ILNews

High court adopts COA opinion in billing dispute

Back to TopCommentsE-mailPrintBookmark and Share

The Indiana Supreme Court granted transfer Wednesday in a dispute over who bears the burden to prove "pecuniary liability" under the Worker's Compensation Act, and adopted the Indiana Court of Appeals' opinion on the matter.

Pursuant to Indiana Appellate Rule 58(A)(1), the high court adopted and incorporated the Court of Appeal's opinion in Washington Township Fire Department v. Beltway Surgery Center, No. 93S02-1002-EX-115, in which the appellate court held an employer, not a medical provider, bears the burden of proving whether the charges for medical services provided to an employee exceed the employee's liability to pay under the act.

Beltway Surgery Center provided medical services to a Washington Township Fire Department employee and then submitted a bill to the township's worker's compensation insurance carrier. After a review to determine Washington Township's pecuniary liability under the act, the insurer decided to only pay part of the bill. Beltway filed an application for adjustment of claim with the Worker's Compensation Board. The board ordered the township to pay the remaining balance and concluded the township has to prove its pecuniary liability to Beltway was less than Beltway's billed charges.

The COA upheld the board's decision and held that where an employer refuses to pay in full a medical provider's billed charges, and the provider files a claim with the Worker's Compensation Board and establishes the charges for services to an employee, it's up to the employer to prove the charges exceed the employer's liability under the act. The board may also require that an employer who doesn't meet this burden must pay the medical provider's full bill.

The Court of Appeals judges concluded that placing the burden of proof on the employer is more consistent with Indiana law generally and with the act itself. They also ruled it would be up to the General Assembly to amend state statute so that medical providers would have to bear the burden of establishing that their bills fall outside certain guidelines.

This is the same issue in five other cases pending before the Supreme Court. In a footnote in the opinion, the justices noted they denied transfer to the other five cases based on its adoption and agreement with the Court of Appeals' opinion in Beltway. Those other cases are Onward Fire Department v. Clarian Health Partners, No. 93A02-0811-EX-1007; Adecco, Inc. v. Clarian Health Partners, No. 93A02-0811-EX-1008; Morgan County Commissioners v. Clarian Health Partners, No. 93A02-0811-EX-1009; City of Michigan City v. Memorial Hospital, No. 93A02-0811-EX-1010; and Wayne Township Fire Department v. Beltway Surgery Center, No. 93A02-0811-EX-1011.

ADVERTISEMENT

Post a comment to this story

COMMENTS POLICY
We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
 
You are legally responsible for what you post and your anonymity is not guaranteed.
 
Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in Indiana Lawyer editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
 
No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
 
We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.
 

Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

Sponsored by

facebook - twitter on Facebook & Twitter

Indiana State Bar Association

Indianapolis Bar Association

Evansville Bar Association

Allen County Bar Association

Indiana Lawyer on Facebook

facebook
ADVERTISEMENT
Subscribe to Indiana Lawyer
  1. Being dedicated to a genre keeps it alive until the masses catch up to the "trend." Kent and Bill are keepin' it LIVE!! Thank you gentlemen..you know your JAZZ.

  2. Hemp has very little THC which is needed to kill cancer cells! Growing cannabis plants for THC inside a hemp field will not work...where is the fear? From not really knowing about Cannabis and Hemp or just not listening to the people teaching you through testimonies and packets of info over the last few years! Wake up Hoosier law makers!

  3. If our State Government would sue for their rights to grow HEMP like Kentucky did we would not have these issues. AND for your INFORMATION many medical items are also made from HEMP. FOOD, FUEL,FIBER,TEXTILES and MEDICINE are all uses for this plant. South Bend was built on Hemp. Our states antiquated fear of cannabis is embarrassing on the world stage. We really need to lead the way rather than follow. Some day.. we will have freedom in Indiana. And I for one will continue to educate the good folks of this state to the beauty and wonder of this magnificent plant.

  4. Put aside all the marijuana concerns, we are talking about food and fiber uses here. The federal impediments to hemp cultivation are totally ridiculous. Preposterous. Biggest hemp cultivators are China and Europe. We get most of ours from Canada. Hemp is as versatile as any crop ever including corn and soy. It's good the governor laid the way for this, regrettable the buffoons in DC stand in the way. A statutory relic of the failed "war on drugs"

  5. Cannabis is GOOD for our PEOPLE and GOOD for our STATE... 78% would like to see legal access to the product line for better Hoosier Heath. There is a 25% drop in PAIN KILLER Overdoses in states where CANNABIS is legal.

ADVERTISEMENT