PENNSYLVANIA WORKERS’ COMPENSATION
CASE SUMMARIES
6/1/2026 – 6/30/2026
MEDICAL FEE REVIEWS
PROVIDER’S FINANCIAL INTEREST IN A PHARMACY
700 Pharmacy v. Bureau of Workers’ Compensation Fee Review Hearing Office (State Workers’ Insurance Fund), (involving five (5) disputes, combined for appeal).
Supreme Court of Pennsylvania – Published Opinion
Decided: June 16, 2026
Issue:
Whether, because Section 306(f.1)(3)(iii) neither includes nor refers to prescription drugs or professional pharmaceutical services, is a pharmacy entitled to payment for prescription drugs and pharmaceutical services provided to a Claimant whose physician has a financial interest in the pharmacy?
Background:
The Pharmacy in which treating physicians held financial interests sought judicial review of decision by the Bureau of Workers’ Compensation Medical Fee Review Hearing Officer denying its fee review applications seeking payment for prescription drugs dispensed to injured workers whose employers’ insurance carrier refused payment, asserting prescriptions resulted from unlawful self-referrals under the Workers’ Compensation Act’s Anti-Referral Provision. The Commonwealth Court affirmed the Medical Fee Review Hearing Office’s determination. The Supreme Court granted pharmacy’s five separate petitions for allowance of appeal and consolidated the cases for appeal.
Holding:
The Supreme Court held that the pharmacy was not precluded from seeking payment for prescription drugs dispensed to injured workers referred by physicians who held financial interests in the pharmacy, since prescription drugs and pharmaceutical services were not included in the workers’ compensation anti-referral provision. Section 306(f.1)(3)(iii) of the Workers’ Compensation Act makes it “unlawful for a provider to refer a person for laboratory, physical therapy, rehabilitation, chiropractic, radiation oncology, psychometric, home infusion therapy or diagnostic imaging, goods or services pursuant to this section if the provider has a financial interest with the person or in the entity that receives the referral.” First, the Court looked to the language of the Anti-Referral Provision of the WCA and determined that the plain language of the statute makes clear the General Assembly did not intend for “goods or services” to be a catchall category bringing non-enumerated medical services within the Anti-Referral Provision’s prohibition on self-referrals. The Insurer’s reliance on Schmidt and Eighty-Four Mining was misplaced. The Court also found that the Insurer’s alternative interpretation of “goods or services” was so overly broad that it encompasses each and every one of the Anti-Referral Provision’s specifically enumerated medical services. Such an interpretation would render those enumerated services mere surplusage in contravention of our rules of statutory interpretation. Their interpretation was supported by the fact that, when the legislature wanted to specifically address prescription drugs and pharmaceutical services in the WCA it did so explicitly but failed to include that explicit language in the Anti-Referral Provision. Section 301(c) of the regulations was consistent with the Court’s interpretation. The hearing officer accurately observed that outpatient prescriptions currently find no safe harbor and are explicitly disallowed under the Stark amendments. The hearing officer was correct that, unlike the Anti-Referral Provision, the Stark amendments explicitly include outpatient prescription drugs as DHS for which providers are prohibited from making self-referrals, see 42 U.S.C. § 1395nn(h)(6), and that outpatient prescription drugs are not included in any of the Stark amendments’ exceptions or safe harbors. However, while the regulations incorporate those exceptions and safe harbors, they do not purport to incorporate the Stark amendments’ list of DHS that providers are prohibited from self-referring. Therefore, the fact that the Stark amendments prohibit self-referrals for outpatient prescription services is of no relevance in determining if the Department’s regulations include such a prohibition. Of even more import is the fact that the text of the Anti-Referral Provision itself fails to include any indication that the General Assembly intended to incorporate the Stark amendments’ list of DHS.
Reversed and remanded.
JUSTICE WECHT, dissenting
He was unconvinced by the Majority’s instance that the statutory language before us plainly and unambiguously prohibits only eight categories of self-referrals. The Majority’s decision is not a plain language decision but an ambiguity analysis that fails to consider the purpose of the Workers’ Compensation Act’s anti-referral provision.
JUSTICE McCAFFERY, dissenting
He feels that the plain language of the Anti-Referral Provision in the Workers’ Compensation Act unambiguously precludes providers from referring a person for “goods and services” if the provider has a financial interest in the entity providing those goods or services, and that phrase plainly includes prescription drugs and pharmaceutical services.
JUDICIAL DISCRETION
Jim’s Commercial Service v. Anthony DiJoseph (WCAB)
Commonwealth Court of Pennsylvania – Unpublished Memorandum Opinion
Decided: June 11, 2026
Issue:
Whether the Claimant failed to present unequivocal medical testimony? Whether the WCJ capriciously disregarded the testimony of Employer’s medical experts?
Background:
In a Claim Petition Claimant alleged that his Dupuytren’s contracture and plantar fibromatosis were caused and/or aggravated by his work with Employer and sought disability benefits as a result. The WCJ found that Claimant met his burden of proof on the Claim Petition and granted disability benefits. The WCJ found that neither Dupuytren’s nor plantar fibromatosis were caused by any work-related condition but that those existing conditions were impacted by Claimant’s work activities. The Board affirmed.
Holding:
Included within the Workers’ Compensation Act’s definition of “injury” is the work-related aggravation of a condition that predated the claimant’s employment. It was proper to award WC benefits where the preexisting condition is aggravated or accelerated by a work-related injury, even if the underlying disease or condition was not caused by a work incident. Here claimant proved that the aggravation arose within the course of employment and that the aggravation was related to that employment. Because aggravating work conditions were alleged in this case, it was properly treated as an aggravation injury, and the substantial contributing factor test is not applicable. Claimant’s experts were not equivocal in their opinions. To the extent that the WCJ’s explanation for his rejection of certain testimony was in any way lacking, a WCJ’s failure to explain why he rejected certain testimony is not fatal to the adjudication, so long as effective appellate review is not precluded. Viewed as a whole, it can be readily understood. The WCJ’s findings have adequate support in the record, including unequivocal testimony by Claimant’s experts that work duties aggravated his preexisting, and ultimately disabling, Dupuytren’s and fibromatosis. The testimony relied upon was not equivocal nor was any testimony disregarded. The Employer’s arguments were essentially an objection to the WCJ’s credibility determinations. The appellate court may not reweigh the evidence or the credibility of the witnesses but may simply determine whether the WCJ’s findings have the requisite measure of support in the record as a whole. There was insufficient basis to overturn the findings made by the WCJ.
Affirmed.
Christine Hamilton v. Ventura Foods, LLC (WCAB)
Commonwealth Court of Pennsylvania – Unpublished Memorandum Opinion
Decided: June 3, 2026
Issues:
Whether the WCJ’s and Board’s decisions were arbitrary, capricious and not supported by substantial competent evidence.
Background:
Claimant had a long history of low back problems. She received social security disability benefits for about 15 years and had back surgery in the late 2000s. In 2019, Claimant went to the emergency room with low back pain radiating into her left leg and urinary incontinence. An MRI revealed findings similar to the 2015 study. In 2021, when Claimant’s disability benefits ended she began working for Employer in May as an inspector. After a few months, Claimant saw her primary care physician and reported radiating leg pain and back spasms. Medical records documented a left-sided radiculopathy. Claimant was given restrictions. Employer then reassigned Claimant to a different position. On the night of the injury, Claimant worked a lot, causing heightened back pain. Claimant spoke to her supervisor saying that her back was killing her. She did not specifically inform the supervisor that her back pain was from lifting boxes. Claimant worked the next day and told the fill-in for the lead that her “back was killing [her] from the night before.” She did not fill out any accident report, did not return to work after that shift, and called off sick for the next few shifts. The following week, Claimant sought treatment at the emergency room. She was referred for treatment and testing. Claimant filed a claim petition, a few months after this, alleging work injuries involving her low back. The WCJ concluded that Claimant had not met her burden to establish by sufficient, competent, credible evidence that she sustained a work injury. The Board affirmed.
Holding:
Claimant has the burden of proving a causal relationship between a work-related incident and her alleged disability. Further, credibility determinations are within the exclusive province of the WCJ and findings of fact can be overturned only if they are arbitrary and capricious, and not supported by substantial evidence. Appellate courts cannot reweigh the evidence. Here, substantial evidence supported the WCJ’s findings, and the WCJ’s credibility determination was neither arbitrary nor capricious. The WCJ gave several reasons for crediting one testimony over another. Those reasons withstand each of Claimant’s challenges. Claimant’s expert, conceded on cross-examination that he could not attribute her worsening stenosis to the October 15, 2021 work activities. The WCJ did not disregard claimant’s expert’s competing testimony. The WCJ’s reasons for crediting the testimony rest on substantial evidence of record, and none of those reasons depends on a material misapprehension.
Affirmed.
AFFIRMATIVE DEFENSES TO CLAIM
SELF-INFLICTED INJURY
Oldcastle Infrastructure v. Dominick DiStefano (WCAB)
Commonwealth Court of Pennsylvania – Unpublished Memorandum Opinion
Decided: June 29, 2026
Issue:
Whether Claimant’s injury was not compensable because it was intentionally self-inflicted?
Background:
Employer petitioned the Court for review of an order of the Appeal Board, which affirmed a decision by the WCJ granting a Claim Petition. Specifically, Claimant was injured when a heavy bolt was dropped on his left lower leg during the course and scope of his employment. Claimant had finished his shift, clocked out, and removed his jacket to remove dust that had accumulated on his clothing, causing a large bolt to impact his leg, leading to the injuries. The WCJ granted the Claim Petition, determining that any injury was not intentionally self-inflicted. Employer appealed to the Board, which affirmed.
Holding:
Section 301(a) of the Workers’ Compensation Act precludes compensation when a worker’s injury or death is intentionally self-inflicted. The burden of proving that a death or injury was intentionally self-inflicted is upon the employer. Claimant was merely negligent in forgetting that the bolt was in his jacket pocket. While Claimant’s use of his jacket to brush dust off his clothing was intentional, it was not the brushing of his jacket but the fall of the bolt that injured his leg. There is no reason to suppose that Claimant harbored any intent to injure himself.
Affirmed.
IMPAIRMENT RATING EVALUATIONS
SUFFICIENCY OF MEDICAL TESTIMONY
Gail Smith v. Atria Management Company (WCAB)
Commonwealth Court of Pennsylvania – Unpublished Memorandum Opinion
Decided: June 11, 2026
Issue:
Whether the WCJ’s decision modifying benefits based on an IRE disregarded previous factual findings in the case and improperly relied on the flawed testimony?
Background:
Claimant sustained a disabling lower back injury while working, described as a lumbar sprain. After an LMS was completed, Employer filed a Modification Petition and Claimant filed a separate petition to modify the injury description to include post-laminectomy syndrome, including arachnoiditis and lumbar radiculopathy, and aggravation of spondylosis and neural foraminal narrowing. The WCJ granted claimant’s Modification and denied Employer’s Petition. Thereafter, Claimant underwent an IRE. Employer filed Modification Petition based on the IRE results. Claimant presented the deposition testimony of an expert who performed a separate IRE of Claimant and assigned her an impairment rating of 36%. This expert acknowledged that patients within Claimant’s injury class could not properly receive an impairment rating beyond 33%, but gave her “4 extra points” because of her pain complaints. The WCJ granted this Modification Petition, finding that Employer met its burden of proof that Claimant’s total impairment rating was below 35%. The Board affirmed.
Holding:
The WCJ did not improperly disregard injuries that an earlier WCJ previously found to have occurred as a result of the work incident. The Employer’s IRE doctor was under no obligation to consider additional, unnamed ailments during the IRE. Claimant’s reliance on Duffey was misplaced, as the claimant in that case suffered from “additional injuries” that arose subsequent to the work incident and “were known at the time of the IRE.” Here, there is no evidence in the record to suggest that any other injuries were “known at the time of the IRE”; to the contrary, the IRE reviewer had no reason to suppose that he was to evaluate Claimant’s impairment for anything other than lumbar radiculopathy and chronic pain, the two ailments that he discussed in his IRE report.
Affirmed.
PENNSYLVANIA LEGISLATIVE REVIEW
House Bill 183 is now Senate Bill 1094.
A few months ago, the Commonwealth of Pennsylvania, House L&I Committee, voted on what was then designated as HB 183. This Bill expands access to workers compensation disfigurement benefits by increasing the duration of eligibility from up to 275 weeks to a new level of up to 400 weeks, extending the benefit to the entire body, and not just to the head, face and neck, and allowing these benefits to be paid simultaneously with indemnity benefits. The bill was passed by the House on April 7, 2025, and has now been referred to the Senate Labor & Industry Committee. It is now under Senate Bill 1094 and has yet to be reported from the committee.
Other Selected Proposed Legislation of Interest in the 2025-2026 session
The following selected amendments to the PA Workers’ Compensation Act have been proposed, but as of this date are in early stages, and no formal vote has been held, and these are referred to their respective L&I Committees:
In the Senate: (these are still in committee)
Senate Bill 801 – Seeks to clarify that the Act provides the exclusive remedy for any injury or disease that may arise out of hazardous occupational exposure, whether the disease is compensable or not.
Senate Bill 894 – Seeks to clarify the “Independent Contractor Classification.”
Senate Bill 1151 – Removal of Clinical Practice Requirement for Physicians Performing Impairment Rating Evaluations (IREs).
Senate Bill 1215 – Addressing Excessive Costs for Prescription Topical Drugs in Workers’ Compensation. Reported as “committed” effective June 2026.
House Bill 2049 – Raising Workers’ Compensation Burial Benefits. (Sent to the senate on June 18, 2026)
House Bill 2087 – Ensuring that volunteer firefighters and EMTs are covered under workers’ compensation when injured during fundraising activities. (Sent to the senate on April 2026)
Approved by the Senate on March 24, 2026 – Sent to the House and now referred out of Committee as amended in April 2026.
Senate Bill 1053 – Seeks to clarify workers compensation coverage for EMS Volunteers.
In the House Only: (these are still in committee)
House Bill 1766 – Workers’ Compensation Coverage of Prescribed Medical Cannabis (Formerly HB 1079).
House Bill 1998 – Modernizing and Improving Medical Treatment in Workers’ Compensation
NEW JERSEY WORKERS’ COMPENSATION
CASE SUMMARIES
6/1/2026 – 6/30/2026
KNEEZEL V. LAMBERTVILLE HOUSE
Superior Court of New Jersey, Appellate Division
A-2729-24; 2026 WL 1532635
Decided: 6/1/2026
Background:
Petitioner injured his back and knee at work and filed a claim petition for workers’ compensation benefits. It was stipulated between the parties that the petitioner was in the course and scope of his employment when he sustained a compensable accident. The petitioner started having back discomfort and radiating pain to the left leg two months after the injury. He was referred to an orthopedic surgeon and back surgery was recommended. The carrier canceled the surgery the day before it was to take place and directed the petitioner to get a second opinion. The petitioner filed a Motion for medical treatment and temporary disability benefits. An Order was entered granting the Motion and directing Respondent to authorize all treatment recommended by the authorized physicians. A few years later, the petitioner received an MRI and injections to his left knee. A knee replacement was also recommended, but the petitioner declined as his pain was being managed by the injections. Two years after that, the petitioner requested additional treatment for his knee and Respondent declined. Petitioner’s counsel arranged for him to be examined, and it was determined that a total knee replacement may be necessary if physical therapy did not work. Petitioner filed a second Motion for medical treatment to compel treatment for his left knee. In response, Respondent submitted with their Answer reports from surveillance investigators indicating the petitioner did not have difficulty walking. They also submitted a medical report indicating the treatment for the left knee was due to his pre-existing osteoarthritis. A trial began and Respondent failed to provide all discovery, mainly all the raw surveillance, to the petitioner prior to the scheduled testimony of the surveillance investigators.
The Judge provided a deadline, and the discovery was not provided by that deadline. The Judge issued an Order directing Respondent to authorize left knee treatment for the petitioner. Respondent moved for reconsideration or a stay, and the Judge denied the Motion. Respondent appealed.
Holding:
On appeal, Respondent argued the Order violated their due process rights as there was no opportunity to be heard. They further argued that the Order suppressed their defenses and granting the Motion was procedurally and factually defective. The Court found the Respondent was provided with multiple opportunities to be heard. The Court further found that a hearing was not required as the Motion was uncontested. Further, there was no due process violation as the Motion was uncontested. The Court found no abuse of discretion by the Judge.
Affirmed.
TIMELINESS OF PAYMENT OF AWARDS
SKIVER V. ALESSANDRA MISC. METAL WKS., INC.
Superior Court of New Jersey, Appellate Division
A-2912-24; 2026 WL 1758291
Decided: 6/18/2026
Background:
Petitioner was injured and the WCJ entered an Order Approving Settlement on December 4, 2024 for the sum of $24,381.00 for permanent disability of the petitioner. Respondent’s counsel subsequently requested information regarding a child support lien, and petitioner’s counsel promptly provided the information. No payment was received and petitioner’s counsel sent follow up emails without reply from Respondent. Petitioner’s counsel advised by email that the sixty-day statutory period for payment would expire on February 2 and if it was not received, there could be penalties. Petitioner’s counsel continued to follow up after February 2nd. On February 4th, the petitioner filed a Motion to Compel Respondent to comply with the Order. On February 5th, Petitioner also filed an application for review or modification of formal award alleging Respondent failed to timely issue the permanency benefits. Petitioner received their first permanency check on February 6th.
An Order for Compliance was subsequently issued finding Respondent failed to comply with the Order and awarding interest and sanctions. Respondent moved for reconsideration. A testimonial hearing on the Motion took place. The claims manager testified that she issued the check on January 31st, but she could not confirm that the check was mailed and postmarked the next day. The WCJ rendered a Decision denying the reconsideration motion and placing the sanction back in effect. Respondent appealed and argued the payment was timely issued on day fifty-eight.
Holding:
The court found that there was substantial credible evidence to support the Judge’s finding that the check was issued beyond the statutory deadline. Further, the Judge did not abuse their discretion imposing a monetary penalty against Respondent and the amount of the sanction was not excessive as it is authorized by N.J.S.A. 34:15-28.2(a).
Affirmed.
Editor’s Note: Please be careful to issue payments within 60 days of an Award as this award was issued within a few days of the 60th day deadline, and sanctions and penalties were permitted and were upheld on appeal. This emphasizes the need to issue payments in accordance with an Order in a timely manner.
WHETHER COVERAGE APPLIES TO A MEMBER
BOZ, ADMINSTRATRATIX OF ESTATE OF SINAN BOZ V. YAVUZ AND BEST MARBLE & GRANITE, LLC AND UNITED STATES LIABILITY INS. CO.
Superior Court of New Jersey, Appellate Division
A-2912-24; 2026 WL 1758291
Decided: 6/18/2026
Background:
Defendants were owners of Best Marble & Granite, LLC (Best Marble), which was insured by United States Liability Insurance (USLI) under a commercial general liability policy. Defendant Boz was fatally injured on Best Marble’s premises. Plaintiff filed a complaint alleging negligence against defendants. USLI denied coverage stating that Boz was acting as an employee when he was killed. The trial court granted summary judgment finding USLI was required to indemnify Best Marble its $1 million policy limits for the default judgment entered against them. A motion for reconsideration was denied.
Holding:
On Appeal, USLI argues that Boz was acting as an employee at the time of the incident and the policy excludes coverage for injuries sustained by employees in the course and scope of employment. The court noted that the policy exclusion provision was based on the individual’s status within the business structure. Here, Boz was an owner and the task he was doing at the time of the injury did not change his designation. It was noted that if an LLC affirmatively elects to purchase workers’ compensation coverage for the members, the statute allows for them to receive coverage. Here the LLC had declined workers’ compensation coverage for the members/owners.
Affirmed.
NEW JERSEY LEGISLATIVE UPDATE
Assembly Bill 4617
Concerns certain workers’ compensation supplemental benefits and funding method.
Last Action: March 10, 2026 – Introduced, Referred to Assembly Labor Committee
Senate Bill 3984/A1023
Requires workers’ compensation, PIP, and health insurance coverage for the medical use of cannabis under certain circumstances.
Last Action: March 19, 2026 – Introduced in the Senate, Referred to Senate Commerce Committee
Senate Bill 3342
Increases statutory mandatory retirement age for Supreme Court Justices, Superior Court Judges, Tax Court Judges, Administrative Law Judges, and Workers’ Compensation Judges from 70 to 75.
Last Action: February 5, 2026 – Introduced in the Senate, Referred to Senate Judiciary Committee
Senate Bill 3571/A3548
Provides certain volunteer and other workers with maximum compensation benefit for workers’ compensation claim regardless of outside employment.
Last Action: May 7, 2026 – Reported and Referred to Assembly State and Local Government Committee
Assembly Bill 4827
Requires Administrative Law Judges to be enrolled in Workers Compensation Judges Part of PERS.
Last Action: May 4, 2026 – Introduced, Referred to Assembly State and Local Government Committee
Senate Bill 4381
Exempts election worker compensation from taxation.
Last Action: June 1, 2026 – Introduced in the Senate, Referred to Senate State Government, Wagering, Tourism & Historic Preservation Committee
