessary medical bills when submitted in the manner prescribed by the act and regulations, which includes the requirement that provider file periodic reports with the employer on an approved form. Budd Co. v. W.C.A.B. (Kan), 858 A.2d 170 (Pa. Cmwlth. 2004).

The Commonwealth Court remanded to the Workers’ Compensation Appeal Board with instructions that the Board remand to the Workers’ Compensation Judge to give the health care provider an opportunity to submit his medical bills on the forms mandated by Act 44, where the regulations reinforce the obligation of the provider to submit his bill on the proper form before payment will be made and, moreover, the regulations require that medical reports be submitted before payment is due. AT&T v. Workers’ Compensation Appeal Board (Dinapoli), 728 A.2d 381 (Pa. Cmwlth. 1999); appeal denied 829 A.2d 311 (Pa. 2003).

Cross References

This section cited in 34 Pa. Code § 127.130 (relating to special reports).