Sullivan v. Barnett
Decision Date | 24 January 1996 |
Docket Number | Civil Action No. 95-201. |
Parties | Delores Scott SULLIVAN, et al., Plaintiffs, v. Robert BARNETT, et al., Defendants. |
Court | U.S. District Court — Eastern District of Pennsylvania |
Alan B. Epstein, Jablon, Epstein and Wolf, Philadelphia, PA, Thomas J. O'Brien, Philadelphia, PA, Lorrie McKinley, Community Legal Services, Inc., Philadelphia, PA, for Delores Scott Sullivan, William Battle, Anthony Cancila, Charles Matthews, Christopher Costello, Lisa Lex, Susan Hansen, Philadelphia Area Project on Occupational Safety and Health.
Ralph J. Teti, Willig, Williams & Davidson, Philadelphia, PA, for The Philadelphia Federation of Teachers, Local 3, AFL-CIO.
Susan J. Forney, Office of Attorney General, Harrisburg, PA, for Robert Barnett, Frank Beal, Constance B. Foster, Catherine Baker Knoll, John P. O'Malley.
Arthur Makadon, Robert McL. Boote, Burt M. Rublin, Celia E. Henry, Ballard
Spahr Andrews & Ingersoll, Philadelphia, PA, for American Manufacturers Mut. Ins. Co., Continential Cas. Co., Defendant USF & G Ins. Co., Zurich American Ins. Co.
Edward D. Rogers, Ballard, Spahr, Andrews & Ingersoll, Philadelphia, PA, for Cigna Corp.
Stephen J. Springer, Pamela Tobin, Patrick Vitullo, Labrum and Doak, Philadelphia, PA, for School Dist. of Philadelphia.
Plaintiffs in this putative civil rights class action claim to be persons who had been receiving medical benefits pursuant to the Pennsylvania Worker's Compensation Law, and who were thereafter deprived of those benefits without prior notice or an opportunity to be heard pursuant to what plaintiffs' counsel characterize as an "automatic supersedeas" as provided by Section 306(f.1)(5) of the aforesaid law, as amended, 77 P.S. 531(5) (Supp.1994), which provides in part as follows:
The employer or insurer shall make payment and providers shall submit bills and records in accordance with the provisions of this section. All payments to providers for treatment provided pursuant to this act shall be made within thirty (30) days of receipt of such bills and records unless the employer or insurer disputes the reasonableness or necessity of the treatment provided pursuant to paragraph (6). A provider who has submitted the reports and bills required by this section and who disputes the amount or timeliness of the payment from the employer or insurer shall file an application for fee review with the department. Within thirty (30) days of the filing of such an application, the department shall render an administrative decision.
Paragraph 6 provides, in part, as follows:
The "automatic supersedeas" to which plaintiffs refer is implemented by regulations which, as of November 11, 1995, provide in part as follows. All regulations hereafter set forth come from exhibits supplied to the court by plaintiffs' counsel.
§ 127.208. Time for payment of medical bills.
The Utilization Review (UR) provisions of Subchapter C relating to medical treatment review provide in part as follows:
§ 127.401. Purpose — review of medical treatment.
§ 127.403. Assignment of cases to UROs.
The Bureau will randomly assign requests for UR to authorized UROs. An insurer's obligation to pay medical bills within 30 days of receipt shall be tolled only when a proper request for UR has been filed with the Bureau in accordance with the provisions of this Subchapter.
§ 127.451. Initial requests for utilization review — who may file.
Initial requests for UR may be filed by an employe, employer or insurer. Health care providers may not file initial requests for UR.
§ 127.452. Initial requests for utilization review — filing and service.
§ 127.453. Initial requests for utilization review — assignment by the Bureau.
§ 127.476. Duties of UROs — form and service of determinations.
§ 127.501. Reconsideration of initial utilization review determinations — who may file.
If the provider under review, the employe, the employer or...
To continue reading
Request your trial-
Sullivan v. Barnett, AFL-CIO
...with respect to the School District as the record was incomplete and more discovery was needed. See Sullivan v. Barnett, 913 F.Supp. 895 (E.D.Pa.1996) (hereinafter, "Sullivan I "). On May 28, 1996, Sullivan moved for class certification to represent the class of workers who have had or will......
-
American Mfr's. Mut. Ins v Sullivan
...The District Court dismissed the private insurers from the lawsuit on the ground that they are not "state actors," Sullivan v. Barnett, 913 F. Supp. 895, 905 (ED Pa. 1996), and later dismissed the state officials who remained as defendants, as well as the school district, on the ground that......
-
Key v. W.C.A.B. (Chestnut Hill Hosp.)
...a WCJ has supersedeas powers related to health care provider expenses under the 1993 amendments to the Act.14 But see Sullivan v. Barnett, 913 F.Supp. 895 (E.D.Pa.1996). ...