The Supreme Court in Kentucky issued a significant workers’ compensation ruling in late 2021 regarding submission of medical expenses. Following is expert legal analysis from Reminger law.
Guest Post by Stephanie Ross, Esq. and Mark Bush, Esq.
In Wonderfoil, Inc. v. Russell, 630 S.W.3d 706 (Ky. 2021), the Kentucky Supreme Court held that the Workers’ Compensation Board and Court of Appeals properly reversed the Administrative Law Judge’s ruling that certain medical expenses had been submitted untimely and held that the 60-day deadline for submission of medical expenses by a claimant only applies post-award.
Perhaps more importantly, the high court cited the prior Board opinion in Brown Pallet v. Jones, Claim No. 2003-69633 (9/28/07), with approval, and described its current opinion as a “natural and logical extension of” Brown Pallet and R.J. Corman Railroad Constr. v. Haddix, 864 S.W.2d 915 (Ky. 1993).
The Supreme Court in Haddix ruled that the 30-day deadline for a carrier to dispute a medical bill, outlined in KRS 342.020, does not apply until post-award. The Board in Brown Pallet cited to the Haddix opinion as support for its determination that the 45-day deadline for a provider to submit a medical bill, also outlined in KRS 342.020, also would not apply until post-award.
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Wonderfoil, Inc. v. Russell
The 60-day deadline for submission of medical expenses by a claimant appears in the administrative regulations, 803 KAR 25:096 §11(2), and not in the statute, KRS 342.020.
Thus, the issue involved a somewhat different analysis than that demonstrated in the Brown Pallet and Haddix opinions. The Supreme Court noted the regulation did not expressly indicate when the 60-day deadline would apply but looked to another regulation, 803 KAR 25:010 §7, as evidence of the Commissioner’s intent that the 60-day deadline should apply only post-award, notwithstanding the fact the relevant section of 803 KAR 25:010 only came about in 2016.
803 KAR 25:010 §7(2)(e) sets forth the procedure for the parties to file notices of disclosure, which are due within 45 days of issuance of the Scheduling Order, and expressly requires the claimant to file “all known unpaid bills to the parties, including travel for medical treatment, co-pays, or direct payments by the plaintiff for medical expenses for which plaintiff seeks payment or reimbursement.”
Section 13 of the regulation requires the claimant to bring to the Benefit Review Conference copies of known unpaid medical bills not previously provided, and further directs, “Absent a showing of good cause, failure to do so may constitute a waiver to claim payment for those bills.”
Based on this regulation, the court reasoned that the procedure for administration of workers’ compensation claims contemplates that medical expenses will be provided to the employer throughout the litigation of the claim. The court concluded that to interpret the 60-day deadline as applicable prior to an award or settlement would be in direct contravention of this procedural regulation. “Accordingly, when viewed in the context of the regulatory scheme, 803 KAR 25:096 §11’s application only post-award best effectuates the intent of the Commissioner and prevents an absurd result.”
Notably, the medical expenses at issue in Wonderfoil were bills incurred for dates of service in 2014 and 2015, filed by the claimant during litigation in 2018, two years after the claim was filed and one year after the Benefit Review Conference had taken place. The court acknowledged that the outcome might have been different had the employer defended the expenses “under any other regulation,” by which it evidently is referring to 803 KAR 25:010 §7(2)(e). This only means the claimant should have filed the expenses within 45 days of filing the Application in 2016, which still was one to two years after the bills were incurred.
In short, this ruling allows claimants to accrue medical expenses without the carrier’s knowledge until the claim goes into litigation, since there is now no applicable deadline to submit medical expenses prior to litigation.
If you have any questions regarding workers’ compensation regulations, please call one of our Kentucky Workers’ Compensation Practice Group members.
This has been prepared for informational purposes only. It does not contain legal advice or legal opinion and should not be relied upon for individual situations. Nothing herein creates an attorney-client relationship between the Reader and Reminger. The information in this document is subject to change and the Reader should not rely on the statements in this document without first consulting legal counsel. THIS IS AN ADVERTISEMENT
About the Authors
Mark Bush is a seasoned litigator and senior partner who mitigates risk and delivers results to his clients by partnering with them to understand the needs of their business, recognizing the nuances specific to each product or service, and counseling them through contentious situations from the inception of a claim through the finality of litigation.
Stephanie Ross is a shareholder in Reminger’s Fort Mitchell office. Her insurance defense practice is focused on representing employers and carriers in a wide range of matters arising out of workers’ compensation, including employee claims, coverage disputes, UCSPA proceedings, medical fee disputes, and subrogation actions.
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