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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. From his recent appearance on WRTV to this story here, Frank is everywhere. Couldn't happen to a nicer guy, although he should stop using Eric Schnauffer for his 7th Circuit briefs. They're not THAT hard.

  2. They learn our language prior to coming here. My grandparents who came over on the boat, had to learn English and become familiarize with Americas customs and culture. They are in our land now, speak ENGLISH!!

  3. @ Rebecca D Fell, I am very sorry for your loss. I think it gives the family solace and a bit of closure to go to a road side memorial. Those that oppose them probably did not experience the loss of a child or a loved one.

  4. If it were your child that died maybe you'd be more understanding. Most of us don't have graves to visit. My son was killed on a state road and I will be putting up a memorial where he died. It gives us a sense of peace to be at the location he took his last breath. Some people should be more understanding of that.

  5. Can we please take notice of the connection between the declining state of families across the United States and the RISE OF CPS INVOLVEMENT??? They call themselves "advocates" for "children's rights", however, statistics show those children whom are taken from, even NEGLIGENT homes are LESS likely to become successful, independent adults!!! Not to mention the undeniable lack of respect and lack of responsibility of the children being raised today vs the way we were raised 20 years ago, when families still existed. I was born in 1981 and I didn't even ever hear the term "CPS", in fact, I didn't even know they existed until about ten years ago... Now our children have disagreements between friends and they actually THREATEN EACH OTHER WITH, "I'll call CPS" or "I'll have [my parent] (usually singular) call CPS"!!!! And the truth is, no parent is perfect and we all have flaws and make mistakes, but it is RIGHTFULLY OURS - BY THE CONSTITUTION OF THIS GREAT NATION - to be imperfect. Let's take a good look at what kind of parenting those that are stealing our children are doing, what kind of adults are they producing? WHAT ACTUALLY HAPPENS TO THE CHILDREN THAT HAVE BEEN RIPPED FROM THEIR FAMILY AND THAT CHILD'S SUCCESS - or otherwise - AS AN ADULT.....

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