OPINION BY Judge BROBSON.
Petitioner Fidelity & Guarantee Insurance Company (Insurer) petitions for review of an order of a hearing officer (Hearing Officer) of the Bureau of Workers' Compensation Fee Review Hearing Office (Bureau), which determined that Community Medical Center's (Provider) Application for Fee Review was timely filed within ninety (90) days of the original billing date pursuant to Section 306(f.1)(5) of the
On December 9, 2006, Janice Matthews (Claimant) sustained work-related injuries when an order picker she was working on fell over while she was counting stacked inventoried items located on an end cap rack. (Reproduced Record (R.R.), 26a, 178a.) Claimant was taken by Life Flight helicopter to Provider's trauma center and was admitted to Provider. (Id. at 64a-68a.) Provider treated Claimant between December 9, 2006, and December 19, 2006, for her injuries. (Id. at 128a.)
On January 18, 2007, Provider mailed a clean bill
After the hearing, the Hearing Officer determined that the date of billing submission by Provider for purposes of Section 306(f.1)(5) of the Act was January 18, 2007, and the date of Insurer's notification of dispute of Provider's treatment was February 21, 2007. (Id.) The Hearing Officer then concluded that Provider's Application for Fee Review, which was received by the Bureau on April 13, 2007, was timely filed within the ninety (90) day period provided by Section 306(f.1)(5) of the Act. (Id.) Insurer then petitioned this Court for review.
On appeal,
First, Insurer contends that Section 306(f.1)(5) of the Act describes a two-pronged limitations period for filing an application for fee review. The first prong requires a provider to file an application for fee review within thirty (30) days following notification of disputed treatment. The second prong of the section requires filing of an application for fee review within ninety (90) days following the original billing date. Insurer contends that the latter prong (90 days) is applicable only in the absence of a fee dispute. Insurer argues that the Hearing Officer's interpretation of Section 306(f.1)(5) of the Act ignores the existence of the first prong of the limitations period, which requires a Provider to file an application for fee review within thirty (30) days of receiving notification of disputed treatment.
When interpreting a statute, this Court is guided by the Statutory Construction
Here, the Hearing Officer concluded that the conjunction "or," as used within the phrasing of Section 306(f.1)(5) of the Act establishing the time period for filing an application for fee review, must be interpreted according to its common meaning which designates an alternative. (Hearing Officer's decision, dated August 10, 2009.) The Hearing Officer's interpretation allows a provider to file an application for fee review within the thirty (30) days following dispute notification or, alternatively, within the ninety (90) day time period following the original billing date of the treatment. This interpretation is supported by this Court's decision in Harburg Medical Sales Company v. Bureau of Workers' Compensation (PMA Insurance Company), 784 A.2d 866 (Pa.Cmwlth.2001) (Harburg PMA), in which we determined that a provider must file an application for fee review no more than thirty (30) days following notification of a disputed treatment or ninety (90) days following the original billing date of the treatment, whichever is later. The Court in Harburg (PMA) concluded that although the time limitation found in Section 306(f.1)(5) of the Act may have passed based on the original billing date, if the insurer denies payment of a resubmitted bill, a provider still has thirty (30) days following the notification of an insurer's denial of the resubmitted bill to file an application for fee review. Id. at 870.
Moreover, this Court's interpretation in Harburg (PMA) of the same language in question recognizes that, contrary to the argument advanced by Insurer, a provider under certain circumstances may file an application for fee review more than ninety (90) days after the original billing date when the provider receives notification of dispute, giving effect to the first prong of Section 306(f.1)(5) of the Act. If an insurer disputes payment of a resubmitted bill, the provider still had thirty (30) days following the notification of the dispute to seek review of the fee dispute. Harburg (PMA), 784 A.2d at 870, n. 5. This Court, thus, has determined that if the Act's ninety (90) day time limitation has passed, the provider still has thirty (30) days following the insurer's notification of the denial of the resubmitted bill to file an application for fee review. Id. Thus, Insurer's argument that the Hearing Officer's interpretation would in all instances nullify the thirty-day time period for filing is without merit. Moreover, we recognized in Harburg (PMA) that "any other interpretation would leave the provider without any recourse to seek payment for a disputed treatment if the provider is barred from
Upon review, we agree with the Hearing Officer's conclusion that the language of Section 306(f.1)(5) of the Act may be reasonably interpreted to provide two distinct alternative time periods for filing an application for fee review: (1) thirty (30) days following notification of a disputed treatment, OR (2) ninety (90) days following the original billing date. Such an interpretation accords the conjunction "or" its common and approved meaning as designating alternatives. It also gives effect to all of the words and phrases of the statute, without rendering any words or phrases as mere surplusage because the interpretation will not nullify either time period for filing. Such an interpretation also does not require additional language (such as "in the absence of a dispute") to the second prong of Section 306(f.1)(5) of the Act in order to convey the intent of the General Assembly.
Next, Insurer argues that the Bureau exceeded its authority when it included the language "whichever is later" in the Regulation because regulations may not amend a statute. Specifically, Insurer contends that the addition of the "whichever is later" language results in the ninety (90) days always being longer than the thirty (30) days because an insurer must always pay, deny, or dispute a bill within thirty (30) days following its receipt. As discussed above, we reject Insurer's premise that the addition of the language in the Regulation nullifies the first prong of Section 306(f.1)(5) of the Act.
As to the validity of the regulation, Section 306(f.2)(7) of the Act, 77 P.S. § 531.1(7), specifically provides, that "[t]he department shall have the power and authority to promulgate, adopt, publish and use regulations for the implementation of this section." The addition of "whichever is later" language found in the Regulation was adopted pursuant to the Department's delegated legislative power. Section 306(f.2)(7) of the Act. "Where an agency, acting pursuant to delegated legislative authority, seeks to establish a substantive rule creating a controlling standard of conduct, it must comply with the provisions of what is commonly referred to as the Commonwealth Documents Law."
This Court has differentiated a legislative regulation from an interpretive regulation, stating that a legislative regulation is substantive and creates a new controlling standard of conduct while the interpretive regulation does not. Borough of Pottstown, 551 Pa. at 609-610, 712 A.2d at 743. Generally, a legislative regulation establishes "a substantive rule creating a controlling standard of conduct." Id. at 609, 712 A.2d at 743. A legislative regulation is valid if adopted pursuant to delegated legislative power in accordance with the appropriate administrative procedure, and if it is reasonable. Id., 712 A.2d at 743; see also Uniontown, 455 Pa. at 76, 313 A.2d at 169 (legislative regulation valid if adopted within ambit of agency's authority as granted by legislature, issued pursuant to proper procedure, and is reasonable).
In this case, the Department enacted the Regulation to provide guidance as to Section 306(f.1)(5) of the Act. The Regulation contains identical language to Section 306(f.1)(5) of the Act with the addition of the phrase "whichever is later." The additional language "whichever is later" sets forth a standard of conduct for timely filing. The Regulation appears to have been adopted pursuant to delegated legislative power and in accordance with the appropriate administrative procedure. Therefore, as long as the Regulation is reasonable, the Regulation may be substantive and may create a new controlling standard of conduct. The provisions of the Regulation in question appear to be reasonable for two reasons: (1) the provisions are consistent with the statutory language set forth in Section 306(f.1)(5) of the Act; and (2) the provisions serve the purposes of the Department as outlined. We conclude, therefore, that the Regulation is a valid legislative regulation, and we reject Insurer's argument to the contrary.
For the above reasons, and in light of the alternative filing periods, we conclude that Provider's Application for Fee Review was timely, as it was filed within ninety (90) days of the original billing date.
Accordingly, we affirm the decision of the Bureau.
AND NOW, this 29th day of October, 2010, the order of the Bureau of Workers' Compensation Fee Review Hearing Office is hereby AFFIRMED.