Pennsylvania Workers’ Compensation Anti-Referral Rule: “Goods or Services” Treated as a Modifier, Not Standalone Prohibitions

1. Introduction

700 Pharm. v. Bur of WC (State Workers' Ins. Fund) is a consolidated set of appeals in the Supreme Court of Pennsylvania arising from fee-review determinations under the Workers’ Compensation system. The central dispute concerns the scope of the Workers’ Compensation Act’s anti-referral provision, 77 P.S. § 531(3)(iii), which restricts self-referrals by providers who have a financial interest in the recipient of the referral.

As framed in the dissenting opinion authored by Justice Wecht, the controversy ultimately turned on a recurring interpretive question with major practical consequences: whether the statutory phrase “goods or services” is itself an additional pair of broad, free-standing prohibitions (capable of reaching prescription drugs), or instead a trailing modifier that must be read back into each earlier, enumerated medical category (thereby limiting the statute to specified kinds of items).

2. Summary of the Opinion

The dissent explains that the Majority held the anti-referral provision is unambiguous and prohibits self-referrals only within eight specified categories, treating “goods or services” as a qualifying phrase that modifies the enumerated items rather than adding independent prohibitions. On that reading, the statute does not create a broad, catch-all ban on referrals for any “goods” or any “services.”

Justice Wecht dissented, arguing the Majority’s “plain language” approach is implausible because it depends on disregarding the statute’s punctuation (specifically, the comma before “goods or services”), misapplies grammar, and undervalues the Act’s cost-containment purpose. In his view, the text is at least ambiguous and more naturally read to prohibit referrals for “goods” and for “services” as distinct final list items.

3. Analysis

3.1. Precedents Cited

  • Starck v. Union Cent. Life Ins. Co., 19 A. 703 (Pa. 1890)
    Cited for the historical proposition that punctuation once was not “seriously regarded” in statutory construction because early legislative enactments often lacked punctuation. The dissent uses Starck to contrast past practice with modern interpretive rules, emphasizing that punctuation can now be used as evidence of legislative intent.
  • Cash Am. Net of Nev., LLC v. Pa. Dept. of Banking, 8 A.3d 282 (Pa. 2010)
    Invoked to show that the Court has relied on comma placement in construing statutes. The dissent cites Cash Am. Net of Nev. to rebut any suggestion that punctuation should be ignored when assessing whether text is “clear.”
  • Jackiw v. Soft Pretzel Franchise (W.C.A.B.), 329 A.3d 1152 (Pa. 2025)
    Cited (via the Majority’s reliance, as described in the dissent) for the Statutory Construction Act directive to give effect to all statutory provisions “if possible.” The dissent criticizes what it characterizes as the Majority’s heavy emphasis on anti-surplusage reasoning at the expense of punctuation and other canons.
  • McGuire on behalf of Neidig v. City of Pittsburgh, 285 A.3d 887 (Pa. 2022)
    Used to support the notion that legislatures sometimes draft redundantly (“belt-and-suspenders” language). The dissent leverages McGuire to argue that potential surplusage is not an interpretive trump card.
  • Barnhart v. Thomas, 540 U.S. 20 (2003)
    Cited for the last antecedent rule: qualifying phrases at the end of a list ordinarily modify only the immediately preceding item, absent contrary intent. The dissent argues this canon cuts against the Majority’s decision to have “goods or services” modify all prior enumerated categories.
  • Pa. Dept. of Banking v. NCAS of Del., LLC, 948 A.2d 752 (Pa. 2008)
    Cited for Pennsylvania’s acceptance of the last antecedent approach “in absence of evidence of some contrary purpose.” The dissent uses NCAS of Del., LLC to reinforce that the Majority’s broad backward-modification reading is grammatically and canonically disfavored.
  • Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc., 721 A.2d 1061 (Pa. 1998)
    Cited to identify the legislative purpose underlying the 1993 cost-containment reforms, including preventing providers from acting in their “own self-interest” in referrals. The dissent contends that once ambiguity is acknowledged, this purpose should steer interpretation toward a broader anti-self-referral scope.

In addition to case law, the dissent relies on the interpretive treatise ANTONIN SCALIA & BRYAN A. GARNER, READING LAW: THE INTERPRETATION OF LEGAL TEXTS, chiefly for propositions that (a) punctuation is a legitimate indicator of meaning and (b) “clear meaning” cannot be declared while ignoring punctuation.

3.2. Legal Reasoning

A. The statutory text and the “list problem”

The dissent centers on the structure of § 531(3)(iii), which lists multiple categories and ends with the phrase:

“... diagnostic imaging, goods or services pursuant to this section ...”

The interpretive fork is whether “goods” and “services” are independent list items (the dissent’s view), or whether “goods or services” is a modifier that must be read back into each earlier enumerated category (the Majority’s view as described).

B. Punctuation as meaning

Justice Wecht argues the comma before “goods or services” signals that “goods” and “services” are additional items in the series. On this account, the Majority’s construction is not “plain language” because it requires treating the comma as if it were not there.

The dissent further explains that Pennsylvania’s Statutory Construction Act allows punctuation as an interpretive aid for statutes enacted after December 31, 1964 (1 Pa.C.S. § 1923(b)), and that the anti-referral provision was enacted in 1993—making punctuation fair game.

C. Surplusage vs. “belt-and-suspenders” drafting

The Majority’s approach (per the dissent) is driven by the anti-surplusage principle: if “goods” and “services” are broad stand-alone prohibitions, then the earlier enumerated categories become largely redundant. The dissent accepts that redundancy concern but argues it is not decisive because legislatures sometimes draft redundantly and because the Statutory Construction Act requires giving effect to all provisions only “if possible” (1 Pa.C.S. § 1921(a)), not at all costs.

D. The last antecedent rule as a counter-canon

The dissent highlights that the last antecedent rule would ordinarily connect “goods or services” to the immediately preceding phrase (“diagnostic imaging”), not to all items in the list. In the dissent’s view, the Majority’s interpretation therefore not only minimizes punctuation but also cuts against a well-recognized grammatical canon.

E. Ambiguity and purpose

A key move in the dissent is methodological: if resolving the statute requires balancing competing canons (punctuation, surplusage, last antecedent), then the statute cannot honestly be declared “unambiguous.” Once ambiguity is admitted, the dissent would give greater weight to purpose and consequences under 1 Pa.C.S. § 1921(c)(1)-(8), emphasizing the 1993 cost-containment aim identified in Eighty-Four Min. Co. v. Three Rivers Rehabilitation, Inc.

3.3. Impact

If the Majority rule described by the dissent controls going forward, its practical effects are likely to be significant in Pennsylvania workers’ compensation cost-containment disputes:

  • Narrower anti-referral reach. Treating “goods or services” as purely modifying language limits the anti-referral rule to the enumerated categories (as the Majority counts them), potentially leaving referrals for other items (including, as the litigation context suggests, prescription drugs) outside the statute’s self-referral prohibition unless separately regulated.
  • Higher reliance on enumerated-list parsing. Future disputes may turn less on broad anti-conflict principles and more on whether a challenged item can be characterized as fitting within one of the listed categories and its associated “goods or services.”
  • Legislative drafting signal. The decision invites legislative clarification if the General Assembly intended a comprehensive “goods”/“services” catch-all. The dissent underscores how small drafting choices (commas; internal “or”) can drive major compliance and reimbursement outcomes.
  • Methodology in “plain meaning” cases. The dissent frames an institutional concern: declaring “unambiguous” meaning while discounting punctuation and competing canons may influence how aggressively courts label contested texts as “plain,” thereby shrinking the domain in which purpose and consequences may be consulted.

4. Complex Concepts Simplified

  • Anti-referral provision (self-referral ban). A rule preventing a medical provider from sending a patient to a business the provider has a financial stake in, to reduce conflicts of interest and unnecessary costs.
  • Oxford (serial) comma. The comma before “and”/“or” in a list (e.g., “A, B, and C”). Its presence or absence can change whether the last phrase is read as part of the list or as a modifier.
  • Rule against surplusage. A canon presuming legislatures do not include unnecessary words; courts try to interpret text so each part has work to do.
  • Last antecedent rule. A canon stating that a qualifier at the end of a list usually modifies only the nearest preceding item, not all earlier items, unless context indicates otherwise.
  • “Unambiguous” vs. “ambiguous.” If reasonable interpretive tools point to competing meanings, a statute is ambiguous; courts may then consider additional factors like purpose and consequences (as reflected in 1 Pa.C.S. § 1921(c)).

5. Conclusion

This case, as illuminated by Justice Wecht’s dissent, is fundamentally about the architecture of statutory interpretation: whether punctuation and grammar can be subordinated to anti-surplusage logic in declaring a text “unambiguous.” The Majority rule described in the dissent narrows the Workers’ Compensation Act’s anti-referral ban by treating “goods or services” as a modifier tied to enumerated categories rather than as broad, independent prohibitions. The dissent’s principal warning is that such a methodology risks converting an interpretive choice among competing canons into a “plain language” mandate, with downstream effects on workers’ compensation cost containment, provider financial-interest regulation, and legislative drafting incentives in Pennsylvania.