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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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  3. The practitioners and judges who hail E-filing as the Saviour of the West need to contain their respective excitements. E-filing is federal court requires the practitioner to cram his motion practice into pigeonholes created by IT people. Compound motions or those seeking alternative relief are effectively barred, unless the practitioner wants to receive a tart note from some functionary admonishing about the "problem". E-filing is just another method by which courts and judges transfer their burden to practitioners, who are the really the only powerless components of the system. Of COURSE it is easier for the court to require all of its imput to conform to certain formats, but this imposition does NOT improve the quality of the practice of law and does NOT improve the ability of the practitioner to advocate for his client or to fashion pleadings that exactly conform to his client's best interests. And we should be very wary of the disingenuous pablum about the costs. The courts will find a way to stick it to the practitioner. Lake County is a VERY good example of this rapaciousness. Any one who does not believe this is invited to review the various special fees that system imposes upon practitioners- as practitioners- and upon each case ON TOP of the court costs normal in every case manually filed. Jurisprudence according to Aldous Huxley.

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