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High court adopts COA opinion in billing dispute

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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.

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  1. Frankly, it is tragic that you are even considering going to an expensive, unaccredited "law school." It is extremely difficult to get a job with a degree from a real school. If you are going to make the investment of time, money, and tears into law school, it should not be to a place that won't actually enable you to practice law when you graduate.

  2. As a lawyer who grew up in Fort Wayne (but went to a real law school), it is not that hard to find a mentor in the legal community without your school's assistance. One does not need to pay tens of thousands of dollars to go to an unaccredited legal diploma mill to get a mentor. Having a mentor means precisely nothing if you cannot get a job upon graduation, and considering that the legal job market is utterly terrible, these students from Indiana Tech are going to be adrift after graduation.

  3. 700,000 to 800,000 Americans are arrested for marijuana possession each year in the US. Do we need a new justice center if we decriminalize marijuana by having the City Council enact a $100 fine for marijuana possession and have the money go towards road repair?

  4. I am sorry to hear this.

  5. I tried a case in Judge Barker's court many years ago and I recall it vividly as a highlight of my career. I don't get in federal court very often but found myself back there again last Summer. We had both aged a bit but I must say she was just as I had remembered her. Authoritative, organized and yes, human ...with a good sense of humor. I also appreciated that even though we were dealing with difficult criminal cases, she treated my clients with dignity and understanding. My clients certainly respected her. Thanks for this nice article. Congratulations to Judge Barker for reaching another milestone in a remarkable career.

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